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I am honoured to have been chosen to give a talk on Septoplasty / Rhinoplasty in Children at the International Conference ESPO 2014. (European Society of Paediatric Otolaryngology )

Having worked with European Surgeons with a long history of research in this area, I operate on the noses of young patients where waiting for mid-facial growth and development would be the poorer option.

When to offer surgery and how to fashion a conservative surgical roadmap will be the objective of this section of decision making workshop.

 

The picture on the left is pre-operative view
The picture in the middle depicts digital morphing
The picture on the Right is post-operative result at Seven Weeks after surgery.

Pictures have been cropped to protect patient Identity and are published with written consent

Beyond the straightening of a crooked nose, reduction of nasal dorsal humps and gross tip asymmetries is the world of Finesse Rhinoplasty where an otherwise symmetrical and otherwise well proportioned nose may be considered for what is called the Finesse Rhinoplasty

Double break of columella: In the profile view the columella is seen to have a double break.

The first break … as one follows down the nasal dorsum and nasal tip … is defined as the point at which the tip of the nose turns inferiorly and posteriorly onto the infra-tip lobule.

The second break occurs at the midcolumella, where the columella takes a more horizontal course and extends posteriorly to the subnasale. This latter point usually corresponds to the junction of the medial and intermediate crura.

This is also the point which is my choice for a trans-columellar incision if using an external approach for Rhinoplasty

From Left … Pietro Palma (Italy), Munish Shandilya (Ireland) & Prof. Gilbert Nolst Trenite (Netherlands) at Sheraton Towers, Chicago … May 2013

Who Does Rhinoplasty ?
Rhinoplasty is typically performed by ENT Surgeons, the Plastic Surgeons and the Maxillo – FacialSurgeons.
Facial Plastic Surgeons are surgeons who initially trained as one of the above three disciplines and then have undergone Fellowship training in Facial Plastic Surgery.Not all Facial Plastic Surgeons have Rhinoplasty as their foremost area of expertise.
A few of the above four recognize what it takes to acheive safe and predictable results in Rhinoplasty and devote most of their time to the learning and teaching of this challanging surgery.
Each of these specialties brings a unique perspective and the science of rhinoplasty is enriched by it.The surgeons who pursue expertise in this surgery often meet at the rhinoplasty workshops and conferences to learn from each other.Rhinoplasty is regarded as the most difficult amongst the Facial Plastic Surgery procedures, to master.

CHECKLIST For choosing your surgeon
Request Consultations from 2 – 3 of your selected surgeons and see who you are most comfortable with.
See portfolios of previous nose surgeries.
Morphing of digital pictures though not essential, can be very useful in conveying your specific aspirations confidently.
In a small population like that of Ireland, Volume of surgeries is vital
for maintaining the skills.You may politely enquire how many nasal functional & cosmetic surgeries your surgeon performs every year.
Appropriate training and Accredited hospital facilities.

Is your surgeon available and interested in your short, mid & long – term follow – up himself ?

Comments, Reviews & Recommendations…

Are these
for Rhinoplasty or other minor procedures like fillers, Botox, facial treatments etc.which some centres do inthousands…

Rhinoplasty is a very sophisticated surgery that is widely recognised as the most difficult facial plastic surgery to master…

Very few centres offer Rhinoplasty exclusively as the only cosmetic procedure and some websites and fora do not differentiate between reviews of one procedure from the other…

Research carefully and take your time…