Age is not just a number when it comes to rhinoplasty surgery. The age at which you undergo this procedure can significantly impact both the surgical technique used and the outcome.

Is there a minimum age for a rhinoplasty?

Often, I will get patients referred because they have problems breathing through the nose, and they have been told that you can’t intervene with septal surgery or septorhinoplasty surgery until the age of 18.

However, these types of obstructions affect your facial development, so in some cases, not intervening adequately early on can lead to further problems down the line.

Mid-facial growth usually finishes about 15 or 16, so structural nasal surgery in the form of a septorhinoplasty or rhinoplasty can be undertaken from that point onwards, as long as the patient is psychologically safe from a counselling point of view.

If a septal operation needs to be undertaken at an early age, then there are methods we can employ to minimise disruption to mid-facial growth. This includes very technical aspects, such as avoiding certain growth plates or junctions between the bone and the cartilage.

Intervening earlier in a conservative way can help in the long term, always taking into account that they may require further surgery at a later date.

Last year, I co-authored a review in the journal Facial Plastic Surgery, which aimed to evaluate the efficacy and safety of septal surgery in paediatric patients with nasal obstruction.

It concluded that “septal surgery for nasal obstruction in children has low revision and complication rates. However, a paediatric-specific outcome measure is yet to be determined. Larger prospective studies with long-term follow-up periods are needed to determine the optimal timing of nasal surgery for nasal obstruction in the paediatric population.”

Performing paediatric nasal surgery

In my practice at Great Ormond Street Hospital for Children, I undertake a lot of these cases.

If surgery is to address a severe nasal obstruction, it is always a careful case-by-case discussion, and then it can be performed as young as six or seven. We always make sure any issues that can cause obstruction, such as adenoid growth, enlarged inferior turbinates or allergic rhinitis, have been treated.

However, if there is severe septal deviation, you can address this in a conservative way that takes into account the anatomy of the growth plates.

Is there a maximum age restriction on rhinoplasty?

Towards the other end of the spectrum, in terms of age limits, there are specific considerations to take into account. First, consider the comorbidities, and then think about the nature of the tissue and how it has changed over time.

This means the bone is more brittle, the cartilages are less robust, and the ligaments between them are less resilient than they were previously. For example, as someone gets older, the tip of the nose often begins to droop down.

In a 2022 paper, I looked at the specific anatomical problems that can occur:

“Studies of older rhinoplasty patients emphasise the need for a tailored approach that preserves natural structures. However, if reinforced structural support is required, especially in functional cases, grafting techniques such as septal extension grafts, spreader grafts and alar strut grafts are required. Furthermore, special consideration must be made for the nasal skin in older patients, and utilisation of dorsal onlay grafts is often necessary.”

The psychological impact of a rhinoplasty at any age

Very importantly, and this is for both ends of the spectrum, is the psychological impact of rhinoplasty.

For the older patient, if they have had this nose all their life, and there is suddenly a significant change – particularly if the decision has been made as the result of a major life event – you have to be careful to counsel patients adequately and remind them that sometimes it can take some time to adjust to your new nose.

My role is to ensure my patients are well-informed about all possible outcomes. To find out if you’re suitable for a rhinoplasty, call +44 (0)203 627 2918 to arrange a consultation.

Four common seasonal respiratory viruses are circulating in the UK this Winter, in what has been dubbed the ‘quad-demic‘ by NHS leaders who have seen a sharp rise in hospital admissions for cases of flu, norovirus, respiratory syncytial virus (RSV) and COVID-19.

Viral infections, bacterial infections, allergies, and asthma are often the cause of most cases of sinusitis. Underlying conditions like chronic sinusitis or allergic rhinitis can also worsen the symptoms of the cold or flu.

“Some people do suffer from a higher frequency of viral infections,” explains ENT surgeon Mr Annakan Navaratnam. “You can take precautions such as washing your hands or staying away from people coughing and sputtering, but contact avoidance is challenging if you live in a city or you’re dealing with people daily.”

“If you have allergic rhinitis or chronic rhinosinusitis, ensure you’re taking your regular nasal medications, including topical nasal steroids and or antihistamines if required.

“An acute viral infection is usually self-limiting in most cases. It will typically last five to seven days and so focus on symptom relief. Use decongestants for a short period of time (not longer than one week), such as Otrivine or Sudafed, and make sure you’re using saltwater wash to rinse any discharge from the nose.”

The difference between a cold and sinusitis

The paranasal sinuses may be small, but they can cause much misery. These four pairs of air-filled interconnected cavities are located behind your cheekbones, nose, and forehead above your eyes. Along with the nasal passages, your sinuses produce and circulate mucus, which protects you from infections by trapping and moving germs out of the body

Signs of a sinus infection to look out for include:

1. Pain in different parts of your face: You may experience discomfort or pain in and around your sinuses, which are on your forehead, cheeks, and behind the nose. You may also experience pain in your upper jaw and teeth.
2. Nasal congestion: Infected sinuses become inflamed and swollen, which can feel like a blocked nose.
3. Nasal discharge: This thick discharge can be green or yellow and drain into your nose.
4. Coughing: If the discharge goes down into your throat, it can irritate and cause you to cough.
5. Headache: Swollen sinuses can cause pressure that leads to a headache.
6. Bad breath: The nasal discharge can even cause bad breath.

“If symptoms last more than a week, and you’re experiencing discomfort across the mid-face, developing discharge from the nose and have a raised temperature, then it may be a bacterial infection. At that point, it’s worth seeing your GP or healthcare provider for a short course of broad-spectrum antibiotics such as Amoxicillin combined with nasal decongestants or steroids.

“However, if your symptoms persist beyond that and, even after a course of antibiotics, you’re getting further infections, or they’re lasting for months on end, then you should consider getting reviewed by a specialist.

“There’s a role for regular steroid medication, to decrease inflammation, allowing the sinuses to drain, but ultimately, in those cases, someone needs to look inside the nose to see if there’s evidence of significant sinusitis or the presence of nasal polyps that may require more advanced treatment medically but also potentially surgically.”

To diagnose sinusitis, call +44 (0)203 627 2918 or email secretary@annakan.co.uk to arrange a consultation with ENT surgeon Mr Annakan Navaratnam.

Ultrasonic rhinoplasty, or Piezotome rhinoplasty, is trending on social media with hundreds of thousands of searches on Instagram, but what exactly is it?

Initially developed in the early 2010s by a plastic surgeon inspired by piezoelectric surgery used in dentistry, its rationale was to address the challenges inherent in nasal bone surgery.

Understanding nasal anatomy

The nose is a complex structure with various components that must be considered when performing nasal surgery.

The nasal cavities are the hollow areas of the nose, separated by the septum, which is made of both bone and firm cartilage. The upper third is composed of bone, formed by the nasal and cheekbones. The middle third is formed of cartilage, which is stiffer in the middle of the nasal bridge and softer at the sides. The lower third, known as the nasal tip, is composed of thin cartilage tissue that arches over the nostrils.

“Ultrasonic rhinoplasty is predominantly used to address the upper third of the nose,” Mr Annakan Navaratnam explains. “Previously, we performed an osteotomy to break the bone and reshape it which can be more unpredictable. The Piezotome allows you better control to sculpt and precisely cut the nasal bones.”

During an osteotomy, hammers and bone chisels are used to reduce the width of the nose, correct asymmetries, or remove bumps. Risks include uncontrolled fractures or the creation of small bone fragments. The Piezotome advanced surgical device emits ultrasonic micro-vibrations to reshape the bones.

“Older patients particularly can benefit. The nasal bones are more fragile, and there’s a risk when fracturing and sculpting.

“Patient selection is critical. For more significant deviations or a twisted nose, it’s not always suitable. I mainly use piezoelectric technology for aesthetic refinements rather than a drastic change. It allows you to essentially sculpt the nasal bones to reduce the dorsal hump or correct minor asymmetries.

“In my NHS work, I use the Piezotome device for craniofacial cases. It’s used for patients with significant deformities or those who have had multiple revision operations as it is precise and effective while sparing the adjacent tissue structures, compared to conventional surgery.”

Is there less downtime after ultrasonic rhinoplasty?

Ultrasonic rhinoplasty are mainly used in open procedures (external rhinoplasty). This involves an incision at the base of the nostrils before the skin is lifted from the underlying bone and cartilage structure.

The Piezotome device emits ultrasonic waves to gently cut the nasal bones with less damage to the surrounding soft tissue. It can also prevent what’s called ‘radiating fracture lines’ which are lines that extend from the point of impact.

However, “any type of rhinoplasty procedure will result in some degree of swelling and bruising. The recovery time varies depending on the individual’s healing process,” warns Annakan. There is less damage to the small blood vessels, which can result in less bruising around the eyes and across the cheeks.

The significant benefit of ultrasonic rhinoplasty is greater precision and control. For more advice on whether you’re suitable, call +44 (0)203 627 2918 or email secretary@annakan.co.uk to arrange a consultation with rhinoplasty surgeon Mr Annakan Navaratnam.

A common concern of patients contemplating nose reshaping surgery is how painful it will be. However, rhinoplasty swelling rather than pain is usually the prevalent post-surgery consequence during the recovery period.

“Rhinoplasty is not usually acutely painful, but it’s very uncomfortable. The nose is the middle of your face, and there is a lot of tissue swelling afterward, particularly if you’ve undergone extensive reconstruction,” London rhinoplasty surgeon Mr Annakan Navaratnam explains.

“Patients do not often appreciate the amount of swelling they will have, which will be significant for the first six weeks or so. After that, it subsides, but it takes six months to a year before all swelling fully disappears.”

Your rhinoplasty recovery timeline

The swelling stages vary from patient to patient but generally, you can expect the following timeline:

Rhinoplasty Recovery Week 1

“Patients can often  breathe better in the first few hours after surgery before the swelling kicks in,” comments Annakan, “but then the nose can become very stuffy and uncomfortable.”

You can expect significant swelling and tenderness for the first few days. You will typically feel very congested and may have difficulty breathing through the nose.

In the first week, you’ll be advised to sleep with your head elevated to reduce swelling. Also I will provide medication to decongest the nose and help clear any dried blood.

“The key thing I advise patients is that it’s good to mobilise. Don’t lie in bed all day as moving around boosts your circulation, which helps reduce swelling.”

Rhinoplasty Recovery Week 2

You can expect reduced swelling compared to the first week, and any bruising can be concealed with make-up. Depending on your type of employment, you may feel up to returning to work.

“We use dissolvable sutures, which can take between two to four weeks to dissolve. Patients often think something is moving inside the nose, but it’s usually just a suture that changes position as the patient moves or as the swelling fluctuates.”

Rhinoplasty Recovery Weeks 3 to 4

You should see a noticeable reduction in swelling, and you can breathe more easily. Your new nose will look more defined, but swelling sometimes recedes unevenly, with one side improving faster than the other. Patients can be concerned about asymmetry at this point.

Rhinoplasty Recovery Weeks 4 to 6

You will start to see the results of your rhinoplasty, and you should feel more confident about your new nose. However, it is essential to realise that there will be some slight residual swelling of the delicate nasal tissues that can take six months to a year to resolve.

Excessive and persistent swelling may be a cause for concern. If you experience severe swelling that does not improve or worsens and which causes nasal obstruction, contact your surgeon for advice.

Revision rhinoplasty swelling

If you have undergone a revision rhinoplasty or have very thick skin, significant swelling can last up to six weeks.

“If we use a graft to reconstruct the columella, the tissue that separates the nostrils at the bottom of your nose, or the dorsum, the bridge of the nose, then there will be significant swelling which may take longer to settle,” Annakan explains.

“Revision rhinoplasty patients are often anxious about swelling. Partly because they are already apprehensive, having undergone surgery previously and they will often compare their first operation to the revision procedure.

“What you often find is that their initial operation was a reduction rhinoplasty so there wasn’t much swelling, but the revision procedure might entail a lot of grafting and reconstruction so there will be much more swelling.”

Tips to reduce rhinoplasty swelling

1. Keep your head elevated in the first week to reduce fluid build-up.
2. Avoid strenuous activities in the initial recovery period, as they increase blood flow, which in turn increases swelling.
3. Avoid hot baths and showers.
4. Avoid salty foods, as sodium increases fluid retention.
5. Stay hydrated.
6. Up your vitamin and mineral intake through a healthy diet that boosts wound healing.
7. Quitting smoking prior to surgery is essential as nicotine is a vasoconstrictor, restricting oxygenated blood from reaching the nose and slowing healing.
8. Avoid taking blood-thinning medications if medically safe to do so.

For more advice on managing rhinoplasty complications, call +44 (0)203 627 2918 or email secretary@annakan.co.uk to arrange a rhinoplasty consultation with Mr Annakan Navaratnam.