Rhinoplasty (Nasal Surgery)
IN SYDNEY
Rhinoplasty
Balanced refinement of nasal form with careful attention to function and airflow.
My approach is considered, curated, and grounded in anatomy. I prioritise techniques that preserve structural support and nasal function while making measured refinements to proportion and profile.
For suitable candidates, I offer closed preservation rhinoplasty as a signature technique - using internal incisions to reshape without external scars, and preserving key support where possible.
Across all rhinoplasty approaches, I routinely use an ultrasonic piezotome for the bony steps because it offers micrometric control of bone work while sparing soft tissues. In cases where only very small bony trims are required and the additional subperiosteal exposure would add unnecessary swelling, I may elect conventional instruments instead.
What is Rhinoplasty?
Rhinoplasty reshapes the nose to improve proportion (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.
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.
Closed Preservation Rhinoplasty - Signature Offering
Access: Internal (endonasal) incisions - no external scar.
Philosophy: Preserve and reposition existing structures (e.g., dorsal preservation with push‑down/let‑down manoeuvres) to maintain native dorsal aesthetic lines and support.
Best for: Straight or near‑straight noses with a hump and good skin quality; refined, natural profile changes with structural stability.
Instrumentation: Ultrasonic piezotome used for bony work when indicated.
Septoplasty & Airway Procedures (May be Combined)
Septoplasty: Straightens the septum to improve airflow and supports symmetry.
Inferior turbinate reduction: Addresses mucosal/structural contributors to obstruction.
Nasal valve support: Spreader/batten grafts as indicated to stabilise the internal/external valve.
Closed Structural Rhinoplasty
Access: Internal incisions.
Philosophy: Structural grafting and suturing to refine tip projection/rotation/definition; selective dorsal or septal work where preservation alone isn’t sufficient.
Best for: Tip refinement in thicker skin, mild–moderate asymmetries, moderate septal deviation.
Instrumentation: Ultrasonic piezotome used for bony steps as required.
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 (lateral/medial), 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/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.
Open Structural Rhinoplasty
Access: Small trans‑columellar incision plus internal incisions.
Philosophy: Maximal exposure for complex tip/valve/septal reconstruction (e.g., revision cases, severe deviation, traumatic deformity).
Best for: Significant asymmetry, complex or revision rhinoplasty, major valve collapse.
Considerations: External scar (usually fine), potentially more swelling; chosen when advantages clearly outweigh downsides.
Instrumentation: Ultrasonic piezotome for precise osseous work where appropriate.
COMBINE YOUR RHINOPLASTY
For Harmony & 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 as indicated.
Staging with Facial Surgery: When pairing with facelift/neck surgery, this is often staged to separate swelling patterns and simplify recovery.
WHY CONSIDER RHINOPLASTY?
Who Is the Ideal Candidate?
You may be well suited if you:
Seek measured refinement of a dorsal hump, tip width/definition, tip rotation, or a crooked 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.
WHAT TO EXPECT
From Consultation to Recovery - Rhinoplasty
Undergoing rhinoplasty surgery is a detailed and personalised process. From your first consultation to your final review, every stage is carefully planned to support your comfort, safety, and optimal healing.
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Your Initial Consultation
Photography and proportion analysis (front/profile/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.
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Preoperative Planning
Personalised instructions (medications/supplements to pause, smoking cessation, skincare).
Anaesthetic review and any tests required.
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Surgery Day
Setting: Accredited day surgery or hospital.
Anaesthesia: General (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 in all rhinoplasties unless minimal bony change makes additional exposure unnecessary
Dressings: External splint ~5–7 days; internal splints or soft packs used selectively.
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Week 1 Post-Op
Bruising/swelling around eyes/cheeks peaks 48–72 hours, improves over 7–10 days.
Splint removal usually day 5–7.
Saline sprays, gentle cleansing; no nose‑blowing; sneeze with mouth open.
Sleep head‑elevated; short walks encouraged.
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Week 2–3 Post-Op
Back to most work/social settings by ~10–14 days; avoid contact sports.
Avoid glasses resting on the bridge until cleared (often ~6 weeks; alternatives can be arranged).
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6 Weeks+ Post-Op
Tip/fine swelling continues to settle over months; subtle refinement up to 12–18 months.
YOUR RECOVERY
Postoperative Care & Follow-up
Expected sensations: Congestion, pressure, upper‑lip stiffness, altered smell (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 2 weeks; gradual return thereafter.
Protection: Avoid trauma; strict sun protection for any external incision; tape or splint use as advised.
Follow‑up (typical): 1 week (splint removal), 4–6 weeks, 3–6 months, 12 months.
SURGICAL RISKS
Risks of Rhinoplasty (Including Functional Work)
Bleeding (including delayed epistaxis), infection (uncommon).
Asymmetry or contour irregularity; persistent swelling or numbness.
Septal haematoma or septal perforation (rare).
Valve insufficiency or ongoing obstruction; need for additional valve support.
Skin changes/irritation; visible scar with open approach.
Altered smell (usually temporary).
Need for revision in a minority of cases.
Anaesthetic risks (VTE, drug reactions, cardio‑respiratory events).
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.
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.
4. Care & Follow-up
Continuity of care in accredited facilities with structured follow‑up.
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.
Rhinoplasty FAQs
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Most patients describe congestion and pressure rather than sharp pain. Oral analgesia usually suffices.
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Closed approaches use internal incisions. Open rhinoplasty has a small external scar on the columella that usually settles well.
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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.
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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.
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Most patients feel comfortable socially by 10–14 days after splint removal; refinement continues for months.
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Yes, when indicated we can combine septoplasty, turbinate reduction, and/or valve support with aesthetic changes.
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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).
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Cosmetic rhinoplasty is generally not eligible. Functional procedures (e.g., septoplasty) may attract rebates when criteria are met; eligibility is assessed individually.
Request a Consultation
If you're considering facial rejuvenation, I invite you to schedule a private consultation. Together we’ll explore your goals, assess your anatomy, and tailor a plan to suit your needs.