What the patients say about rhinoplasty under my care:
“I recently had a septorhinoplasty with Dr Amen and am entirely pleased with the experience from start to finish. Dr Amen’s expertise and approachable manner were evident from the initial consultation. I felt listened to, comfortable and informed at every stage. I am thrilled with the results of the procedure and was supported through every step of the recovery process. I am truly grateful and would highly recommend Dr Amen.”
“Mr Amen was my consultant for a Septorhinoplasty. I am a 19-year-old girl and needed my deviated septum sorting as well as reducing the hump on the bridge of my nose. It was a big decision to go ahead with this operation as it can be scary but after research into consultants and meeting a couple, when I finally came across Mr Amen at the Fitzwilliam Hospital in Peterborough I could not have been more impressed. Mr Amen's level of professionalism and attention to detail was outstanding. He always made sure I felt completely at ease and knew I was in safe and experienced hands. Mr Amen took plenty of time to explain the procedure, as well as explaining how my nose would change visually. He did numerous tests, as well as taking lots of pictures to ensure the final result was perfect. My operation was a complete success and I no longer have effects of rhinitis and cosmetically my nose looks brilliant and very natural. I could not be happier. The recovery was far better than I imagined with minimal bruising, swelling and absolutely no scarring. From the first appointment to the end, Mr Amen was fantastic and myself and my family would highly recommend him for a Septorhinoplasty or any other surgery.”
“I was referred to Mr. Amen by my GP and underwent a septorhinoplasty, carried out by him. From my initial consultation to my post-operative and discharge appointments I experienced Mr. Amen as respectful, attentive and caring. He spend time informing me about the procedure and discussing my expectations and concerns. He carried out a complex procedure with skill and sensitivity, achieving a result that, both functionally and aesthetically, I am delighted with. I would recommend him unhesitatingly.”
I perform surgery to improve the shape of the nose and the breathing through the nose. You might have injured your nose or over time the nose can grow and bend naturally.
When you come to see me, I would ask you what about the shape of the nose bothers you: some patients have a hump, the nose might be bent to the left or right, it might be droopy, or the tip might be bulbous.
Some patients’ breathing might be blocked in one or both nostrils. The nose might be bent on the outside and the partition which separates the right side from the left side (the nasal septum) might also be bent internally. I would ask if you had any other nasal symptoms such as facial pain, nose bleeds, sneezing or lack of sense of smell.
I would then examine your nose. I would look at your nose from the front, side, and underneath. Then I use special small tongs and a headlight to spread the nostrils apart gently to have a look in. I would complete the examination by using a camera (nasendoscope) to look up the nose and check if the partition is bent, for nasal polyps, allergy, pus (sinusitis) or tumours blocking the nose. I would also take photographs to keep in your medical records and to help me plan surgery.
The partition (nasal septum) is the foundation upon which the nose is built. It separates the right side of the nose from the left side of the nose. As an ENT surgeon, I am an expert in examining and dealing with the partition and nasal blockage. After examining you, if the partition is bent (deviated nasal septum) I would give you a steroid nasal spray (e.g pirinase) to try for 6 weeks. Whilst this won’t change the bend in the partition, after 6 weeks of use it might shrink down the shelves and the lining of the nose enough for you to breathe past the deviated nasal septum and avoid surgery.
If the nose is bent, externally and internally, a septorhinoplasty operation, that straightens the inside and the outside of the nose, may help. Some times a septoplasty operation, alone, is performed for such a problem. It would be better to straighten both the inside and the outside at the first sitting, as doing a septoplasty alone often leaves you with persistent nasal blockage and requires a second operation which is made more difficult by all the scarring from the first operation.
The best way I could put it is, if you have a house with wonky external and internal walls, and you try to straighten out the internal walls without fixing the external walls, your house will still be wonky!
Correcting the shape of the nose (rhinoplasty) is less about surgery and is more of an art. When I do this surgery, I create a work of art that you will wear in the middle of your face for the rest of your life. I also want it to function well and for you to be able to breathe comfortably through the nose. This is an advantage of choosing an ENT surgeon over a plastic surgeon to perform your surgery as I shall examine your nose inside and out, in clinic, and have a plan for both. I am aiming for the nose to look natural. Someone meeting you for the first time, won't realise you have had such complex surgery.
I deal with all types of nasal deformities: humps, bulky tip, bent and droopy noses. A septorhinoplasty or rhinoplasty operation involves coming into hospital and having a general anaesthetic, so you will be fully asleep. Once you are asleep, I would clean the nose with antiseptic, trim the nasal hairs with a scalpel, and inject local anaesthetic with adrenaline into the partition and the nose to minimise bleeding during surgery. I would make an internal incision at the front of the partition and then use special instruments to peel the lining of the nose (mucosa) away from the cartilage and bone of the partition. I remove any bent cartilage or bone from the partition to straighten it. I keep this in saline just in case I need to use it later to reinforce the nose’s structure. Depending on the type of deformity of the nose and partition, I would perform an internal or external approach rhinoplasty. For a simple hump, an internal rhinoplasty may suffice. This involves internal incisions to access the hump and four 2mm incisions on the bridge of the nose (two either side). I use a file, and chisels to remove the hump. This makes the bridge of the nose flat, so then I use a small chisel placed through the 2mm external incisions to make controlled breaks in the nasal bones, either side, and refracture the nose into the midline to narrow the bridge again.
If the tip needs to be refined, or I need to straighten the upper portion of the partition of the nose, I may need to perform an external-approach rhinoplasty. I would make a small incision underneath the nose and lift up the skin to access the cartilaginous framework of the nose. I would then reshape the cartilage to produce the desired effect and improve the shape and function of the nose. Occasionally, I might borrow some cartilage from the outer part of the ear to reconstruct the nose. The incision for this is hidden behind the ear, so it would not be apparent that any cartilage had been removed. I would then suture the internal incisions closed with absorbable sutures. I also sometimes shrink the normal shelves in the nose (SMD) to improve nasal airflow through the nose. I would close the external incision, under the nose, with non-absorbable sutures which are removed after 7 days in clinic. I would the put absorbable packs in the nose to prevent bleeding from the nose and to aid healing. Then, I would apply a plaster of Paris to the exterior of the nose to keep the nose straight whilst it heals and secure this to the nose and face with tape. A cotton swab is applied under the nose, with bands to secure it over the ears (nasal bolster) to catch any mucus mixed with blood that is expected to drain out of the nose after surgery. The nose drains blood and mucus for 8 weeks after surgery – it should not bleed like a tap. Initially, the nose can be more blocked and it can take 8 weeks for the swelling inside the nose to settle and for all the clots to absorb so you can start to breathe through your nose.
You will be woken up from the anaesthetic and be taken to the recovery area, and then the ward. Most people go home the same day after surgery, unless the surgery is done later in the day, and you are too sleepy to go home the same day and instead go home the following morning. You are sent home with painkillers, although the surgery is not too painful, and you can use a saline rinse, e.g. sterimar, to gently wash the nose out twice a day. If you have had cartilage grafting or special non-absorbable sutures placed inside the nose, I might prescribe a week of antibiotics.
The risks of the operation include: pain, bleeding, infection, general anaesthetic, numbness of the front two teeth, a hole in the partition of the nose if healing does not occur properly (septal perforation) – this can crust and bleed, you may be unhappy with the shape of the nose, or still be blocked after surgery which is uncommon.
I categorise the form and function of the nose (breathing) into very poor, poor, below average, average, above average, good and excellent. If I perform an operation on the nose the outcome depends on a complex interaction between my surgical skills, and the way the nose heals. The nose is largely composed of cartilage and it has a memory. When I straighten the nose, the cartilage will try to spring back to its original position because of this memory. The best result we can hope for is an incremental improvement in form and function i.e. a very poor nose may become below average. I could never take a very poor nose and change it into excellent. Another way of thinking about this is that the nose will never be perfect in terms of form and function.
You come back to clinic after about 7 days for the removal of the plaster cast and any non-absorbable stitches. At this stage, you can expect the nose to be swollen, and for you to have bruising around the eyes, if I have refined the nasal bones at the top of the nose. I would see you again at 3 months. Most of the swelling should have settled down by this stage. I would take photographs for your medical records at this point and ask you if you are willing to consent for your photographs to be used to counsel other patients before surgery. It takes about 1 year for the final shape of the nose to become apparent.