Episode 8 – Podcast Show Notes

🎙️ Dr Dan Behind the Scalpel – Episode: The Middle Vault

The middle vault is one of the most important — and most commonly misunderstood — parts of the nose. In this episode, Dr Dan explains what the middle vault is, why it is critical for both nasal appearance and breathing, and how failure to support it during rhinoplasty can lead to classic long-term deformities.

🔎 What You’ll Learn in This Episode:

• What the middle vault is and where it sits within the nasal framework.
• Why the middle vault plays a key role in nasal airflow and valve function.
• Common deformities that occur when the middle vault is weakened or disrupted.
• How surgeons reconstruct and stabilise the middle vault during rhinoplasty.
• Why some rhinoplasty patients develop breathing issues or visible deformities months after surgery.

🗝️ Key Notes

• The middle vault is formed by the upper lateral cartilages attached to the dorsal septum.
• It acts as the structural bridge between the nasal bones above and the nasal tip below.
• Damage or collapse of the middle vault can result in:
  • Narrowing of the nasal sidewalls
  • Internal nasal valve collapse
  • Postoperative breathing difficulty
  • Visible contour deformities
• Proper treatment of the middle vault often requires:
  • Spreader grafts to restore width and support
  • Reattachment and stabilisation of the upper lateral cartilages
• A common cause of poor outcomes is:
  • Failure to use spreader grafts, particularly in non-specialist rhinoplasty
• This can lead to the classic inverted V deformity, where the nasal bones remain narrow but the middle vault collapses inward.

💡 Key Takeaway

The middle vault is essential for long-term nasal function and aesthetics. Without proper reconstruction, rhinoplasty can look acceptable early on but fail structurally over time — leading to deformity and breathing problems.

🎧 Listen & Subscribe

Find this episode and more on:

• Spotify
• Apple Podcasts
• Google Podcasts

Follow the show for clear, anatomy-driven explanations of facial plastic surgery from behind the scalpel.

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🔥 Social Media Teaser

Struggling to breathe after a nose job? 👃 Dr Dan breaks down the middle vault, why it collapses, and how skipping spreader grafts can cause the inverted V deformity. Essential listening for anyone considering rhinoplasty.

🎙️ Dr Dan Behind the Scalpel – Episode: Nasal Tip Cartilages

The nasal tip is one of the most complex and delicate parts of rhinoplasty. In this episode, Dr Dan breaks down the anatomy of the tip cartilages, the common deformities that affect tip shape, and the surgical techniques used to refine and support the nasal tip while maintaining long-term function and aesthetics.

🔎 What You’ll Learn in This Episode:

• What the nasal tip cartilages are and why they are critical to nasal shape and support.
• Common nasal tip deformities, including boxy tips, twisted tips, and hanging columella.
• Why some tip deformities are caused by cartilage shape, spacing, or weakness.
• Key surgical techniques used to correct tip cartilage problems.
• The defining features of a beautiful, well-supported nasal tip.
• Common mistakes in tip surgery and how they lead to long-term complications.

🗝️ Key Notes

• The tip cartilages (lower lateral cartilages) are responsible for tip shape, definition, and nostril contour.
• A boxy tip can result from broad cartilages, widely spaced domes, or a combination of both.
• Lateral crural concavity can distort nostril shape and weaken tip support.
• A twisted tip is often due to asymmetry in cartilage orientation or strength.
• A hanging columella is frequently caused by imbalance or malposition of the tip cartilages.
• Tip correction techniques include:
  • Lateral crural tensioning
  • Tongue-in-groove fixation to the columella
  • Flip-flop flap for cartilage concavity
• A beautiful nasal tip features:
  • A clear supratip break
  • A strong tip-defining point
  • Everted nostril rims, created by lower lateral cartilage eversion or rim grafts
• Common causes of poor outcomes include:
  • Failure to use a septal extension graft
  • Over-tight dome-binding sutures leading to nostril retraction and distortion

💡 Key Takeaway

The nasal tip is where rhinoplasty success or failure is most visible. Precise cartilage support and thoughtful technique are essential to achieving a refined, stable, and natural-looking tip.

🎧 Listen & Subscribe

Find this episode and more on:

• Spotify
• Apple Podcasts
• Google Podcasts

🎙️ Dr Dan Behind the Scalpel – Episode: How to Choose the Right Surgeon

Choosing a surgeon is one of the most important decisions you’ll ever make — whether it’s for yourself or a loved one. In this episode, Dr Dan shares his insights on what really matters when deciding who should operate on you. From formal qualifications to soft skills like trust and communication, this guide gives you the confidence to make an informed choice.

🔎 What You’ll Learn in This Episode

• Why your surgeon must hold a qualification from a recognised College of Surgeons.

• The importance of being a Fellow of the Royal Australasian College of Surgeons in Australia.

• Why comfort and trust with your surgeon matter just as much as technical skill.

• How fellowship training provides additional expertise in complex procedures.

• The right way to ask: “How many of these procedures have you actually done?”

• How surgeons can (and should) measure their outcomes, from metrics to before-and-after photos.

• Why it’s perfectly okay — even encouraged — to seek a second opinion.

🗝️ Key Notes

• Always check for accredited surgical training — don’t assume every “doctor” is a surgeon.

• The Australian training program is among the toughest worldwide.

• Extra fellowship training is especially valuable for complex or delicate surgeries.

• Numbers matter: ask how often your surgeon performs the procedure you need.

• A good surgeon should welcome your questions and never pressure you into surgery.

💡 Key Takeaway

The right surgeon is qualified, experienced, and — most importantly — someone you feel comfortable with. If you don’t, it’s always worth getting another opinion.