Surgical specialty

Nose surgery.

The nose is at once an aesthetic structure and a functional organ — airflow, mucosal physiology, and its proportional relationship to the rest of the face. Nasal surgery is not a matter of placing material on a dorsum; it is work on a three-dimensional structure that demands specialist training.

Why the nose is the most demanding facial procedure.

Among facial procedures, rhinoplasty is widely regarded by specialists as the most technically demanding. The reason is that a few millimeters of cartilage adjustment carries consequences beyond the visible change in shape — it affects airflow, the permanent supporting framework, and the feasibility of any future revision.

For this reason, we do not treat rhinoplasty as a "quick" procedure. At The Gioi Dep, every nasal operation is performed under monitored anesthesia, with a pre-operative anesthesia consult, overnight inpatient observation, and a structured 12-month follow-up schedule.

Procedures.

Structural rhinoplasty →

Reconstruction of the nasal cartilage framework using autologous cartilage (auricular, septal, or costal) to reshape the dorsum, tip, and columella. This approach allows for deeper and more durable correction than techniques relying on synthetic material alone.

Suitable for

  • A flat, short, or asymmetric nose
  • A bulbous, drooping, or deviated tip
  • Revision of an unsatisfactory prior rhinoplasty

Technique

Open approach through a transcolumellar incision for direct visualization; techniques include controlled bony reduction, columellar strut grafting with septal cartilage, and tip refinement with auricular cartilage.

Anesthesia

General anesthesia

Inpatient stay

One-night inpatient

Expected recovery

External splint for 7 days; periorbital swelling and bruising for 10–14 days; final contour settles by 6–12 months

Implant-based rhinoplasty with cartilage cover

Augmentation of the dorsum using a synthetic implant (medical silicone or ePTFE/Surgiform) combined with autologous cartilage at the tip to mitigate implant exposure — a complication associated with synthetic material in thin-skinned areas.

Suitable for

  • A low dorsum with otherwise acceptable tip anatomy
  • A preference for shorter operating and recovery time compared with structural rhinoplasty
  • First-time rhinoplasty patients

Technique

Closed (endonasal) approach; placement of a dorsal implant with auricular cartilage cover at the tip.

Anesthesia

General anesthesia or sedation with local anesthesia

Inpatient stay

Day case or one-night inpatient

Expected recovery

External splint for 7 days; swelling 7–10 days; settles by 3–6 months

Revision rhinoplasty

Correction of an unsatisfactory result from a previous rhinoplasty. Revision is technically more demanding than primary rhinoplasty due to scar tissue and altered anatomy. We require a minimum interval of 12 months from the prior surgery before performing revision.

Suitable for

  • A deviated dorsum after prior surgery
  • Exposed or extruding implant material
  • Tip contracture, alar deformity
  • Airway obstruction following previous rhinoplasty

Technique

Depends on the specific anatomical problem; costal cartilage is often required to rebuild lost structural support.

Anesthesia

General anesthesia

Inpatient stay

1–2 nights inpatient

Expected recovery

Similar to structural rhinoplasty; scar tissue takes longer to settle (12–18 months)

Functional rhinoplasty (septoplasty)

Correction of a deviated septum to improve nasal airflow. May be performed alone or in combination with cosmetic rhinoplasty. This is a medically indicated procedure, not purely cosmetic.

Suitable for

  • Chronic nasal obstruction
  • Snoring related to nasal obstruction
  • A deviated septum from trauma or developmental causes

Technique

Intranasal approach; correction of the septal cartilage and bone without external incisions.

Anesthesia

General anesthesia

Inpatient stay

Day case or one-night inpatient

Expected recovery

Intranasal swelling 1–2 weeks; meaningful improvement in airflow at 4–6 weeks

Materials: autologous cartilage and synthetic implants.

Autologous cartilage (harvested from the patient's own ear, septum, or rib) is the preferred material for areas under load or with thin overlying skin — particularly the tip. Advantages include biocompatibility and the absence of foreign-body reaction. Limitations include the need for a donor-site incision and the possibility of warping over time.

Synthetic implants (medical-grade silicone, ePTFE/Surgiform) avoid a donor site and provide stable dorsal augmentation. However, placing synthetic material in thin-skinned areas (tip, columella) carries a long-term risk of exposure — this is why we do not use synthetic implants in these regions.

The choice of material is a clinical decision made in consultation, based on the patient's anatomy and the goals of the procedure.

Before you decide.

Rhinoplasty is not appropriate for patients with active nasal infection, acute sinusitis, or uncontrolled coagulation disorders. Patients under 18 are generally not candidates for cosmetic rhinoplasty because nasal growth has not completed.

One point to understand: the final shape of the nose only stabilizes after 6–12 months, sometimes longer in revision cases. During this period, the nose passes through phases of swelling, and the tip settles downward as healing progresses. The appearance during the first week after surgery is not the final result.

When will we say "no"?

When a patient's request exceeds what their nasal structure can safely accommodate. When the patient is in a period of significant psychological distress. When prior surgeries have left tissue compromised to a degree that further intervention is not safe.

What a consultation looks like.

  1. Examination, inside and out. Assessment of the septum, turbinates, skin thickness and quality, cartilage resilience.
  2. Airway evaluation. If you have obstructive symptoms, these must be identified before any aesthetic planning.
  3. Discussion of goals. You may bring reference images, but the surgeon will discuss what is achievable given your anatomy — not how to reproduce a template.
  4. Presentation of options. Including technique, materials, procedure-specific risks, and limitations.
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