I have been performing cosmetic surgery privately for 18 years now, I have now decided in the past ten years to focus ” EXCLUSIVELY” in Cosmetic Rhinoplasty. The demands of Ethnic and Revision Rhinoplasty are so demanding and exacting that I have decided to focus on this Singular aspect of nasal plastic surgery…….” STRICTLY RHINOPLASTY” and the FULL range of rhinoplasty from reduction to augmentation, functional, tip surgery, trauma, snoring and breathing and sleep disorders. In other words an ” Ultra Specialist ” in all aspects of Rhinoplasty…..my passion!

Luke Durham

Consultant ENT Rhinoplasty Surgeon

www.cosmeticrhinoplasty.org

Chapter 1 – The History of Plastic Surgery

It is thought that the ancient Egyptians and Romans performed plastic cosmetic surgery.  There is the Smith  papyrus in a  museum describing in interesting detail manipulation of a fractured nose.  It was also thought the Romans performed simple techniques on damaged ears, possibly from the gladiatorial events at around the 1^st century BC.

More importantly it is often quoted that the first procedure of note involving plastic surgery was carried out in India at around 2,000 BC.  Sushruta was considered the father of the so called Indian forehead flap.  The penalty for adultery and other serious crimes was amputation of the nose, often known as rhinokopia, which left a horrific disfigurement.

The Indian caste system found this deformity too horrendous to bear and the use of a forehead skin graft would then apply to covering the nose.  Surgeons discovered this technique much later at the time of the Indian Raj.  Joseph Constantine Carpue spent two decades in India studying local methods often carried out by the Potters cast and there are descriptions of this in the gentleman’s magazine  published in 1794.  The so called Indian flap is still alive and kicking today and used to reconstruct traumatic and tumour deformities of the nose with great success both under local and general anaesthetic.  Carpue performed the first major surgery of this type in the Western world by 1815.  He had performed an operative procedure on a British military officer who had lost his nose due to the toxic effects of mercury treatment (this mercury treatment was often given for syphilis).  It has been amusingly quoted; one night with Venus and the rest with Mercury!).  These procedures were the forerunner of the famous rhinoplasty better known today as the nose job!

The Cosmetic surgery business is a thriving industry!  Type into  the  Google  box a phrase such as ” Nose Job” or ” Face LIft ” and a bewildering page of companies , agents , brokers, celebrities

and high profile surgeons leap to the page !  Every one of them making claims and  with enticing  deals both home and abroad !

” Hard Sell “   !!?? … You know that,  and I know that too !

With this in mind I felt compelled to write a short series of articles to dispel some of the so called myths regarding facial cosmetic surgery.  Did you know that in the United Kingdom: there is

NO  formal procedure based training of surgeons in Cosmetic Surgery !!!!  The NHS ( National Health Service ) provides funding for cosmetic surgery procedures for individual patients BUT  only in

rare and    exceptional cases.  I can only assume that this is NOT the case in the United States of America .

As a result, the practice of cosmetic surgery in the UK is characterised by :

- Great variation in practice

- Limited recognised standards of practice

- Limited regulation of practitioners other  than the General Medical Council and the Courts .

Where does this leave our  client ?  How do they find a surgeon of their choice ?  This leads me to dispel a myth regarding cosmetic surgery, particularly facial cosmetic surgery.

Did you know that there are at least  five different types of specialist surgeons who regularly perform cosmetic surgery   of which plastic surgeons are only one group !  Let me explain further :

There are 850 to 900 surgeons in the UK who have completed a recognised training programme where there  is some aspect of cosmetic  surgery training  as part of their curriculum leading to

the Specialty Fellowship Examinations.

This group comprises  500  ENT  Surgeons  ( Otolaryngologists / Head and Neck Surgeons )

350  Plastic Surgeons

100  Breast Surgeons

80  Oculoplastic / Eye Surgeons

280 Maxillofacial Surgeons

A  significant proportion of these surgeons undertake cosmetic procedures  “within their anatomical areas of expertise”.  This last point is perhaps the MOST important factor !

Take for example the ENT (ear, Nose and throat ) surgeons; now known as Otolaryngologists/ Head and Neck Surgeons.  They are very often called upon to do corrective surgery

on the nose for functional reasons such as breathing disorders after trauma or congenital disorders, these are usually coupled with a cosmetic element to a lesser or greater degree .

The broken nose is a prime example, the corrective Rhinoplasty ( commonly called the ” Nose Job ” )  enables the Otolaryngologist to perfect their training in this aspect of of BOTH

functional and Cosmetic  Rhinoplasty surgery. The same principle applies to surgery of the throat / neck and the so called neck lift too !!   So if you require a nose job , it makes good sense to see a

site  specific experienced Rhinoplasty Surgeon  ( usually an Otolaryngologist/ ENT specialist).

In a similar fashion Eye specialists ( Ophthalmologists ) who carry out Oculoplastic Surgery are very highly specialized within their anatomical ares of expertise .  Unfortunately their numbers are

small but growing !   Training in cosmetic surgery should be as rigorous as training in the NHS and be governed by numerous factors of which ” SITE ” specificity , ultra specialization and the

numbers of surgical procedures performed during training and after training are considered.  This is more so in the Facial Plastic field.

If a surgeon wishes to specialize in the Facial Plastic/ Cosmetic  field  should they not be members of a  peer review   group such as The European Academy of Facial Plastic Surgery  , an open source

forum of surgeons of differing specialties dedicated to this area !   This amalgamation of cosmetic surgery  training between the various surgical specialties  not a personalist view it is being addressed

now by the

Cosmetic surgery inter specialty group and the senate of surgery of Great Britain and Ireland.  This can only be of benefit to our future clients in the growing field of Facial Plastic Surgery.

I look foward to keeping you posted in this fascinating world of Facial Plastic Surgery  as a source of information .

THE NON SURGICAL NOSE JOB

The non-surgical nose job is a new and exciting alternative available to patients interested in improving the shape of their nose without
undergoing invasive surgery. The benefits of nose jobs without surgery are faster results, quicker healing time, and little or no pain.

The 15 Minute “Nose Job”

Non-surgical rhinoplasty is sometimes otherwise known as the 15 minute “Nose Job” because it’s a quick, effective and cheaper  alternative to traditional surgical rhinoplasty. Some people are put off by the potential problems of undergoing rhinoplasty surgery and the possibility of unfavourable results after the procedure is complete, not to mention the cost of the surgery itself. Non-surgical rhinoplasty is an affordable alternative to surgery, though not as permanent, for people who want the nose reshaping benefits of rhinoplasty quickly and safely.

What Are the Benefits of a Non-Surgical Procedure?

The Rhinoplasty or Nose Job is still one of the most desired cosmetic procedures, but many patients are put concerned by the potential complications and the risks of unfavorable cosmetic results, not to mention the cost of the surgery itself. Although not as permanent, this procedure is for people who want the nose reshaping benefits of rhinoplasty quickly and safely, without undergoing extensive rhinoplasty.

Criteria for non-surgical rhinoplasty are fairly specific, and it is unlikely the procedure will be beneficial for the majority of people wishing to undertake such surgery. It is improbable that the results will be as dramatic as they would be from a conventional rhinoplasty and, should the patient ever decide to have full surgery, the previous dermal filler injections may leave fibrous tissue behind that could impede the surgeon’s ability to deliver long term results. There is also the possibility of the other complications related to dermal fillers including allergic reaction, infection, granulomas and in rare cases skin necrosis. These are rare .

Dermal fillers aren’t permanent but long lasting so you’ll have to get this procedure more than once over a few years to maintain the desired shape. Touch ups are necessary to maintain the desired shape but usually require less filler than the first time. However if you are interested in changing your nose without having to undergo surgery, it could be something to consider.  We use local anaesthetics with a cream or tiny injections to numb the area so your experience is as painless as possible.

For the minor or finesse finishing touches, the Non Surgical Nose Job is an excellent alternative, with the caveat that it be performed with the eye of a rhinoplastic surgeon!