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 nose reshaping, 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?
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, research, postgraduate teaching and now, complete and utter devotion and passion…. to only rhinoplasty surgery.
Nothing less than pursuing perfection for this surgery, achieving the best possible silhouette form of the nose (nose reshaping), 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.
Rhinoplasty: my way
Rhinoplasty: my way
Rhinoplasty is a very significant operation that can potentially alter the way you view yourself, and even improve your nasal airflow. My approach to rhinoplasty includes meticulous planning and assessment of the patient, listening to the patient’s requests, and creating a game plan that is unique to that particular patient’s aims and desires. You may have already seen examples of noses (nose reshaping) on the Internet that are unnatural, unbalanced, or look artificial. These are practices that I avoid at all times. The concept of a YOUnique Rhinoplasty forms the central axiom of my approach: each operation is tailor-made for the patient as every patient’s face and desires are unique. My goal consists in creating a nose that is balanced to the individual patient’s facial features so that the ultimate result looks absolutely natural.
Treating form and function
Treating form and function
The nose consists of bones and several sets of cartilages that are bound to each other to form three distinct arches: superior bony arch (solid), middle cartilaginous arch (semi-flexible), and inferior cartilaginous arch, made by tip cartilages and ligaments (flexible). While airflow can be affected by the integrity of this supporting scaffold, the lining of the nose is a highly complex organ that responds to many factors such as changes in temperature, humidity, hormones, and to diseases like allergic and non-allergic rhinitis. Therefore, if your nose has problems with airflow, I might recommend medical therapy for the underlying problem of the nasal lining, or suggest a combination of surgery and medicine. There are a whole range of medicines and other minimally invasive procedures that are available for the treatment of nasal airflow problems. Many patients who seek rhinoplasty also suffer from sinus problems. For these individuals a combination of rhinoplasty and minimally-invasive endoscopic surgery (FESS) can be appropriate. I have been trained in management of nasal and sinus diseases and can therefore combine aesthetic rhinoplasty and functional nasal-sinus surgery. Endoscopic surgery involves putting refined micro-cameras in the nose to directly visualize the operative field using sophisticated micro-instruments. There are no external incisions and the recovery time is much shorter compared to the traditional methods.
The sensation of free airflow through a previously blocked nose, creates a feeling of relief and liberation for a seemingly relentless symptom. Designed to ensure physical well-being, free nasal airflow is also a vehicle for psychological wellness. However, one should not lose sight of the fact that the sensation of nasal airflow is a highly complicated phenomenon and not simply related to the architecture of the nose.
Which rhinoplasty
Which rhinoplasty
Traditionally, rhinoplasty has been divided into external and endonasal or “closed” types. In external rhinoplasty, the surgeon “opens” the nose making a skin incision at the columella. This allows the surgeon to expose the cartilages and bones of the nose to full view. Many rhinoplasty centers around the world practice open rhinoplasty. This operation might leave a visible scar even when the columellar incision has been placed and closed correctly. Usually, it is barely visible. In the external approach, the nose has to be deconstructed and then reconstructed to regain its stability.
However, this complex, time-consuming and potentially risky approach is often not required for the majority of patients who desire an aesthetic improvement. (Watch my patient’s video)
In other centers, the emphasis is totally on a closed technique where incisions are hidden within the nose. This approach makes it more difficult for the surgeon to visualize the nasal structures, especially the nasal tip. In the classical “closed” rhinoplasty, the emphasis is mainly on bone and cartilage reduction. In experienced hands it can achieve excellent results.
I have developed a hybrid technique, already described and published in the prestigious journal Archives of Facial Plastic Surgery. Hybrid approach means that an external incision will NOT be made and therefore, a scar on the outside of the nose cannot form. The advantage of the hybrid approach, compared to the standard closed reduction rhinoplasty, is that most of the techniques of the external approach can be used to elegantly reshape the size, angles, curves, or proportions of the nose. One could think of this approach as a “scar-free” rhinoplasty technique that takes advantage of the best of both worlds of open and closed rhinoplasty. The endonasal “hybrid” technique provides an excellent alternative to the more aggressive external approach as it allows for minimally invasive techniques whenever possible, and more extensive surgery when necessary. The hybrid approach permits the maximum of surgical versatility, which is the key in aesthetic rhinoplasty.
Consultation
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 anesthetic spray.
Taking photographs of your face in various poses is an integral part of planning and assessment. I will take the photographs myself, and analyze 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
Operation
You have had time to consider your options and carefully weigh the information supplied to you by me. From mid-night 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 anesthetist who has worked with me for many years and is accustomed to the needs of a rhinoplasty surgeon will give you a general anesthetic. 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
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.
About rhinoplasty cost
About rhinoplasty cost
I understand that the cost of rhinoplasty is a major issue for a number of patients.
The decision to undergo rhinoplasty must never be rushed in order to find a cheaper alternative.
There is a huge difference between a surgeon performing rhinoplasty occasionally among many other procedures and a super specialist who has dedicated his professional life to rhinoplasty only, performed thousands of cases, and has developed a world-wide reputation. Simply hunting for the cheapest option on Google cannot be in your best interest and can expose you to the dangers of poor results with a subsequent increased risk of revision surgery in the future. You would expect to pay more for the services of a master craftsman compared to a novice or a non-specialist. The same applies to rhinoplasty.
Technically, rhinoplasty is an extremely demanding operation, quite different from other cosmetic surgeries. There is no standard cost because of the uniqueness of each individual nose. This situation is made even more challenging by previous rhinoplasties. More specifically, endonasal (closed) scarless rhinoplasty requires superior technical expertise, surgical maturity, tactile sense and artistic talent of higher rank.
The cost of rhinoplasty includes more than the operation itself. The estimation of the total cost should take into account the full spectrum of the services provided. A modern and fully equipped office, a tailor-made pre-operative plan, computer-assisted photo-analysis and simulations play a pivotal role in the quality of the final result.
Patient’s safety is my main concern. I prefer to perform the operation supported by an experienced anesthetist in a top-ranking clinic, equipped with high level technology, qualified personnel, and excellent accommodation. A 24 hour emergency unit also provides a safe environment that makes my international patients feel secure.
It might be a good idea to have a consultation with more than one rhinoplasty specialist surgeon before making the decision to go ahead. After careful consideration, feel free to contact me by email for a tentative cost estimate and treatment plan for your unique case.
Follow us on Instagram and stay tuned!
🇬🇧 MY JOSEPH LECTURE What to say?
🔹There are moments when emotions cannot be controlled, even when maturity has been reached.
🔹Well, it happened last Saturday, at the conclusion of my Joseph Lecture, the MASTER LECTURE assigned every year to a world-renowned surgeon on the occasion of the Annual Congress of the European Academy of Facial Plastic Surgery (EAFPS), that this year was held in Verona from 14 to September 17th under the presidency of my dearest colleagues Dario Bertossi e Stelio Mocella.
🔹 The STANDING OVATION at the conclusion of my presentation was a highly emotional, UNFORGETTABLE moment.
🔹I structured my lecture “RHINOPLASTY. THE POWER OF LESS.” so that the PROTAGONIST was not so much me as the surge#n, but above all my patients for whom I have been done and continue to do the BEST POSSIBLE of my skills, trying to combine maximum effectiveness and minimal invasiveness.
🔹 Obviously, I illustrated my operative solutions and my results with before/after pictures and surgical videos regarding thorny topics in rhinoplasty: the BIG nose, the DROOPING and over-projected tip, the SADDLE nose, and different REVISION surgeries.
🔹 The final message to my younger colleagues was to AVOID the traps of overdoing, EMBRACE surgical philosophies that respect anatomy and, always, look after the EMOTIONAL BALANCE of every single patient.
⠀
#josephlecture #eafps #rhinoplastymaster #pietropalma #rhinoplastyexpert #hybridrhinoplasty #rinoplasticaibrida #closedrhinoplasty #rinoplasticamilano #rinoplasticachiusa #noscarrhinoplasty #endonasalrhinoplasty #youniquerhinoplasty #verona
🇬🇧News from EAFPS Verona 2023.
Yesterday I gave two lectures on KEY ISSUES in rhinoplasty:
🔹tip over-projection and
🔹bulbous tip.
I showed my personal surgical recipes to deal with a variety of surgical situation. MINIMIZING surgical trauma and aiming at natural results represent the path and the destination of my surgical philosophy.
They were very well received by the international audience.
I’m almost ready for Joseph lecture…
🇮🇹 Notizie da Verona, congresso EAFPS 2023.
Per me ieri due presentazioni su due argomenti “caldi” in rinoplastica:
🔹 iper-proiezione della punta e
🔹punta bulbosa.
Ho presentato le mie “ricette” chirurgiche per una serie di pazienti, differenti per anatomia e aspettative.
Molto soddisfatto per il riscontro estremamente positivo da parte di tanti colleghi, italiani e non.
Quasi pronto per la Joseph lecture, la mia lettura magistrale…
#eafps #eafps2023 #rhinoplastyspecialist #rhinoplastyexpert #hybridrhinoplasty #closedrhinoplasty #endonasalrhinoplasty #rinoplasticaibrida #rinoplasticaendonasale #rinoplasticamilano #youniquerhinoplasty #pietropalma
THE 2023 JOSEPH LECTURE
I am happy to attend the Annual Meeting of the European Academy of Facial Plastic Surgery (EAFPS) to be held in Verona, September 14-17.🇮🇹
Every year a WORLD-RENOWNED surgeon and MENTOR is appointed to deliver the Joseph Lecture at the EAFPS Annual Meeting, in honour of Jacques Joseph (1865-1934), the father of rhinoplasty.
⠀
This year I have the HONOR and the PRIVELEGE to be the Joseph lecturer.
⠀
It happens ONCE in a life time.
⠀
🔷 I will share my experience as well as the ideas that I have developed in my LONG RHINOPLASTY JOURNEY shared with thousands of patients.
🔷 PERSONAL CONCEPTS like the:
- visual distractors,
- hybrid route,
- multiportal approach,
- aesthetic subunits of the nose,
- analytical/surgical focus on nasal surface and contours will be explained in details.
🔷 I aim to the NEXT LEVEL of results while REDUCING surgical invasiveness.
⠀
🔹 I thank my PATIENTS wholeheartedly for their trust.
🔹 I thank my MENTOR Prof. Giorgio Sulsenti.
🔹 I thank my dearest FRIEND , Prof. Paolo Castelnuovo.
🔹 I thank the many COLLEAGUES that have been teachers and role models.
🔹 I thank my FAMILY for giving me strength and love to pursue such a passionating professional path.
⠀
#eafps #eafps2023 #josephlecture #rhinoplasty #rhinoplastymentor #rhinoplastyexpert #rinoplastica #rinoplasticamilano #rhinoplastyitaly #hybridrhinoplasty #closedrhinoplasty #rinoplasticaibrida #rinoplasticachiusa #youniquerhinoplasty #pietropalma
🎤I'm a SPEAKER at the 46th annual meeting of the EAFPS (European Academy of Facial Plastic Surgery) in Verona.
The meeting is just around the corner.
📌Mark your agenda and JOIN US for the ONLY ONE and UNIQUE session of this meeting where we'll talk about PROFESSIONAL but NOT TECHNICAL aspects that are essential for each of us.
Are you curious?
➡️Follow me and in the coming days I'll reveal a secret.
Beautiful and romantic Verona, where surgery meets beauty, is waiting for us!
#eafps #eafps2023 #eafpsannualmeeting #womeninsurgery #YOUniqueRhinoplasty #verona