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.

A pollybeak deformity, also known as supra-tip fullness, is an undesirable side effect of a less-than-successful rhinoplasty procedure. It manifests as an unusual fullness above the nasal tip, affecting the desired nasal contour. The area above the tip of the nose on the bridge is the highest part of the nose when seen in profile. The rather unflattering term ‘pollybeak’ comes from how the nose resembles a parrot’s beak.

“Rhinoplasty is a complex procedure, and there’s a fine balance between lowering the bridge too much and giving the appearance of a saddle deformity and not lowering the bridge enough and causing a pollybeak deformity,” explains rhinoplasty expert Mr Annakan Navaratnam.

“There are multiple factors involved, which include the thickness of the patient’s skin, the cartilage position and the potential functional compromise that can occur.

“To avoid a pollybeak deformity, I always make careful assessments of the thickness of the skin and nasal anatomy. I also typically use a technique called a septal extension graft, and there is evidence that it maintains the tip position much better in the long term.”

Pollybeak deformity causes

This rhinoplasty complication can occur due to two main reasons:

Soft tissue pollybeak

One type of pollybeak deformity is the soft tissue variant. This usually occurs when too much of the underlying cartilage structure is removed during the initial rhinoplasty procedure. Skin thickness is also a factor. If the skin is relatively thick, the resulting space can fill with scar tissue, leading to a noticeable fullness.

Cartilaginous pollybeak

The other type is the cartilaginous pollybeak deformity. This happens when the rhinoplasty surgeon reduces a bump on the nasal bridge but focuses only on the bony portion without sufficiently reducing the cartilaginous part. Post-surgical swelling may initially mask this issue. However, the unaddressed cartilage above the nasal tip can remain prominent as the swelling diminishes.

Pollybeak deformities are relatively uncommon and typically result from technical errors during the initial rhinoplasty. This underscores the importance of selecting a skilled, experienced surgeon for rhinoplasty procedures.

The appearance of a pollybeak deformity usually becomes noticeable about three to four months after surgery, as post-surgical swelling subsides. However, the exact timing can vary based on individual healing rates and the nature of the deformity.

What are the solutions to a pollybeak deformity?

Hyaluronic acid dermal fillers – also referred to as a liquid nose job – can help augment the nasal profile and lessen the look of a soft tissue pollybeak deformity. Patients looking for a non-surgical solution may find this appealing, but the results are temporary, and the procedure may need to be repeated every six to twelve months.

In cases where a cartilaginous pollybeak deformity is present, revision rhinoplasty surgery is usually required. This involves a secondary rhinoplasty to further reduce the excess cartilage that was not adequately addressed in the initial surgery and reinforce the nasal tip for a more balanced and aesthetically pleasing outcome.

The importance of choosing an experienced surgeon

Choosing an experienced surgeon is critical when considering any rhinoplasty. The surgeon’s expertise in rhinoplasty procedures, understanding of nasal anatomy, and ability to manage potential complications are all factors in achieving a successful outcome.

“Once surgery is undertaken, there’s not too much you can do to avoid it thereafter. Careful planning of the initial surgery is key,” concludes Annakan.

For more advice on possible rhinoplasty complications and how they will be managed, call +44 (0)203 627 2918 or email secretary@annakan.co.uk to arrange a consultation with rhinoplasty surgeon Mr Annakan Navaratnam.

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.