Who Nose About Rhinoplasty? An interview with Dr Terrence Scamp

Rhinoplasty interview with Dr Terrence Scamp

Trish Hammond: I’m really excited. I’m here today with Dr. Terrence Scamp on the Gold Coast. He’s from Esteem Medi Spa and Dr. Scamp is without a doubt one of my favourite plastic surgeons, so that’s why I like to choose him for some of my procedures as well. Welcome, Dr. Scamp.

Dr Terrence Scamp: Hello there, Trish. How are you?

Trish Hammond: I’m really good, thank you.

Dr Terrence Scamp: That’s great.

Trish Hammond: We’re going to have a little chat today about rhinoplasty, with me getting a few queries from consumers. I thought we would just talk to someone about it so we can answer all the consumer questions so thank you for sharing your knowledge with us today.

Dr Terrence Scamp: Sure, that’s great.

Trish Hammond: Lovely. Now, with rhinoplasty surgery, I know there’s lots of different techniques but is it a different thing for different person, or is it basically one technique for everyone? Tell us a little bit about it.

Dr Terrence Scamp: It’s about matching the nose to the face. We look at two things. How well the nose works. Can they breathe okay? Try to optimise that. Then we look at the shape of the nose, ask somebody what they don’t like about their nose, look at the features of the nose, look at the features of the face, and that brings in things like their racial background and we try to build a nose that’s in harmony with the face.

Trish Hammond: Yeah, great. I actually had a nose job myself about 20 years ago. I went into my plastic surgeon in Adelaide, and I said to him, “This is what I want. I want the little ski dip on the end, the nice skinny nose.” And he was like, “No. No way. I’m not doing it because you’re Italian, you’ve got a Roman nose. You still have to keep that same …”

Dr Terrence Scamp: Exactly.

Trish Hammond: So that’s what you mean?

Dr Terrence Scamp: Yeah. That’s exactly what I mean. That small little doll nose works fine on a scant Scandinavian, for example, but on a Mediterranean, Slav, Eastern European, they have a different bone structure to their face so the nose that looks right on their face is not the nose that looks right on somebody else’s face.

Trish Hammond: Yes, and I have seen those situations where people have gotten exactly what they wanted and it might not have been the right thing and it just looks weird.

Dr Terrence Scamp: Yeah. If the nose looks out-of-place then it’s a bad operation. What I want to hear most from my patients is that nobody’s said anything. In other words, the nose is so harmonious with the face that no one tweaks to the fact that there’s been a change at all.

Trish Hammond: You just look better and no one can tell why.

Dr Terrence Scamp: Yeah. Exactly, because when we look at a face, we don’t look at the nose first of all. In fact, we don’t look at the nose much at all. We only look at the nose if it’s a distraction. In other words, we’re looking at someone’s eyes as we talk to them. If the nose is twisted or out of proportion or a bad shape then we get distracted by … What we want is a nose that we don’t even become aware of.

Trish Hammond: Yeah, of course. I’ve heard of a couple of different techniques like the open and the closed. What does that mean?

Dr Terrence Scamp: With the open technique there’s this small scar across the columella, the bridge of skin between the nostrils. With the closed technique it’s all done through cuts on the inside of the nose. These days I think most rhinoplasty surgeons, the vast majority prefer the open technique because they can then expose the structures of the nose. They get a very good idea of what they look like and they’re often asymmetric and try to build something that is as symmetric as possible, and just have more control over the final result.

Trish Hammond: Okay. I know that things change over the years, but how has the classic rhinoplasty changed in the last 50 years or so?

Dr Terrence Scamp: Historically, the operation was developed to make the very large nose small and the initial techniques we would now regard as extremely destructive, where they were taking out big chunks of bone and cartilage and trying to create something that sort of really wasn’t meant to be there. These days we are thinking about the airway as well and we’re trying to leave a structure there that will support the skin of the nose and age well so it still looks good years and year down the track and people can still breathe well. I guess above all else, we want a nose that looks like it’s never had an operation.

Trish Hammond: Yeah, right. I look at my before … Well, actually, in those days, 20 years ago, I wasn’t really big on taking photos. After I had my nose done, when he first took the nose thing off I couldn’t believe it. I just looked like someone else. But then after a couple of months, I thought, “Oh my God, there’s no difference to my nose.” I held a before photo compared to now and there was such a big difference but I couldn’t tell because my nose still looked like me.

Dr Terrence Scamp: Yeah. That’s the real key. It should be in harmony. With an Italian ancestry, you want a strong bridge line, a well shaped tip, and a nose of a reasonable size to match the full cheek bones and the full jawline that you usually see with a Mediterranean face. You don’t want to build something that’s tiny and small. Part of that is the fact that we’re changing the structures of the nose and we’re relying on the skin to shrink and fit that shape. Skin of the nose, it doesn’t want to shrink much at all. Therefore, if we try and build a nose with structures that are too small you just kinda end up with this bag of skin with no shape. You’re much better off to have a nose with a good shape that’s a little bit larger.

Trish Hammond: That’s so true. That’s kind of what I ended up with. I don’t have a small nose at all, but it’s smaller than it was.

Dr Terrence Scamp: Yeah, and I guess the other side of the coin is with the Asian nose these days. That’s a nose where you’re usually trying to enlarge it, project the tip more, create a stronger bridge line. Historically, that’s been done with nasal implants for more than 30 years. The issue with them is they don’t age that well. As the years go by you start to see the edges of the implant and they often rotate a bit to one side. These days with the Asian nose, and with some others as well there’s a nonsurgical alternative where we use the same sort of injectables we put in lips and cheeks to build the shape of the nose that we’re trying to achieve. The nice thing about it is these injections into the nose, they tend to last about one to two years, so it’s not something you have to do too often.

Trish Hammond: So you can do it for someone who’s got a nose that’s too big, but also there’s some treatments for people who’ve got a nose that’s too small or looks smaller on the bridge as well.

Dr Terrence Scamp: Yeah, that’s right. We can build a nose up as well as bring it back. We usually do both. There are parts of the nose where, in most people’s cases, where we want to build it out a little and on the other hand there are bits of the nose we want to make smaller.

Trish Hammond: Yeah, of course. Someone comes to have a … They have a consult, they decide they’re going to have a nose job, you work out what’s going to happen for them, from there is it a day time procedure or do you have to stay in the hospital over night?

Dr Terrence Scamp: Well, firstly, in the consult itself we use the Vector 3D to give them an idea of the changes that we want one to create there. It helps to elate a lot of fear and anxiety. They’ve got a good idea of what I’m trying to achieve before I start. The operation itself, it’s done as a day patient under a general anaesthetic. I think what surprises people most is that it’s not a painful operation. When you bump the nose it hurts a lot, but when you happen to have an operation, firstly, once you’re asleep we put a lot of injections in to make the nose numb and that keeps it numb for about 12 hours. The operation itself makes the nose a bit numb for about six months, feels a bit weird there. The upside of that is you don’t tend to have much pain at all. You do, however, have a splint on the nose for a week and you often get black eyes that hang around for about ten days. At a week I see the patients and I take the splint off, but they’ve usually got some bruising around their eyes. Some bruise a little, some bruise a lot. That’s a bit unpredictable.

Trish Hammond: That’s true. When I had mine done, I had it done on a Thursday and I was back at work on a Monday and I had this splint on my face and people thought I was in a car accident. I was like, “Okay, yeah.”

Dr Terrence Scamp: And when the splint comes off people see a change, but they don’t see the final result. It takes about a year for things to shrink and form to the shape that they’re going to be.

Trish Hammond: Oh, okay, so I was gonna ask how will my nose look over time. You reckon after about a year it will kinda be where it’s gonna be or does it grow? Someone told me that it grows continuously, but that’s not true is it?

Dr Terrence Scamp: No. What you see at a year is reasonably stable. As we age, the skin in the upper part of the nose often becomes a bit more thin, whereas the lower part of the nose looks a bit more heavy. By a year after the operation you’ve got a pretty good idea of how the nose is going to be. If you end up making any alterations again, which we do in something less than 10%, we always wait a year to see how the nose evolves.

Trish Hammond: Yeah. The person having the surgery, will they need any help at home or is it the sort of surgery that it’s not really that … I know for example with a tummy tuck or a breast reduction you might need some help for a few weeks at home, but with a nose job you don’t really, do you?

Dr Terrence Scamp: No. With the nose job they just need someone to pick them up from the day theatre and stay with them for the first night, then after that they can putter around the house and take care of themselves. They don’t have a lot of pain, they’re not mechanically disabled, they just need to take it easy.

Trish Hammond: You’re absolutely right with what you said. Everything’s fine until someone bumps your nose. If you got little babies as my son was a baby at the time, and you pick him up, if they bump your nose you certainly know about it.

Dr Terrence Scamp: Yeah. That would be most uncomfortable. [crosstalk 00:11:35].

Trish Hammond: Sorry.

Dr Terrence Scamp: It takes about six weeks for the bones of the nose to heal. We get people to be careful during that period of time.

Trish Hammond: Okay. Just one last question. Risk and complications, can there be any? If so, what are they?

Dr Terrence Scamp: Yeah. There’s risks in any operation. The most common ones are bleeding and infection. With bleeding, it’s really important that people don’t take anything for two weeks prior or even after the operation that makes them bleed. Things like aspirin, cold and flu pills, that sort of thing because if they bleed they may have to go back to theatre to stop that. Of course, the less they bleed, the less they bruise and the faster they look presentable.

Infection in the nose is fortunately quite rare. It can be quite nasty if it gets into the cartilage or the bone and we give them a dose of antibiotics into their vein as they go off to sleep. I guess the overall restriction is the one thing we can’t control well is the skin. We rely on the skin to shrink and fit the new shape. Often skins don’t do what we want. Some skins are too fine and they show every little bump and dip and there are always little bumps and dips there. Some skins are too thick and they just won’t shrink down to fit the shape we’ve built, which is a bit frustrating.

Trish Hammond: Yeah, of course. It makes so much sense. Well that’s been fantastic. I will actually just ask you one more question, if you don’t mind. There’s some situations where someone might need some help with the breathing side of their nose and while they’re at it they think, “I might as well just have that bump removed on my nose.” How does that work? Does that mean they’d be covered? They may have some Medicare coverage with the surgery or …

Dr Terrence Scamp: Yeah. There’s a Medicare item number for work on the septum, which is commonly done to improve the breathing. There’s also one for reshaping the nose after trauma to the nose. They’re the two situations in which there’s an item number that can be used for these operations.

Trish Hammond: Yeah. That at least helps with the hospital side of it, as well.

Dr Terrence Scamp: Yeah, it helps. Yeah, that’s for sure.

Trish Hammond: Well thank you so much. That’s been really, really helpful. Hopefully I’ve asked all the questions that have been asked in our group.

Dr Terrence Scamp: That’s great. You’re most welcome.

Trish Hammond: Thanks for your time. Ladies and gentlemen, if you’re out there and you’re looking for a rhinoplasty surgeon on the Gold Coast or if you’re wanting to travel to the Gold Coast, you can get in touch with Dr. Terrence Scamp at the Esteem Medi Spa or you can drop us an email at [email protected]. Thank you so much.

Dr Terrence Scamp: Thank you.

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