Consultant ENT and Rhinoplasty Surgeon
Mr Michael Tsounis is an experienced, qualified Head & Neck Surgeon with a special interest in Facial Plastic & Reconstructive Surgery. His expertise is Functional and Cosmetic Rhinoplasty and he has been trained in this field in leading academic medical centres of London, Nottingham and Amsterdam. He is an active member of the European Academy of Facial Plastic Surgery and the European Rhinologic Society and he holds a PhD in Otorhinolaryngology. He is comfortable in both ‘open’ and ‘closed’ approaches thus maximising his aesthetic achievements as well as his ability to correct potential deviations of the nasal septum that can give rise to symptoms of snoring and sleep apnea. Mr Tsounis’ philosophy in Rhinoplasty is to create a natural nose, which is in harmony with the features of each individual face and which can at the same time function and breathe properly.
In-depth consultations directly with an NHS trained consultant surgeon
Surgeon-led and managed care throughout for a truly personalised approach
Walk in and walk out the same day with anaesthetic techniques adopted from the USA
Comprehensive aftercare programme
Financing options available
Call us on 020 7993 4849 / 0900 – 1730 Mon – Fri
Rhinoplasty, or nose reshaping, is one of the most commonly performed procedures in the UK today.
Why have a rhinoplasty in London?
Traumatic injuries of the nose: Slips, trips and falls are common causes of injuries to the nose. To correct deformities to the nose, rhinoplasty will be required to restore the structure of the nose. The latest surgical techniques are used to perform rhinoplasty surgery.
Aesthetic: the nose plays a major role in balanced facial aesthetics. For patients who are unhappy with their nasal structure, this can be corrected with a rhinoplasty procedure.
Airflow through the nose: Many patients experience problems with breathing through their nose and depend heavily on mouth breathing. Both plastic surgeons and ENT surgeons have specialist expertise in correcting the airflow pathways of the nose. A rhinoplasty procedure can be performed with surgery of the partition of the nose (septoplasty) to address airflow problems.
Rhinoplasty is a continually evolving operation, but the fundamental philosophy and principles have not changed dramatically over recent years. Advances have been made in the refinement of rhinoplasty through a better understanding of nasal analysis, anatomy, function and long-term postoperative healing. Novel surgical manoeuvres and techniques have also been developed that improve the long-term results of rhinoplasty from both aesthetic and functional standpoints. Furthermore, technological advances in computer imaging and innovative surgical tools have widened the choices available to the surgeon performing rhinoplasty.
Aesthetic surgery of the nose is considered to be the most challenging, rewarding and humbling of all cosmetic surgery procedures. Every rhinoplasty operation presents the surgeon with a diversity of nasal anatomy, contours and proportions, requiring a series of organised and interrelated surgical manoeuvres tailored to each patient’s anatomical and functional needs. The surgeon controls the operation and must also become skilled at manipulating and controlling the dynamics of postoperative healing to attain optimal long-term aesthetic results. A necessary prerequisite is the skill to visualise the ultimate healed outcome while modifying nasal structures.
Such skills require many years of study and experience as the surgeon observes, analyses, and modifies his/her surgical results. With the improved methods of analysis and the increased popularity of open (external) rhinoplasty, surgeons may be able to perform precise rhinoplasty techniques under direct visualisation. The key to continuous improvements through experience is accurate record-keeping using diagrams couples with long-term patient follow-up and evaluation.
The unique anatomy of the nose is the critical factor influencing the final result of each individual rhinoplasty procedure. Differences between individuals in nasal anatomy demands refined diagnostic skills to identify the infinite variety of problems that could be encountered. The aesthetic judgement of the surgeon guided by patient expectation, determines the surgical changes planned. No single procedure or technique will suffice to reconstruct every nose in an aesthetically pleasing fashion. Therefore the surgeon must be skilled in many different approaches to handle the wide range of nasal anatomical combinations. The ability to identify correctable deformities and limitations inherent in each patient exists as the single most critical prerequisite to attainment of outstanding results on a consistent basis. Misguided attempts to create changes greater than the tissues will permit, will result in aesthetic and functional complications resulting from overaggressive resection of supportive structures.
Our surgeons utilise the most advanced contemporary and innovative techniques from top centres in Belgium and the USA. In approximately 20% of all patients, the side profile may reveal facial imbalance with a small chin, we may then advise the use of a chin implant to restore balance to make a good result into a fantastic result. Rhinoplasty is considered technically the most challenging cosmetic surgery of the entire body, a great looking rhinoplasty requires a balance of patient’s genetic makeup and healing, surgical technical excellence and the surgeon’s artistic talent.
Many patients who come to see our facial surgeons are concerned about recovery after surgery and downtime. We advise all patients, 1-week off work is all that is required, for some patients 2-weeks is preferred as by this point the majority of swelling has gone down. We employ fine microsurgical techniques to preserve the nasal cartilages and ensure minimal disruption to the natural anatomy of the nose to reduce swelling and bruising. Most of our patients have minimal or no bruising after surgery and most do not require analgesia after surgery.
Rhinoplasty is an day-case procedure performed under anaesthesia with IV sedation or general anaesthesia. The procedure may be performed as an open (small skin incision under the nose) or closed (internal incisions) approach. The procedure takes between 1-2 hours and afterwards a splint is placed on the nose that remains for 1-week. Sculpting and reshaping the nose is a challenging procedure as every nose is unique in skin type and thickness, strength and size of the underlying cartilages and bony support. In addition each nose presents different functional breathing issues, commonly with deviated septum and enlarged turbinates. Our facial surgeons use both open and closed techniques, although the closed technique is preferred as there are no incisions in the skin. For some noses, particularly where delicate surgery of the tip that requires millimeter refinement, the open technique is preferred as this gives the best long-term result. We use suture and micro-refinement techniques to maximise tip refinement. We also use the most innovative facial plastic surgery techniques to maintain functional breathing that may involve the use of fine grafts that support the airway of the nose preventing potential collapse. Our surgeons are acknowledged experts in rhinoplasty and take an active interest in researching the latest techniques to keep their skill-sets up to date in the rhinoplasty field.
Rhinoplasty surgery can be performed in a number of different ways: the base of the nose can be narrowed, humps on the bridge can be removed, correcting flared nostrils or even refining the tip of the nose. Whether you choose to have a rhinoplasty because of aesthetic reasons, previous trauma or airflow problems – there are some fundamental pre-requisites to make sure you get the best possible outcome from your rhinoplasty procedure.
- Patients must be over the age of 18
- Healthy – physically and mentally
- A non-smoker
- Realistic expectations of what can be achieved
- Aware of the recovery process and the temporary period of soreness and discomfort which will develop after the procedure
To find out if a rhinoplasty procedure is appropriate for you, please fill out the information box below to learn more. Alternatively, please proceed straight to our innovative online suitability assessment to get a personalised response within 24 hours.
You will initially be reviewed by a plastic surgeon or head and neck surgeon experienced in rhinoplasty surgery. Your ideas, concerns and expectations will be fully discussed in order to understand what rhinoplasty involves. You will have an opportunity to ask questions about all aspects of the procedure.
The rhinoplasty assessment:
- A full history and examination will be performed
- Explain what the rhinoplasty surgery involves
- The surgeon will offer his/her professional opinion of what can/cannot be done to achieve the ideal aesthetic outcome
Rhinoplasty surgery is ideally suited to be performed on a day-case basis. Our well-equipped day surgery units (DSUs) are staffed by highly experienced nurses to make your experience as comfortable and anxiety-free as possible. The latest anaesthetic techniques mean you will be able to recover either at home or at one our partner hotels.
The structure of the nose varies in different ethnic groups. Those of Caucasian origin will have more defined characteristics while other groups such as those of Asian origin will have greater width to the base of the nose. The skill of the surgeon rests in restoring the contours of the nose to be in harmony with the face as a whole to create a natural appearance.
Our anaesthetic team have special expertise in anaesthesia for day case rhinoplasty surgery. Twilight anaesthesia is one of the most advanced techniques available today. Please read more about anaesthesia on the side bar located on the right side of this page. The rhinoplasty procedure on average, takes about two hours excluding anaesthesia time.
Closed rhinoplasty vs open rhinoplasty.
- closed rhinoplasty – cuts will be concealed inside the nose
- open rhinoplasty – a small incision is performed on the area at the inferior aspect of the nose between the nostrils. This area is called the columella
After you are asleep, the bones of the nose and the cartilaginous areas will be exposed. This allows the rhinoplasty surgeon to use specialist instruments to shape the nose. Some procedures may require the use of cartilage taken from other areas of the body such as the back of the ear or even from a very small area of the ribcage. This is required for the extra support to maintain the structure of the nose. Air flow issues are corrected by ensuring the septum of the nose is straightened up. Tiny stiches will be used to close up any incisions that were made. A special packing material will be placed to eliminate the risk of bleeding, and a splint is worn for one week to facilitate proper healing. You will be discharged the same day and you can rest at either one of our partner hotels or in the comfort of your own home providing you have a responsible adult with you for at least 24 hours. Our medical team will phone you the next morning and you will see the surgeon one week later for removal of the splint. There will then be subsequent follow up appointments to monitor your healing and progress.
After your rhinoplasty procedure, there will be bruising and swelling. In particular, the lower eyelids may look particularly bruised. This is normal and will subside with time.
To minimise the impact of the bruising and swelling, you should lie with head up in bed on a few pillows. We also highly recommend our patients to apply ice packs for the first 48 hours following the surgery. Other top tips include:
Avoid bending and heavy lifting
Avoid bumping the nose
Avoid gym activities for 2 weeks
Avoid showering – take a bath instead
Avoid blowing your nose
Avoid hard-to-chew foods for the first week or two
Avoid glasses for six weeks after surgery
Avoid excessive smiling or laughing
Avoid high sun exposure in the first several months following the surgery as skin on the nose will be prone to sunburn
Sleep promotes healing so take naps when you need to
How do I get the best outcome from rhinoplasty surgery?
Smoking impairs healing and so you should aim to stop smoking at least one month prior to rhinoplasty. Medicines which thin the blood should also be stopped – you should consult your GP if you have any concerns about your health. You will be required to wash with a special antiseptic solution prior to surgery to minimise the risk of infection.
Am I an ideal candidate for rhinoplasty surgery?
You must have realistic expectations of what can be achieved with rhinoplasty surgery. Your health should be optimal and you must be at least 18 years of age. Performing rhinoplasty on the still growing facial skeleton can impair the results.
What does the rhinoplasty procedure involve?
A closed rhinoplasty or open rhinoplasty can be performed. An open rhinoplasty is better for correcting tip deformities and revision rhinoplasty surgery. The closed rhinoplasty technique is better for correcting hump deformities and the healing is generally quicker. Rhinoplasty surgery is one of the most commonly performed procedures at Centre for Surgery.
How long does the procedure take?
The procedure can take up to two hours for completion while a revision surgery can take up to two and a half hours.
Can I leave right after the surgery is completed?
You will be discharged on the same day after the effect of anesthesia wears off and you can rest at either one of our partner hotels or in the comfort of your own home providing you have a responsible adult with you for at least 24 hours.
What is the rhinoplasty healing period like?
A nasal splint similar to a plaster cast will be applied to your nose and this must be worn for one week before being removed in the clinic. This ensures healing can proceed in an optimal manner and also to protect your nose from any potential knock and further injury. Bruising should start to resolve after two weeks but swelling can last for up to four weeks. The definitive appearance should start to become apparent between six months to one year after the rhinoplasty procedure.
Can I take medications or herbal remedies to speed up the healing?
Surgeons at Centre for Surgery can prescribe pain medications and antibiotics to prevent infection, but other medications may complicate your aftercare. We advise our patients to consult with their surgeon before taking any medications. As for herbal remedies, it is best to avoid herbal supplements before as well as after surgery as they their safety and purity are unregulated by the FDA.
What results can I expect from the surgery?
Although initial swelling will subdue within a few weeks and you will start seeing gradual changes in the appearance of your nose, but it could take up to a year to see the final results of the nose-reshaping surgery.
What are the risk of rhinoplasty complications occurring?
Rhinoplasty complications are uncommon. Potential complications with rhinoplasty include bleeding, wound breakdown, dorsal bridge depression, nasal airflow problems and surgical site infection. Our day surgery units are specially equipped for the performance of rhinoplasty surgery that is both safe and effective. Rhinoplasty complications are minimised through meticulous preparation and pre-operative planning by the surgical team.
Are there things I need to avoid after the surgery?
As you will experience certain degree of swelling and bruising you should avoid excessive physical activities for at least 2 weeks. If you wear glasses, we recommend not to wear it for 6 weeks following your surgery to gain the best outcome. Also avoid smoking and high exposure to the sun as it will slow down the healing process.
I want revision surgery, how long do I need to wait after my initial surgery?
After your first nose-reshaping surgery, it is ideally recommended not to have any further work done for 12-18 months so that favorable outcome can be achieved after a revision surgery. However, seldom waiting for a whole year could worsen the nasal framework and make the correction harder. Hence, the waiting period between your first and revision surgery must be carefully decided by you and your surgeon by looking at the result that was achieved and your expectation.
I have breathing problems, can I still opt for a nose-reshaping surgery?
Yes, certain breathing problems caused by crooked or pinched nose can be cured with nose-reshaping surgery and it can help improve both appearance and functionality of the nose.
I have very thin nasal skin, will that affect the results I can achieve?
Thin-skinned patients are regarded as the most challenging type of people for the nose-reshaping procedure as imperfections can be very visible. Nevertheless, you can still achieve satisfactory results with meticulousness and precision when contouring the nasal framework.