Rhinoplasty is typically performed with either a combination of local anesthesia and sedation or with general anesthesia. The incisions of latest rhinoplasty are often made inside of the nose, which is referred to as ‘closed rhinoplasty’, though an external incision made on the underside of the nose is sometimes required, which is referred to as ‘open rhinoplasty’. No visible scarring results from closed rhinoplasty, while open rhinoplasty will result in a well-concealed, fine-line scar. Open rhinoplasty is often preferred in more complicated cases. One the incisions are made, nose skin is being taken of or will be separated from the bone and cartilage, which is then reshaped and sculpted to create a new framework and refined appearance. Skin will then be redraped over the framework and the incisions are sutured closed. The surgery typically takes between one and two hours to complete, though more complicated procedure can take longer.
After rhinoplasty, the nose is bandages and a small cast is applied. The cast will remain in place for the first week. The stitches are removed within one to two weeks. Swelling and bruising is common, most of which subsides within the first month. Some discomfort may also occur and this can be controlled with pain medication. Most patients find that they can return to work within one to two weeks after rhinoplasty surgery, though more strenuous activities should be avoided for two to three weeks and sunburn should be avoided for eight weeks. Full healing from rhinoplasty surgery can take a full year. This is the amount of time needed for all of the swelling to fade, though it is typically not noticeable after the first month, and for the final result to be achieved.
The potential complications that can occur with rhinoplasty include adverse anesthesia reaction, infection, nosebleed, small burst blood vessels on the skin, and the need for additional surgery.
Several changes to the nose’s appearance can be achieved with rhinoplasty, including an overall increase or reduction in size, removal of a hump, a change in the shape of the tip or bridge of the nose, a change in the angle between the nose and upper lip, and a narrowing of the span of the nostrils. The best candidate for rhinoplasty is a man or woman who is physically healthy, realistic in their expectations and looking to improve the appearance and/or function of the nose. It is generally recommended that surgery be postponed until children have finished growing, around the age of fifteen for girls and eighteen for boys, as continued growth of the nose can alter the results achieved through surgery.
Rhinoplasty henceforth applies to patients who have a post-traumatic deformity of the nose or a blocked nasal airway or both. Medicare has not yet provided guidelines for assessing the airway. A history of blockage confirmed by the referring doctor’s letter of referral is likely to be acceptable. A new item numbe total rhinoplasty for significant developmental abnormality, has been added to the Medicare schedule. Full clinical details, including photographs taken before and after treatment, are to be lodged with Medicare for consideration. Medicare increased benefits on 1 November 2000 by 1.2%, well short of the annual inflation rate, September 1999 to September 2000 of 6.1%. Therefore, the gap between a surgeon’s fee and the Medicare rebate will continue to increase.
Medicare increased benefits on 1 November 2001 by 1.6%, again well short of the 6% inflation rate it recognised by indexing up the government’s out-of-hospital gap by 6%. Through the effects of cumulative interest Medicare rebates are falling way behind common fees.
The 85% rebate applicable to procedures done out of hospital was eliminated for 1,400 item numbers. Rhinoplasty with grafts, 45641, is one such number so benefits may not be paid if the surgery is done in the office procedure room. This change impacts on patients who have no private medical insurance. We are hoping that the 75% in hospital rebate can apply but the Medicare spokesman did not know if it could or not. Mayne Group Limited signed an agreement with Affinity Health, a consortium comprising Ironbridge Capital Pty Limited, CVC Asia Pacific Limited, GIC Special Investments Pte Limited and Mayne’s Hospitals management (the Buyers), for the sale of its entire Hospitals business in Australia and Indonesia. This includes Castlecrag Private Hospital, our Thursday and Friday venue.