Nasal surgery for improved confidence in appearance has been in evidence for centuries, even preceding the development of anaesthesia to make it comfortable!
Nasal shape and form has tremendous cultural and gender significance. Jonathan uses detailed planning, up to and including sophisticated 3D techniques, to facilitate aesthetic rhinoplasty for each component of the nose.
His experience in remodelling and restoration of the nose in response to birth and developmental anomaly, gives him a rare insight in both analysis and technical surgery.
A range of bone, cartilage and soft tissue techniques are used to achieve aesthetically balanced results. Procedures take from one to three hours and clients can expect to resume life as normal in four to six weeks with one to two weeks away from work. A cast may be worn if nasal framework change is undertaken, and this may be required for seven to ten days after surgery.
Rhinoplasty is a family of surgical procedures that can reshape and restructure the nose. Popular with both men and women rhinoplasty for confidence in appearance change, for improvement in comfort in breathing, or for a combination of both is a ‘craniofacial’ surgical specialty which combines anatomical study, surgical craftsmanship, and learned artistry.
Developments in techniques and surgical technology have seen significant improvements in rhinoplasty practise at a rapid pace in recent years.
Aesthetic rhinoplasty surgery improves form and function, and balance and proportion to the nose. Functional rhinoplasty surgery targets improvements in breathing and comfort in sleeping.
From minor imperfections and subtle changes in the nasal tip to more complex reconstruction procedures, rhinoplasty brings measurably high satisfaction to patients, giving stable results for an improved quality of life.
The creation of a naturally balanced nose is based upon the scientific principles of anatomy and blood supply, married to the art of proportion and refinement. These come together in surgical experience and expertise, formed within a comprehensive foundation of craniofacial aesthetic and reconstructive surgery.
The study of the form and function of the face, which is an essential prerequisite to the art of facial and nasal surgery, requires cultural, social, psychological and gender sensitivity. No two patients are the same and Jonathan’s international experience in craniofacial reconstructive and aesthetic rhinoplasty gives him a unique perspective in the analysis, which is both cultural and technical. His meticulous surgery, comprehensive planning (including 3-D surface scanning and computer-based projection), and attentive listening are the basis of his success.
Many new terms of language, once buried within the deeply technical world of rhinoplasty surgeons, have entered the public domain and become a part of the rhinoplasty consultation. Language such as “let down”, “push down”, “preservation”, and “hybrid”, have become part of the rhinoplasty consultation with patients who have, in many understandable ways, over – researched. These terms have replaced the questions once asked about “open rhinoplasty” versus “closed rhinoplasty”.
The key questions for both patient and surgeon are; ‘Where are we going with this?’, ‘What do we want to achieve?’, “Are we agreed on the priorities here?’ The discussion which flows from that is: “Can these aims be reasonably achieved?”, and, “Do we have the techniques in rhinoplasty urgery to do this?’ The more challenging discussion is often: “Are these aims reasonable?”, “How would we react if expectation is not met?”
The value of the 3-D planning exercise is as much in the conversation it stimulates as it is the excitement of shaping the digital nose on the digital face. This conversation is where the understanding between surgeon and patient is developed. In rhinoplasty almost more than any other facial surgical field, the “analytics phase” is key, and is part of the professional pleasure.
Not all analytics have to be digital, sometimes simple photography, armed with a soft lead pencil (the ‘sketch exercise”) can do the trick – but the key is the ability to connect between patient and surgeon to understand the goals, the tools to achieve them, and the potential challenges along the way. Without the trust; the skills, the sophisticated techniques, and the modern technology of rhinoplasty, have little value.
– Jonathan Britto –
Do you have difficulty in making eye contact with others? Do you avoid having a photograph taken? Do you prefer to pose in a particular way before a facial photograph? These things are frequently mentioned by our patients seeking a rhinoplasty procedure. The nose, compared to other anatomical areas for facial plastic surgery, creates particular insecurities for us all. Rhinoplasty is part of the the definitive approach to resolving such insecurities – and when undertaken in an holistic and multidisciplinary way can lead to huge uplift in confidence in appearance, and well-being in life.
Have you tried describing your nose to yourself in the mirror? It is not easy! It is for this reason that the rhinoplasty consultation is such a rewarding and challenging part of Jonathan’s practice.
There are three stages of rhinoplasty – planning, surgery, and recovery. In the planning, or “analysis” phase, we spend time listening, understanding, and where necessary using the tools of digital technology to illustrate the conversation. This is where the exciting work begins, where Jonathan learns from you ‘why and where’ to apply the technical skills of his professional life. Jonathan brings a complete understanding of the behaviour of the lining, framework, and ‘envelope’ of the nose to surgical planning and technique – required to bring about a balanced and harmonious result.
Patients of all ages seek rhinoplasty surgery, from younger patients who worry about moving through adult life with a nose they don’t feel ‘fits’ their face; to older patients who have longed to change the shape of their nose and have lived with a sense of embarrassment and insecurity for many years. Others might seek help following an accident which has resulted in change in the shape of the nose that they feel are not only aesthetically unattractive – but also are a constant visual reminder of a distressing event.
With two decades of excellence in multidisciplinary planning for facial and nasal aesthetic restoration, Jonathan brings discipline empathy and good humour to the planning and the patient care, and meticulous technique to the surgery.
At the Jonathan Britto clinic we use the cutting edge ultrasonic, piezoelectric technology which improves upon the accuracy of the ‘chisel and hammer’ approaches of old. The piezo technique uses high-speed sound waves to vibrate tiny cutting and shaving tips that offer precise, accurate removal and remodelling of bone and cartilage without injuring soft tissues. With the millimetre accuracy of the cutting edges that the Piezo offers, accuracy increases, the risk reduces, and recovery is made faster.
Rhinoplasty anaesthesia is a specialised discipline of anaesthetics, and Johnathan’s anaesthetic team are highly expert. With hundreds of rhinoplasty patients successfully treated, we have the evidence that points to comfort, and rapid recovery. The rhinoplasty surgery requires a “blood free field” for visibility and accuracy in highly delicate work. The combination of anaesthetic technique and surgical accuracy and still makes for the best outcomes.
There will be no coughing, no rise in blood pressure, no nausea, and no pain or discomfort. This is a first-class experience, which alleviates anxiety and increases choice for patients.
The day case general anaesthetic technique is so well honed that the majority of our patients request a day-case surgery. These are choices that the modern rhinoplasty patient can make, for comfort and safety, and convenience.
We understand what a big step to consider rhinoplasty surgery. Many feel overly self-aware and uncomfortable and find it difficult to explain clearly what they want without feeling embarrassment, while others know exactly what they want and can articulate their concerns well. We recognise the often overwhelming feelings associated with the rhinoplasty consultation and take time to listen and understand the concerns, fears and hopes of our patients.
The consultation is usually a 2-3 step ‘analysis phase’ at either our London or Essex clinics. Alternatively we can arrange a video consultation from the comfort of your own home.
1. Discretionary free-of-charge video-call
Jonathan will enjoy introducing himself to you in a free video-call to discuss your request. It would be very useful if you could send us some selfie photographs (to medsec@jonathanbritto.com; held securely as part of your medical record), which will help inform the conversation.
2. Face-to-face consultation
If you would like to receive a detailed written analysis, with a quote for treatment, Jonathan will meet you in clinic for a face-to-face appointment. You are welcome to bring a friend or family member for support. The medical history and physical analysis in the privacy of the consulting room is an essential part of making the treatment plan. After this meeting you will receive a detailed plan and a written quote, together with a suite of information about our ’twilight’ surgeries, relevant comments from prior patients, and some insights about the psychology and holistic care that is part of our commitment to you.
3. Face-to-face or remote catch up…
Jonathan recommends that you open a “procedure diary” on your phone, into which you can drop any questions that occur to you throughout the day, and after receiving the clinic letter and information from your face-to-face consultation.
This third conversation is to answer any questions you have, and to allow Jonathan to ask you about any reflections he has had to refine your care.
4. In truth, our door is always open, and Jonathan will be very happy to see you face-to-face or remotely if you have further questions about your requested procedure.
Consultation fees: £295 is charged prior to Step 2
Data Security:
Please be aware we use a data security software to encrypt any correspondence that we send you which includes your personal data. These emails may fall into your junk folder, so following your consultations please keep a regular check on this folder.
If you wish to receive un-encryped, ‘open’ email to your inbox – please can be requested via an online, ‘one click’ consent form.
You will wear a nasal splint for the first 7 to 10 days after your rhinoplasty. Once this is removed you will notice moderate swelling and possibly bruising around your eyes that could last up to two weeks. Therefore, you are advised to take 2 weeks off work (unless working from home) and social activities. You are asked to refrain from physical exercise for up to 6 weeks after the surgery particularly with contact sports or sports involving a ball (3 months). You will be invited to regular appointments to monitor your progress and these visits are all part of the service with our ‘open door’ policy to post – operative patients
There are many variations of rhinoplasty surgery. The type of surgery will determine the placement of scars.
There will generally be a scar across the midline columella between the nostrils and on the inside of the nostrils. Occasionally the inside nostril scar is all that is required.
Other scar options include behind the upper lip, within the nostril, and tiny ‘stab’ incisions in the creases between the nose and the cheek.
The area across the bridge of the nose where glasses rest is normally swollen following rhinoplasty surgery and patients are asked to avoid wearing their heavy framed glasses for up to 6 weeks following the surgery.
This allows the framework to heal and the bones to consolidate and stabilise. For those that need their glasses to drive alternative arrangements should be made.
The early days after a rhinoplasty will have swelling of the lining of the nose. This will reduce the quality of smell. As all heals the normal sense of smell will return. The nerves of smell which enter the lining of the nose from above are not affected by rhinoplasty surgery and the sense and quality of smell will recover.
Most patients find quite the opposite and can breathe more comfortably than they could before the surgery. Some patients may experience some mild to moderate congestion in the first 2 to 3 weeks after surgery but this is only temporary.
Secondary, or revision rhinoplasty, is really a reconstructive procedure, even if the prime aim might be for restoration of appearance rather than for breathing and function. The framework of the nose has been disrupted by the primary surgery. That surgery may or may not have healed well, and the reasons for the request for secondary surgery are very important in considering whether a further rhinoplasty procedure should be considered and undertaken.
The assessment and analysis phase, the technical aspects, and the quality of the relationship between surgeon and patient is very important. Once these things are established, there is every reason for secondary rhinoplasty to be a success.
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– Jonathan Britto –
