Hello, my name is Mike Tyler and I'm a plastic surgeon and I work in -- one of my special interest is Rhinoplasty. I'd like to spend a few minutes just talking about what Rhinoplasty is and the different types of Rhinoplasty that you can have, and also the main pains of having a Rhinoplasty operation. Rhinoplasty really is a nose job in common language, and it's an operation that designed to change the size, the shape, and the different angles that the nose has. Broadly speaking, there are two types of Rhinoplasty; one is the Rhinoplasty that could be termed Closed Rhinoplasty. This is an operation where all the incisions are actually done inside the nose, you are not going to have any external scalps; and the other type of Rhinoplasty is where you -- it's called an Open Rhinoplasty.

During an open Rhinoplasty, as well as having some incisions inside the nostrils, you will also have a little incision just running along the bottom of the central anatomy that's called Columella. I'm going to spend a little bit more time talking about open Rhinoplasty because I spend most of my time doing open Rhinoplasty. The reason why I prefer doing Rhinoplasty in an open fashion as opposed to closed is because it gives me great access and I could actually see the aspects of cartilage that I'm trying to move in order to shape the nose in a much better light than during a closed Rhinoplasty when a little bit -- more of the operations are done by a few.

So who is a good patient for an open Rhinoplasty? Well the sorts of things that we do with Rhinoplasty is that we often have to remove a dorsal hump where you have a large part of the nose sitting just here, and that's a very common part of any Rhinoplasty operation to remove a little bit of dorsal. The other things that we often do with Rhinoplasty is to make the tip of the nose just a bit here, a little bit less bump as and we can do that by reducing the amount of cartilage you have got there. And the third common element with lot of Rhinoplasty is just to set the tip, either if the tip is a little bit too low, I mean if you want to lift it up a little sometimes, sometimes if the tip is a little too high you can bring it down.

During a Rhinoplasty, in most Rhinoplasty that we do, we actually take away a little bit of tissue, we take a little bit tissue of the hump, we take away a little bit of tissue on the tip. Some Rhinoplasty operations we do the opposite. We actually put tissue in and the most common areas where we put the tissue in, if you have got a subtle force, and it got too bigger dip here or if you have got various deflection gaps in the cartilage that would give rise to little hollows within the nose and sometimes we use to fill those. We fill those using cartilage either from nose, sometimes we pinch a little bit from the ear and in very severe cases, we sometimes pinch a bit of root cartilage but that's very rare. So we use it with typical patients who would like to have a Rhinoplasty, a lot from, adults usually between some 20 to 50 years of age. Most people who have grave, ever since they were teenagers. So most of my patients come along and tell me they always want to know if it's done.

The best kinds of Rhinoplasty there is the -- a very clear idea of what aspect of the nose they want to change. So I like patients come along and say it's the hump doctor I didn't like or the tip I think is too big, and if I have a definitive target I can then usually surgically change that target. If you come along with an aim to be looking like Brad Pitt if you are a male or Angelina Jolie if you are a female, then it's much more difficult for me to ascertain how I'm going to change that nose. So the key thing when I think about Rhinoplasty is trying to identify which parts of the nose you don't like and articulate that to the surgeon when you come to the preoperative consultation.

During the preoperative consultation, I would be looking for what sort of techniques I'll be needing to employ during the course of the Rhinoplasty. And as I said, the key elements that I'd be looking at is what I have to change on this part of the nose, the dorsum, either if there is a hump you can get through, or if it's very thick in its top, the top part of the nose. Then I'd also have a look on this middle part of the nose and see whether if -- again it's very pointy or very narrow, or it's going to be, whether there is any hollow in there and then I start to look at the tip, and when I look at the tip I look at to see how bulbous the tip is. I also look to set the position of the tip.

Once I have got the position of the tip, I am then looking at the various angles. This angle here between the nose and the lips, the older we get, the more and more obtuse that angle becomes. That's why when we draw elderly patients, we usually draw them with a low overhanging tip on the nose because as we get older that nose starts to drop. If your nose is dropped a little bit too prematurely, then one of the things that I'll be wanting to do is just to reset that tip back off a little bit.

So that would be after we have done the brought outlines of the major aspects of the Rhinoplasty operation, and then look at some of the final points, whether I'd be wanting to do any work around the mid part of the nose and under the sides of the nostrils, whether there is anything else that might be needed. We can then sit down and discuss the risks, working after you go through the course of the operation, what the alternatives are and also the risks, another series of very important part of the preoperative consultation and if you like to know more about that, I'd ask you obviously to contact us. Thank you very much.