Rhinoplasty, commonly referred to as a nose-job or nose surgery, alters the nose’s external appearance. It is performed for cosmetic and/or functional (improve nasal airway) purposes; very often both.
Rhinoplasty should always look to maintain (and in most cases strengthen) structural supports to the nose to preserve or restore a good nasal airway and achieve a long-lasting result. The appearance of the nose with surgery is always of utmost importance as form follows function. Historically, rhinoplasty to improve appearance has lead to a weakening of the structure and a compromise to function (blocked nose) as well as a deterioration in appearance over time. This need not be the case. From these important goals (Good function, pleasing appearance and maintained framework support) the term “Structural Rhinoplasty” has been coined as is a good descriptor. Mr Jumeau only performs structural rhinoplasty.
Adenoids are lymphoid tissue (like tonsils) situated at the back of the nose above the palate. They are largest in young children (generally under six) and then slowly regress and are usually not present in young adults. Adenoids may be removed in children to help a blocked nose, improve snoring, aid middle ear infections or hearing loss due to middle ear fluid. They are frequently combined with tonsillectomy and/ or grommets depending on the problem to be addressed and its severity.
Adenoidectomy alone (or with grommets) is a straightforward procedure performed as day-stay surgery (home same day). It normally takes 15-20 minutes of surgery time, and regular panadol is usually sufficient for the 2-3 days of post-operative discomfort.
Tonsils are most commonly removed in young children to help with snoring, sleep apnoea or recurrent tonsillitis. In these settings, the adenoids are often removed too. In adults recurrent tonsillitis, chronic tonsillar debris and infections or to exclude cancer are the major indications. In adult snorers with large tonsils, removal can make a big difference.
Tonsillectomy may be a day stay or an overnight stay in the hospital. Surgical time can vary from 15-45mins. Tonsillectomy is a painful procedure and patients are discharged home with strong painkillers. Pain is pronounced for the first week and then backs off dramatically in the second week although one should allocate 2 weeks for a full recovery. There is a risk of bleeding following tonsillectomy depending on patient age (younger less common) and how large, scarred and infected the tonsils are. This risk is highest 5-14 days post-surgery.
Grommets are a general term for any ventilation tube placed in the eardrum to help those with eustachian tube dysfunction. Eustachian tubes connect the middle ear space (deep to the eardrum) with the back of the nose and allow ear pressures to be equalised. Dysfunctional people are prone to recurrent middle ear infections and or hearing loss. This is much more common in children than adults. Grommets are expected to fall out after 6-18 months and allow another means of pressure equalisation while we wait to see if growth and time allow the natural eustachian tube to mature. They are not a cure in themselves but aim to reduce infections and aid hearing while we wait. Some children and adults require multiple sets.
Insertion of grommets in children is done under general anaesthesia (patient fully asleep in the hospital) and is a quick day stay procedure. It is performed down the ear canal with just a tiny cut on the eardrum. The grommets are not visible externally. The procedure is not particularly sore, with most people and children not requiring any post-surgery pain relief. In adults, most grommets can be performed under local anaesthetic (eardrum numbed and patient awake) in Mr Jumeau’s rooms.
The nasal septum is the midline partition that separates the two nostrils. It needs to be straight to allow good nasal airway and strong to maintain nasal tip support. It can become deviated simply from growth but sometimes also from trauma. Straightening of the septum is called septoplasty. Septoplasty can typically be done as a closed procedure (no external cuts) and is often combined with turbinoplasty. In some people, the septum severely deviates, and surgery requires an open rhinoplasty approach to address adequately. Sometimes minor septoplasties are performed endoscopically (using a small surgical telescope up the nose).
Septoplasty usually takes 30-60 mins surgery time. It should not impact the external appearance of the nose or lead to any facial bruising unless combined with a rhinoplasty. Packing placed in the nose slowly dissolves in the days following the surgery with the aid of nasal rinses and blowing. No sutures or packing needs removing in the post-surgery period. All nasal procedures carry a risk of bleeding, but this is small. Pain can vary a lot following septoplasty from mild to quite intense, depending on how much work is needed. Septoplasty can be a day stay or overnight stay.
The turbinates are pads on the internal sidewall of the nose that fluctuate in size over the day to regulate airflow. They can be very large or irregular (especially when the septum has deviated), and reducing their size can aid the nasal airway. Mr Jumeau performs turbinoplasty endoscopically (using a small surgical telescope up the nose).
Turbinate surgery takes about 15mins and on its own is not particularly painful. It requires a general anaesthetic. Like all nasal procedures, there is a small risk of bleeding. Nasal packing is inserted and dissolves slowly in the days following the surgery with saline rinses and blowing.
FESS (Functional Endoscopic Sinus Surgery)
FESS is surgery to aid in the drainage of the sinuses in those that get sinus infections. It can vary from minor surgery addressing one or two sinuses with mild disease to a much more extensive procedure in those where all sinuses are diseased. More significant procedures may be necessary where polyp disease is present, fungal infections are present, or multiple previous surgeries were performed. Sometimes Mr Jumeau uses image guidance (on operating table real-time instrument imaging for exact positioning) for complex cases and some frontal sinus work. If performed correctly, the vast majority of patients do not need further surgery. However, those with significant allergies or polyp disease may get recurrent symptoms over time and sometimes, these people need additional work in later years.
Sinus surgery requires solid experience to be performed well, especially in complex cases. Some cases can take over 2 hours if complex, but most take less than that. There is not usually much post-surgery pain, with paracetamol or panadeine being sufficient. However, a minimal subset of patients has had chronic mid facial pain issues that often get very sore for a few days. Surgery may be a day stay or overnight. As in all nasal surgery, there is a risk of bleeding. Some cases may also carry a very tiny risk of injury to the eye and potentially cerebrospinal fluid leakage that needs correction. These risks are minimal in experienced hands and can be managed appropriately in the rare instance they occur. Mr Jumeau will discuss these risks in the context of your required surgery. All sinus surgeries by Mr Jumeau are performed endoscopically (using a small surgical telescope for visualisation and fine endoscopic instruments that allow a maximum field of view with just minimal access up the nostril and no external cuts) which is current best practice. Adequate and confident removal of all diseases is impossible if not done endoscopically and is the modern-day standard for sinus surgeons.