For you

Welcome

Dear visitor,

I am a surgeon whose professional practice is wholly devoted to the practice of the art and science of rhinoplasty surgery. This super-specialization of my practice has been borne from my years of training, reseach, postgraduate teaching and now, complete and utter devotion and passion…. to only rhinoplasty surgery.

My belief is simple. To understand all the nuances of an art and skill form, one must submit oneself to that art, and that art alone. A minimum of 10 years of specific experience would be required before a surgeon gains enough knowledge and experience to begin to be fluent with the endless variability of nasal shapes, and the rainbow of desires of every single patient.

The way to master this complex surgical craft, in my humble opinion, comes only with years of a singular commitment, followed by a life-long dedication to this singularity of being super-dedicated to rhinoplasty surgery. Only then, do I believe that one can master and predict the outcomes of this finest surgery, from the subtle aesthetic changes to the nose, to the major reconstruction in revision cases.

And what, I am asked, is my reward for this super-dedication to rhinoplasty surgery only, especially when most plastic surgeons fill their days with myriads of aesthetic surgery to the face and body? Nothing less than pursuing perfection for this surgery, achieving the best possible silhouette form of the nose, embracing its aesthetic harmony with the eyes and lips, and matching its form, without sacrificing, and always enhancing the nose’s function.

The zenith reward for my work is sharing moments of my patients’ joy, in our coupled journey together, and building with them, an enhanced self-confidence with the faultless matching of form with function. It is as life changing for them as it is for myself. How can I accept anything less?

Your journey of self-improvement starts here. Simply look through the next few pages, and view the various stages involved in rhinoplasty. Let your journey commence.

Primary?

Primary rhinoplasty is a highly complex operation requiring specialized technical skills and
sophisticated aesthetic judgment. There is no such thing as a “routine rhinoplasty”. The
unique combination of the anatomy of the nose requires a highly experienced surgeon, to
get the operation right the first time.
It is vital to choose a competent surgeon possessing a specific expertise in rhinoplasty
with refined aesthetic judgement and sound anatomical knowledge. In my opinion, a
successful primary rhinoplasty relies on the technical expertise of an experienced surgeon.
The surgeon you choose should have the necessary skills repertoire for the surgery. A
tailor-made, patient-centred rhinoplasty is the key, my key.
My YOUnique belief is that non-destructive and non-palpable techniques are paramount in
primary aesthetic rhinoplasty surgeries. I believe that the use of structural grafts should be
minimized whilst the use of contour grafts to achieve a smoother aesthetic balance across
the nasal aesthetic sub-units, is essential in any primary aesthetic rhinoplasty.

Revision?

A revision rhinoplasty is a procedure to correct any unsatisfactory results that may have
occurred due to an initial rhinoplasty.

I am increasingly seeing patients with multiple rhinoplasty procedures performed
elsewhere. With several procedures in the past, it is not unusual to find that these
operated noses lack support, have multiple grafts, a reduced blood supply and poor quality skin envelopes. I believe that many unsatisfactory rhinoplasties have emanated from
too much unnecessary structural grafting for a primarily aesthetic rhinoplasty. In these
patients, the septal cartilage has been used for the grafting. These “septal cartilage-depleted”
patients seeking further revisions, pose a specific challenge for revision rhinoplasty surgery.

Re-building the necessary structural support and/or creating subtle changes for revision
rhinoplasty patients require experience as much as talent. Depending upon the condition
of the tissues, most revision rhinoplasty patients may still be provided with visible and
significant improvements. However it is improvement, and not perfection, the aim
of any revision procedure.

Unfortunately, for some patients, revision surgery is not the solution, and surgery can
cause further problems and result in extremely poor outcomes. I believe that with these
patients, I have to undertake an honest, firm and expert conversation to dissuade any
further surgery that would be detrimental or catastrophic. This conversation is paramount
for the health of my patient.
My YOUnique revision rhinoplasty journey with my patients, is to provide the hope of a
better nose whenever it is possible, and a conclusion to avoid further disappointment and
health deterioration, when it is not.

Ethnic?

The "ethnic-specific” features of the nose and the face is a highly complex issue.
Patients may be proud of their ethnic heritage, and wish to preserve it. These wishes
should be taken seriously when planning and executing an “ethnic” rhinoplasty.

In spite of this, my experience with my international clientele have shown myself that the
younger generations are profoundly influenced by facial beauty paradigms propagated
by fashion, the entertainment industry and the ever-glossy magazines. It is my job to
guide them through from these paradigms of fashion, towards a sensible yet aesthetic
rhinoplasty that would reflect a more beautiful them, whilst preserving their ethnicity.

It is my enduring philosophy that from the moment a patient seeks my care until that
patient concludes the surgery, each rhinoplasty should be considered ethnic. This “ethnic”
patient still demands a rhinoplasty surgeon with excellent rhino-analysis, meticulous
surgical technique and an attention to high detail throughout their experience.

For my ethnic patients, they can remain confident that their rhinoplasty is tailored to them,
from start to finish, for a YOUnique rhinoplasty that is uniquely personalised for them.

Consultation

You have carefully considered the problems of your nose. Your first consultation is a highly emotional experience and sets the background for the quality of the doctor-patient relationship. This is the first step towards reaching your goals.
I will establish the history of your problems. It is extremely helpful if you can bring the list of your current medications and alternative medicines with you. Furthermore, any previous letters or imaging such as CT or MRI scanning from other clinics or hospitals are very useful.
 Often, I will need to examine the inside of your nose with small endoscopes to gain an impression of the architecture of the nasal interior, the state of the lining, and the opening of the sinuses into the nose. This procedure may be carried out even without a local anaesthetic spray.

Taking photographs of your face in various poses is an integral part of planning and assessment. I will take the photographs myself, and analyse them after the consultation. This analysis involves detailed and careful measurements of facial and nasal outlines. This is a time-consuming and specialist tasks that will reveal all the problems of the nose. Furthermore, based on this analysis, I and my team will create computer-assisted simulations that try to combine your desires for change with various possible scenarios. These simulations are not exactly predictive of the result, but form a list of possibilities. The main function of the simulations is to create a tailor-made operative plan for your individual needs.


Then a second consultation is scheduled for clarification of your questions and concerns. During the second consultation, you will have the opportunity to see the simulations and discuss the details of operation. I will insist that you carefully consider the options open to you before the operation. After this second consultation, I will formulate the surgical plan which is custom-made on YOUR unique anatomy, wishes and expectations.
 By the end of the second consultation, the minutest details will be thoroughly defined in order to obtain the best possible result.

Operation

You have had time to consider your options and carefully weigh the information supplied to you by me. 
From midnight the night before, you will be fasting, which means no food or drink must pass your lips. Chewing gum is also not permitted. A map of the private clinic where the surgery will occur together with detailed logistical information will be provided for you once you have decided to go ahead with the surgery. 
I will see you on the morning of the operation after your admission in the clinic. This is a time for positive excitement about the improvement in your nose, and also of slight worry, which is normal for anyone undergoing surgery. A highly experienced anaesthetist who has worked with me for many years and is accustomed to the needs of a rhinoplasty surgeon will give you a general anaesthetic. I will be near you in the operating room, accompanying you when you will receive the sleeping medication. Your pre-operative pictures, simulations and surgical plan will be on display so every single imperfection will be checked intra-operatively and carefully fixed. Perfectionism is the key to success. The final result is the one that I see at the end of the operation. If your nose doesn’t look good in the operating room, it is not going to look good afterwards in the office. Surgery is never complete until the results are the absolute best they can be.

Recovery

After you wake up, you will not suffer major amounts of pain or discomfort. Nausea or vomiting is unusual in this period. You will have a splint covering your nose, and I may sometimes put a light dressing in your nose to soak any extra seepage from the nose and to support the nose internally as it heals. Expect to be swollen and bruised in the eye and cheek areas. You may feel like you have a cold. Bruising is usually minor and resolves with a short period of time. Within a few hours of the operation, the nose will swell to a variable degree. This is a normal reaction to surgery and should not alarm you. The swelling subsides quickly, and after a few days, most of it will have resolved. However, the soft-tissues of your nose will continue to improve from this process over the next few months.
You will be asked to rest at home after discharge. To keep swelling to a minimum, sleep with your head elevated and use cool compresses. Analgesic (“pain-killer”) medications will help to keep you comfortable. It is also common to experience a dry mouth caused by being unable to breathe through your nose. Drinking extra fluids can help alleviate this symptom. Heavy physical work, exercise, and large amounts of alcohol are discouraged for 3 weeks. You will also be advised to avoid minor trauma to your nose by avoiding crowded, busy places such as cinemas or sports stadia. 


I will arrange to see you before you are discharged home. I will provide you with post-operative written instructions and my mobile phone number for queries about possible problems. Furthermore, I will provide you with adequate analgesia, antibiotic coverage and other products, if necessary. Your nose evolves after the operation and this process can take several months. Therefore, the nose that you see immediately after the removal of the external dressing will look and feel a lot better 6 months after the operation.

Keep in mind

Keep in mind #1
Internet resources and e-communication with surgeons on your nasal condition provides only general information. These are not, and never will be, a substitute for a face-to-face personal consultation with a highly experienced rhinoplasty surgeon.

Keep in mind that following advices from surgeons on whatever website who proposes to tell you what to do without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, evaluating your level of maturity, and discussing the pros and cons of the operative procedure with you would not be in your best interest.

Your pre-rhinoplasty consultation is an important prerequisite for any successful rhinoplasty surgery. Only a personal consultation provides you with the opportunity to discuss your concerns with your surgeon, to align both your expected outcomes, and for you to be comfortable with and trusting of your selected surgeon.


Keep in mind #2
Despite meticulous clinical planning, and expert surgery, not all goals can be achieved in rhinoplasty. As no surgical operation has a 100% success rate, rhinoplasty patients must accept that some imperfections can persist in about 10% of the cases, leading to a not completely satisfactory result. Unless the patient is willing to accept that imperfect results may happen, the operation cannot go ahead.
There are several reasons for post-operative problems. First, the nose can only be changed to a certain degree: trying to force nature to do things that are impossible, simply does not work. Secondly, each patient heals according to his/her genetic background such that the same operation may produce slightly different results in two individuals. Thirdly, in revision cases the nose lacks much of its supporting structure, may have received several grafts, and the quality of blood supply has decreased. Furthermore, nasal skin that has been exposed to previous multiple operations often does not heal as well as ordinary skin, and itself this can create a barrier towards an optimal result.


So, even in the hands of world-experts, a second procedure known as “touch-up” surgery may be required to refine results. Although we do not charge you, this “touch-up” procedure will carry a reduced charge for anaesthetist care and clinic facilities.


Unfortunately, some patients cannot be helped by revision surgery. Under these circumstances, surgery can cause further problems and result in a very poor outcome. Honest, firm and expert advice is paramount here. In some cases, I do advise these patients that in their particular condition, major revision surgery should not be undertaken. In other cases, minimally invasive touch-ups can help in restoring a more natural look.