Sydney ENT and facial plastic surgeon Dr. Michael Zacharia answers the questions a patient needs to ask to obtain the best possible rhinoplasty.

Doing rhinoplasty, I regularly find myself faced with revision surgery - correcting faulty procedures from other surgeons. Rhinoplasty is very difficult surgery and it's understandable that it may not always be perfect the first time. I've done 200 rhinoplasties in training and now perform 100 a year. They make up about 50 per cent of my work. This is challenging work so you don’t want someone who has only done one or two.

So if you're contemplating rhinoplasty, here are some of the questions you need to ask - and the answers you do and don't want to hear.

What sort of surgeon is preferable?

I believe that ideally you want an ear, nose and throat surgeon with training in facial plastic surgery. Someone who only has experience in plastic surgery can make your nose look more beautiful but they may not have any idea of the internal function of the nose. There is no point in having a good-looking nose if you can't breathe through it.

Which approach is preferred? Internal or external?

My partner at our clinic does most of his operations externally; I do most of mine internally. It depends on what each surgeon prefers. External approaches are for difficult noses or revision noses where you need to see everything that is going on so you can fix it up - so if you think that is your problem, you might want to ensure you will receive external surgery.

What about computer imagery?

This is essential to temper inappropriate expectations. I show people what I can do for them rather than what they want to see. With a lot of the revisions I do, I find the doctor has never shown the patient their face on screen or explained to them exactly what is going to happen. Digital imagery is excellent for that. It's very realistic and you can be gratifyingly accurate.

What if you suspect the surgeon is offering you an unrealistic prognosis?

Probably the most common erroneous claim a surgeon makes is telling a patient who has a big tip to the nose that they can make it into a neat little tip.

Treating tips of noses can take a very long time. I saw a patient recently who had her surgery done 18 months ago and is only now starting to see shape to the tip of the nose.

Cosmetic surgery patients may have huge expectations and we have to make them realistic. If you have a 1/10 nose, you’re never going to have a 10/10 nose. It is realistic to hope for a 5/10.

Do you get the impression the surgeon is being totally honest with you?

The surgeon shouldn't just tell you what you want to hear. They should warn you that recovery might be slow, that you may need a touch-up operation and that if you have an asymmetric nose it may remain crooked.

Crooked noses are the most difficult to treat successfully because cartilage tends to have a memory and wants to go back the way it was. So you might have a beautiful nose after the operation but down the track it might start to bend a little bit. Also, the best bone and cartilage you get is that provided by Mother Nature. It is perfectly smooth. After surgery, you might get some bumps. And patients should also be warned that immediately after surgery, they might find their breathing pattern is affected.

Do you feel comfortable with your surgeon?

If you don't, then walk away. If you're not comfortable, you won't communicate and you won't get the results you want.

BEFORE	AFTER rhinoplasty and chin implant with Dr. Zacharia

BEFORE	AFTER rhinoplasty and chin implant with Dr. Zacharia