The cost of rhinoplasty can be significant both from a monetary perspective and potential emotional investment. The cost for a nose job includes the surgical, anaesthetic and hospital fees. This fee may typically vary from $15K to $40K depending upon the experience of the surgeon. When rhinoplasty is performed for functional or post-traumatic reasons, health insurance may cover a portion of the hospital fee but typically rebate very little for the anaesthetic and surgical fee. There is no rebate for a purely cosmetic rhinoplasty and GST is also added.

It is essential to be informed as best as one can be prior to committing towards an operation as the benefits of surgery should be balanced with what is achievable and the risks entailed with undergoing an operation. Dr Michael’s experienced administrative team will be able to provide further information about approximate costs. However, an assessment in person by Dr Michael will be required for a more accurate figure as costs vary with the length and complexity of surgery and as each patient is unique and is each procedure if tailored to that individual.

In your first consultation, Dr Michael will take a detailed history about issues with your nose and also perform an endoscopy. You will have photos taken of different views of your nose and you may require specialised scans of your nose. This is especially the case if you have had previous injuries. You will also be asked to complete questionnaires regarding issues with your nose. These can de downloaded here and completed before your appointment. You will also be sent information regarding the cost of rhinoplasty surgery. Rhinoplasty costs will vary dependant upon the complexity of operation and if the operation is purely a cosmetic rhinoplasty or not. It is important that individuals have a clear understanding of what rhinoplasty surgery can achieve together with its limitations and potential risks. Hence, the majority of patients will be seen for a second visit prior to proceeding with surgery.

At your second appointment Dr Michael will clarify and queries that you may have about your rhinoplasty operation. This will be done with the help of your photographs, scans and may also involve computer aided modifications to help illustrate the operation. If you wish to proceed with rhinoplasty surgery, final consent forms will be completed. Dr. Michael undertakes at rhinoplasty operations in Melbourne.

It is important that you stop smoking two months before rhinoplasty surgery as smoking affects blood vessels and hence the blood supply to the nose.  Please also cease medicines that may increase bleeding, three weeks before the operation. These medicines include anti-inflammatory medicines such as Aspirin, Nurofen and Voltaren and also some herbal medicines containing garlic, fish oil, gingko, ginseng and vitamin B12. 

You will also be seen immediately before the operation and Dr Michael will answer any further queries that you may have.

Patients undergo the operation with general anaesthesia which means that they are asleep and are unaware of the procedure and do not feel any pain. Rhinoplasty surgery may be undertaken through cuts made within the nose. However, in those but the most simple procedures, Dr. Michael favours an approach termed open-structured rhinoplasty which involves a small incision on the under surface of the nose. The scar from this generally fades very well and is usually imperceptible in the subsequent years. The operation is then performed to correct and stabilise the bony and cartilaginous framework of the nose. As the nose is comprised of multiple elements,  rhinoplasty surgery is in fact a collection of multiple separate procedures to address any deformities.

Additional procedures may be needed and include straightening or reconstructing the nasal septum or reducing the size of the nasal turbinates. When further support to the nose is considered, grafts may be required. These are typically taken from the nasal septum but if this site is insufficient, grafts may need to be taken from the ear or rib cartilage. The exact parts of the operation will be discussed with you during your consultation. 

Once the operation is completed, you will have a cast together with tapes over the bridge of your nose and may have plastic splints within your nose. In approximately 1 in 20 cases, nasal packing may be required. These are removed the following day. There is usually minimal pain when you wake after the operation as Dr Michael uses a long-acting local anaesthetic which numbs the nerves that supply the nose.

You will return to the ward and will usually be able to go home the same day. The tip of your nose will feel numb as nerves to sensation have to be cut. The sensation to this area usually returns after about 3 months as the nerves regrow but some people may still have an area of numbness over the nasal tip.

If the nasal bones had required realignment, you may develop bruising underneath the eyes. This has usually settles by 2 weeks after your operation. However, Dr Michael often uses an a technique called ultrasonic rhinoplasty using an instrument called a piezotome which is associated with less bruising after surgery. Your nose will be swollen for a period of a few weeks and you may see a difference in swelling between the morning and evening. The nose may also twist in one direction the next.

Generally, you will require approximately 2 weeks off from work. However, you may feel well enough to return to work after a week if you are undertaking desk duties alone. You may still feel congested and may have some bleeding at this time. The congestion sensation can feel like a heavy cold and persist for 6 weeks.

Dr Michael will see you after five days to remove stitches, your external and internal nasal splints. Taping over the bridge of your nose will be replaced. During this time, you will require antibiotics and also to wash your nose with salt water. Discomfort is usually managed with Panadol.

Your nose will likely look very swollen initially. During the course of the next few months, swelling will decrease and healing will be continuing. This means that the tip of your nose may feel firm and then soften with time.

Additionally, the shape of your nose may change. In fact, after about 6 weeks the nose will be about 60% of the final result and 95% at about 12 months. This reduction in swelling varies between individuals and takes longer in people with thick skin or those who are having revision surgery.

While your nose is healing, it is gaining strength and so it is important to avoid injury to it. This includes refraining from exercise for 6 weeks and all contact sports even after that period. Small children at home can be notorious for hitting noses that have had operations!

Also, limit sun exposure with a wide brimmed hat and high factor sun lotion. Moisturising cream can be helpful to the skin of the nose. In particular, using cream may help limit the amount of bruising that will develop. Some people develop an acne type skin after the operation but this usually settles. 

Most patients experience bleeding that usually decreases over the 24 hours following surgery and is followed by a watery blood tinged discharge for the subsequent days as old blood is cleared from the nose. If bleeding is excessive, then nasal packing may be required.

Infection is a rare possibility and may need further courses of antibiotics. Dr Michael does not routinely use any permanent artificial implants in the nose as these have been associated with an increased infection risk.

Nasal congestion is typical after the operation but usually subsides over the course of 4-6 weeks. This congestion may feel as if you have a heavy cold. Saline washes for your nose will help clear crusting that forms in the nose as the nasal lining heals and so help the feeling of a blocked nose.

Pain is uncommon and worsening pain may signify an infection.

Persistent numbness over the tip of the nose may occur in approximately 1 in 100 patients.

Operations on the nasal septum may result in hole in the septum if healing does not occur satisfactorily. This may cause crusting, whistling or dryness and if the nasal septum is further involved may cause loss of nasal support and subsequent change in shape. This is an uncommon complication.

Some patients experience numbness involving the upper lip, front upper teeth and/or the roof of their mouth. This usually settles within a few weeks.

The mouth can feel very stiff when people smile. This sensation settles usually after the first month or two.

Rarely, especially in a nose that is twisted, the ‘memory’ of the cartilage may result in it remembering its pre-operated position and re-twisting. 

There are general risks from the anaesthetic. Minor risks of nausea and vomiting may occur but can be managed by further medicines. Risks of serious complications are extremely rare. As a comparison, a general anaesthetic is considered to be much safer than road travel.

Dr Michael follows up his patients for at least one year to ensure that the surgical outcome is optimal. However, while absolute perfection is always aimed for, this may not be achievable in light of the intrinsic structure of the nasal framework. In some cases, revision surgery is appropriate after considering risks versus potential benefits. This would usually involve minor revisions.