Rhinoplasty

Rhinoplasty is one of the most complex and challenging operations in facial surgery. The nose is a small, central feature made up of bone, cartilage and skin that all need to work together for both appearance and breathing. Small changes can have a large effect, and the result depends on technique, judgement and an understanding of how the nose heals over the long term. For these reasons, it is worth choosing an experienced surgeon and taking time over the decision.

Rhinoplasty is a large part of Dr Ricketts’ facial aesthetic practice and an area of special interest, with experience built over many years. Her experience covers primary and revision rhinoplasty, and includes cosmetic, functional, post-traumatic, and cleft lip rhinoplasty. Her facial reconstructive work in the public system, including major facial tumour reconstruction and facial trauma, informs how Dr Ricketts approaches the structure and function of the nose.

Rhinoplasty can change the shape of the nose, improve breathing, or both, and it is planned around your nose and your face rather than a single ideal. The nose works in balance with the rest of the face, including the chin and the forehead, so Dr Ricketts assesses your face from all perspectives when planning your surgery.

Dr Ricketts performs predominantly open structural rhinoplasty. In this approach, a small incision is made across the columella, the strip of skin between the nostrils, which allows the skin to be lifted so the underlying framework can be seen directly. Where necessary, she also addresses the septum, the wall that divides the two nasal passages, and the turbinates, the structures that affect airflow. The advantages of the open approach are visibility, access and accuracy, which matter when reshaping and supporting the framework of the nose, particularly in more complex cases. Modern structural techniques aim to preserve and support the framework, often with cartilage grafts, rather than simply remove tissue, which helps maintain breathing and a lasting stable shape.

With the exception of certain circumstances, closed rhinoplasty is now less common for total rhinoplasty cases. The traditional closed method involved radical trimming and removal of cartilage to create shape at the expense of the integrity and support of the nose, which could cause collapse over time and tell tale signs of surgery. Dr Ricketts uses a closed approach, where the incisions sit inside the nose, when the work required is less complex and when direct visibility is less critical. Its advantages are that there is no columellar scar and there can be somewhat less swelling and recovery time, and she will explain whether it is suitable for your nose.

Revision rhinoplasty, sometimes called secondary rhinoplasty, addresses the shortcomings of a previous rhinoplasty or septoplasty. It is more challenging than first time surgery because of scarring and because cartilage may have collapsed or been removed at the earlier operation. Many surgeons choose not to perform this surgery, including some who perform primary rhinoplasty. Revision work often requires cartilage graft to rebuild support, which may be taken from your own body, such as the septum, ear or rib, or in some cases from a donor source. Dr Ricketts will assess your nose carefully and explain honestly what is and is not achievable, as revision results are less predictable than first time surgery.

Rhinoplasty in patients of different ethnic backgrounds can be challenging, often because of thicker skin, which affects how the underlying changes show through, and because the framework of the nose may need support or augmentation rather than reduction. It is important to understand the cultural differences in what is considered balanced and appropriate for each individual, rather than applying a single standard. Dr Ricketts’ goal is a result that suits your face and respects your features and ethnicity if that is your desire. These goals will be discussed with you in detail during your consultation.

Rhinoplasty may suit you if you would like to change the shape of your nose, if you have difficulty breathing through your nose, or both, and if you are in reasonable general health. Because the nose heals slowly and the final shape takes a long time to settle, the procedure suits people who can be patient with the recovery and who have realistic expectations. It is best to be at a stable point in your life and, for younger patients, to have finished growing and are mature enough to understand and accept what is expected during recovery. Dr Ricketts will be honest with you about what is achievable for your nose, your skin and the way you heal.

At your consultation, Dr Ricketts examines the outside and the inside of your nose, including how you breathe, and she assesses the bone, cartilage and skin as well as the balance of your whole face. We discuss what is troubling you and what is realistic for your nose, and she explains the approach she would recommend, the recovery and the risks. Rhinoplasty is a considered decision, so she gives you written information and encourages you to take your time, ask questions and consider a second opinion.

Rhinoplasty is performed under general anaesthetic, usually as a day case or an overnight stay. On the day Dr Ricketts confirms the plan with you and our team supports you through your admission, the operation and your recovery. A splint is applied to the outside of the nose, and you will go home with clear instructions and a support person.

Rhinoplasty is commonly performed as a day case or overnight stay. A splint is usually worn on the outside of the nose for around a week, and there may be soft internal splints for support. In the first one to two weeks expect bruising and swelling around the eyes, which is most noticeable early and then fades. Your nose will be congested while the lining heals, and will look considerably swollen for the first few weeks. Sleeping with your head elevated in the first week helps to minimise early swelling.

Many people return to desk work after about two weeks, once the splint is removed and the bruising has settled enough. Breathing through the nose is often congested in the early weeks and improves gradually as the swelling settles. Strenuous exercise and activities that risk a knock to the nose are restricted for four to six weeks. The nose continues to refine for a long time. Much of the swelling settles over the first few months, but subtle changes, particularly in the tip, can continue for a year or longer, and thicker skin tends to take longer to settle. Dr Ricketts will see you for review appointments and guide you on activity. Healing varies between individuals, and the outcomes one person experiences do not necessarily reflect what another will experience.

Dr Sophie Ricketts is a specialist plastic surgeon based in Richmond, Melbourne, with a focused practice in facial surgery, including Rhinoplasty procedures. She is a Fellow of the Australian and New Zealand College of Surgeons (FRACS) and a member of the Australian Society of Plastic Surgeons (ASPS) and the Australasian Society of Aesthetic Plastic Surgeons (ASAPS), the peak professional bodies for plastic surgery in Australia. You can also find her on RealSelf. Each of these listings is maintained by independent organisations and provides patients with a straightforward way to check the qualifications, training, and scope of practice of the listed providers before booking a consultation.