Nasal Surgery

Rhinoplasty (Nasal Surgery)

Balanced refinement of nasal form with careful attention to function and airflow.

For suitable candidates, I offer closed preservation rhinoplasty as a signature technique, using internal incisions to reshape without external scars while preserving key support where possible.

Surgical focus

My approach is considered, curated and grounded in anatomy. Rhinoplasty is not simply about refining profile; it is about creating balanced nasal proportions while preserving structural support, airflow and long-term function.

Understanding Rhinoplasty

Rhinoplasty reshapes the nose to improve proportion from the front view and profile and, when required, addresses airway issues such as septal deviation or valve collapse. It may refine a dorsal hump, tip width, definition, rotation, nostril shape, or a crooked appearance after injury, while maintaining support for long-term stability and function.

What is Rhinoplasty?

Rhinoplasty reshapes the nose to improve proportion and, when required, addresses airway issues such as septal deviation or valve collapse. It may refine a dorsal hump, tip width, tip definition, tip rotation, nostril shape, or a crooked appearance after injury, while maintaining support for long-term stability and function.

When bony contouring or osteotomies are needed, I typically employ ultrasonic (piezo) instrumentation to execute precise bone cuts and smoothing while respecting the surrounding soft tissue envelope.

What Are the Different Types of Rhinoplasty?

Facelift surgery encompasses a range of techniques, each tailored to the degree and pattern of facial ageing. The choice of technique depends on anatomical findings, the desired outcome, and your tolerance for downtime and scarring. Here are five commonly performed approaches – each with its own advantages.

1. Closed Preservation Rhinoplasty – Signature Offering

Access:

Internal (endonasal) incisions with no external scar.

Philosophy:

Preserve and reposition existing structures, for example dorsal preservation with push-down or let-down manoeuvres, to maintain support and natural contour.

Best for:

Straight or near-straight noses with a hump and good support.

Instrumentation:

Ultrasonic piezotome used for bony work where appropriate.

2. Closed Structural Rhinoplasty

Access:

Internal incisions.

Philosophy:

Structural grafting and suturing to refine tip projection, rotation and definition, with selective dorsal or septal work where preservation alone is not sufficient.

Best for:

Tip refinement in thicker skin, mild to moderate asymmetries, and moderate septal deviation.

Instrumentation:

Ultrasonic piezotome used for bony steps as required.

3. Open Structural Rhinoplasty

Access:

Small trans-columellar incision plus internal incisions.

Philosophy:

Maximal exposure for complex tip, valve or septal reconstruction, including revision cases, severe deviation and traumatic deformity.

Best for:

Significant asymmetry, complex or revision rhinoplasty, and major valve collapse.

Considerations:

External scar, usually fine, and potentially more swelling; chosen when advantages clearly outweigh downsides.

Instrumentation:

Ultrasonic piezotome for precise osseous work where appropriate.

4. Septoplasty & Airway Procedures (May be Combined)

Septoplasty:

Straightens the septum to improve airflow and support symmetry.

Inferior turbinate reduction:

Addresses mucosal or structural contributors to obstruction.

Nasal valve support:

Spreader or batten grafts as indicated to stabilise the internal or external valve.

5. Precision/Ultrasonic Rhinoplasty (Piezo) – Bony Work

Modality:

Ultrasonic micro-vibrations (piezotome) selectively act on bone while sparing soft tissues.

Where it helps:

Controlled dorsal contouring, precise osteotomies and smoothing of bony irregularities.

Advantages:

Micrometric control and refined bony edges; useful when accuracy of cuts and contour is a priority.

Considerations:

Often requires wider subperiosteal exposure than traditional rasps or osteotomes; in selected cases this extra dissection can contribute to swelling.

My practice:

I routinely use ultrasonic instrumentation for the bony steps in rhinoplasty. I may choose conventional tools only when the added exposure would be unnecessary for very small bony trims.

Who Is the Ideal Candidate?

You may be well suited if you:

  • Want balanced refinement of nasal shape, profile, tip, bridge or nostril appearance.
  • Have nasal obstruction from septal deviation or valve narrowing that can be addressed at the same time.
  • Prefer internal incisions, where suitable, and a technique that prioritises structural support and function.
  • Are in good general health and have clear, realistic goals.
When another approach may be better:
  • Major post-traumatic deformity, severe septal deviation or complex revision – open structural rhinoplasty may provide necessary access.
  • Very thick skin or substantial tip work – structural techniques may be preferable to preservation alone.

Recovery and Aftercare

Expected sensations

Congestion, pressure, upper-lip stiffness and altered smell, usually temporary.

Wound care

Keep incisions, if any external, and nostrils clean as directed; saline sprays as prescribed.

Activity

Walking from day 1; avoid strenuous exercise for 2 weeks; gradual return thereafter.

Protection

Avoid trauma; strict sun protection for any external incision; tape or splint use as advised.

Follow-up

Typically 1 week for splint removal, then 4-6 weeks, 3-6 months and 12 months.

What Are the Risks of Rhinoplasty?

All surgery carries risk. Possible complications include:

  • Bleeding, including delayed epistaxis, and infection.
  • Asymmetry or contour irregularity, persistent swelling or numbness.
  • Septal haematoma or septal perforation, rare.
  • Valve insufficiency or ongoing obstruction requiring additional care.
  • Skin changes or irritation; visible scar with open approach.
  • Altered smell, usually temporary.
  • Need for revision in a minority of cases.
  • Anaesthetic risks.

Instrumentation note: Ultrasonic (piezo) bone work offers precise control but may require wider subperiosteal exposure in selected cases, which can contribute to swelling. Instrumentation choice is tailored to your anatomy and the goals of surgery.

Combine your Rhinoplasty

Facial Balance & Function

Chin augmentation/reduction

Harmonises the profile and chin-nose balance, particularly when adjusting the dorsal profile.

Functional procedures

Septoplasty, turbinate reduction and valve support may be combined when indicated.

Staging with facial surgery

When pairing rhinoplasty with facelift or neck surgery, this is often staged to separate swelling patterns and simplify recovery.

Dr Phaethon Karagiannis measuring a patient’s facial proportions during a consultation.

WHAT TO EXPECT

From Consultation to Recovery

Your Initial Consultation

Photography and proportion analysis (front, profile and base views).

Nasal exam including septum, turbinates and valves.

Discussion of closed preservation vs structural approach, functional needs, anticipated course and costs.

Ultrasonic (piezo) plan for bony steps discussed when osseous work is indicated.

Preoperative Planning

Personalised instructions, including medications or supplements to pause, smoking cessation and skincare.

Anaesthetic review and any tests required.

Surgery Day

Setting:

Accredited day surgery or hospital.

Anaesthesia:

General anaesthesia in most cases.

Duration:

Typically 1.5-3.5 hours depending on complexity and functional work.

Technique:

Internal (closed) or open approach as indicated; ultrasonic piezotome used for bony steps unless minimal bony change makes additional exposure unnecessary.

Dressings:

External splint around 5-7 days; internal splints or soft packs used selectively.

Week 1 Post-Op

Bruising and swelling around eyes and cheeks peaks 48-72 hours, improving over 7-10 days.

Splint removal usually day 5-7.

Saline sprays, gentle cleansing, no nose-blowing and sneeze with mouth open.

Sleep head-elevated; short walks encouraged.

Week 2–3 Post-Op

Back to most work and social settings by around 10-14 days; avoid contact sports.

Avoid glasses resting on the bridge until cleared, often around 6 weeks; alternatives can be arranged.

6 Weeks+ Post-Op

Tip and fine swelling continue to settle over months; subtle refinement may continue up to 12-18 months.

Why Choose Dr Karagiannis
for your Rhinoplasty?

1. Expertise & Experience

Signature expertise in closed preservation rhinoplasty for suitable candidates – prioritising internal incisions, preserved support, and measured profile refinement.

2. Ultrasonic Piezotome

Routine use of ultrasonic piezotome for the bony steps across rhinoplasty approaches to enhance precision; conventional tools only when added exposure would be unnecessary.

3. Functional–Aesthetic Planning

Septum, turbinates, and valves assessed and addressed when indicated.

4. Anatomy‑first Judgement

Closed preservation when appropriate; structural or open methods when they clearly serve the outcome and function.

5. Care & Follow-up

Continuity of care in accredited facilities with structured follow‑up.

Dr Phaethon Karagiannis

Rhinoplasty FAQs

Most patients describe congestion and pressure rather than sharp pain. Oral analgesia usually suffices.

Closed approaches use internal incisions. Open rhinoplasty has a small external scar on the columella that usually settles well.

Yes. I routinely use a piezotome for the bony steps in rhinoplasty because it allows precise bone cuts while sparing soft tissues. If only minimal bone trimming is needed and the extra exposure would add unnecessary swelling, I may choose conventional tools.

Ultrasonic energy acts on bone rather than soft tissue, which can be helpful. Overall bruising and swelling depend on the extent of surgery, anatomy, and healing. In some cases, the additional exposure required for piezo work may contribute to swelling – this is weighed case by case.

Most patients feel comfortable socially by 10–14 days after splint removal; refinement continues for months.

Yes, when indicated we can combine septoplasty, turbinate reduction, and/or valve support with aesthetic changes.

Light walking from day 1; avoid strenuous exercise for 2 weeks (then gradual return). Avoid glasses on the bridge until cleared (often ~6 weeks; taping or alternatives can help earlier).

Cosmetic lip lift is generally not eligible for rebates unless specific reconstructive criteria are met.