To gain the best possible results from aesthetic surgery requires careful patient selection. Not all procedures are suitable for all patients, therefore it is impossible to offer anything other than very general advice before seeing a patient. It is certainly better to have no procedure than an inappropriate one. To undergo aesthetic surgery is a major decision requiring appropriate discussion and thought.
Cosmetic Procedures

Rhinoplasty is an operation designed to re-shape the nose and/or improve nasal respiration. While the indications and exact surgical procedure vary considerably from patient to patient, there are overall similarities.

Surgery may involve operation on the cartilage of the nose only (approximately the lower two-thirds of the nasal skeleton is cartilage) or, more frequently, it may involve surgery to the nasal bones. In some instances where the structure of the nose has been damaged or is congenitally deficient, it may be necessary to insert support into the nose. This is usually achieved by the use of bone grafts or cartilage grafts since the patient's own tissue is very much more reliable than other prosthetic (artificial) material.

Although there are a number of different types of rhinoplasty, in essence they may be divided into two major groups: endonasal rhinoplasty, in which all the incisions are made on the inside of the nose, and open rhinoplasty.

In the latter case, most of the incisions are made on the inside of the nose but a small incision, in the shape of a step, is made at the junction of the upper two-thirds and lower third of the columella - this is the strip of skin and cartilage that joins the tip of the nose to the centre of the upper lip. The scar left from this incision is usually extremely difficult to see and open rhinoplasty offers very distinct advantages in some patients. It provides the surgeon with an unobstructed view of the nasal anatomy, which facilitates the identification of the precise problems that require correction and allows accurate and precise surgical alterations to be made. This has particular application when complex tip work is required, particularly when cartilage grafts are used, and in patients who have had previous surgery, injuries or congenital deformity.

In patients where it is necessary to narrow the base of the nose, further external incisions are used, which are sited where the base of the nose joins the cheek. These are fairly difficult to see but will leave permanent scars and the indications for this particular manoeuvre are relatively few.

The exact type of rhinoplasty most suitable for a patient will be discussed at the consultation stage. For many, rhinoplasty will be an aesthetic procedure only (ie it will have no impact on nasal function or respiration). However, in some patients where there has been damage to the internal structure of the nose, or it has developed in a less than ideal fashion and breathing is compromised, it will be possible to improve this aspect of nasal function at the same time as altering its shape.

Since the precise requirements for nasal surgery in any particular patient vary so widely, detailed consultation and examination is essential before any precise advice may be given.

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