Episode 12– Podcast Show Notes

🎙️ Dr Dan Behind the Scalpel – Episode: Making a Bent Nose Straight

A crooked or bent nose is one of the most common reasons patients seek rhinoplasty. In this episode, Dr Dan explains why noses become bent, the structural principles behind straightening them, and why achieving a “perfectly straight” nose isn’t always realistic.

From congenital asymmetry to trauma from contact sports, this episode breaks down how each third of the nose is surgically corrected — and what can go wrong long after surgery.

🔎 What You’ll Learn in This Episode:

• The two main causes of a bent nose: facial growth asymmetry and trauma.

• Why the nose often bends toward the smaller side of the face.

• How trauma from sports like rugby, AFL, boxing, and league can distort nasal bones.

• The surgical principles behind straightening each third of the nose.

• Why perfection doesn’t exist when it comes to facial symmetry.

• What causes noses to deviate again months after surgery.

🗝️ Key Notes

• No human face is perfectly symmetrical — the nose sits in the centre and often reflects that imbalance.

• A bent nose can result from:

– Congenital facial asymmetry

– Trauma causing displaced nasal bones and cartilage

• Straightening the nose typically requires an external (open) rhinoplasty approach.

• Treatment of each nasal third:

– Upper third (nasal bones): Osteotomies to reposition and realign bone.

May involve double, triple, or quad-line osteotomies for controlled fracture patterns.

– Middle third: Spreader grafts extending from nasal bones to tip to create a cantilevering stabilising effect.

In congenital bends, a double spreader graft may be required on one side.

– Lower third (tip): Septal removal and replant (septal replantation) to create a new straight foundation.

Tip cartilages are then secured to the reconstructed septum to maintain alignment.

• A perfectly straight nose does not exist — the goal is improvement, not perfection.

• Late deviation can occur due to:

– Differences in soft tissue tension between facial sides.

– Ongoing muscular pull.

• Post-operative nasal massage plays a key role in maintaining long-term alignment.

• In select cases, a K-wire may be used for additional structural support.

💡 Key Takeaway

Making a nose straight isn’t about forcing symmetry — it’s about rebuilding the nasal framework so it sits in better balance with the face. Long-term success depends on structural reconstruction, patient expectations, and careful post-operative management.

Episode 11 – Podcast Show Notes

🎙️ Dr Dan Behind the Scalpel – Episode: Treatment of the Nasal Tip

Treating the nasal tip is one of the most technically demanding aspects of rhinoplasty. In this episode, Dr Dan explains how surgeons approach tip correction, the principles that guide decision-making, and why long-term support is far more important than simply reshaping cartilage.

🔎 What You’ll Learn in This Episode:

• The goals of nasal tip treatment in rhinoplasty.
• Why structural support is essential for long-term tip stability.
• Common techniques used to refine and reposition the nasal tip.
• How tip support affects both appearance and breathing.
• Mistakes that can lead to tip distortion over time.

🗝️ Key Notes

• Successful tip treatment focuses on support, projection, and rotation, not just narrowing.
• Weak or poorly supported tip cartilages can lead to:
  • Tip droop
  • Loss of definition
  • Nasal obstruction
• Common techniques used in tip surgery include:
  • Tongue-in-groove fixation to control projection and rotation
  • Lateral crural tensioning to refine shape and improve support
  • Cartilage grafting where native support is insufficient
• Over-reliance on tight sutures without structural support can cause long-term distortion.
• A stable nasal tip requires careful integration with the septum and middle vault.

💡 Key Takeaway

Treating the nasal tip is about building a stable framework first. When support is prioritised, refined tip shape and long-lasting results naturally follow.

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🔥 Social Media Teaser

The nasal tip can make or break a rhinoplasty 👃 Dr Dan explains how surgeons treat the tip, why support matters more than sutures, and how to avoid long-term distortion. Essential listening for anyone considering nose surgery.

Episode 10 – Podcast Show Notes

🎙️ Dr Dan Behind the Scalpel – Episode: Treatment of the Middle Vault

The middle vault is a critical structural component of the nose and one of the most common sources of functional and cosmetic failure in rhinoplasty. In this episode, Dr Dan focuses on how the middle vault should be treated surgically, why reconstruction is essential, and what happens when it is overlooked.

🔎 What You’ll Learn in This Episode:

• The surgical goals when treating the middle vault.
• Why the middle vault must be reconstructed after rhinoplasty.
• Techniques used to stabilise and support the middle vault.
• How middle vault treatment impacts nasal airflow.
• Common errors that lead to deformity and breathing problems.

🗝️ Key Notes

• The middle vault is formed by the upper lateral cartilages and the dorsal septum.
• Any dorsal hump reduction or septal work will disarticulate the middle vault, requiring reconstruction.
• Key treatment principles include:
  • Restoring width and symmetry
  • Supporting the internal nasal valve
  • Maintaining smooth dorsal lines
• Common surgical techniques include:
  • Spreader grafts to restore support and valve angle
  • Precise reattachment of the upper lateral cartilages
• Failure to properly treat the middle vault can result in:
  • Inverted V deformity
  • Middle vault collapse
  • Persistent nasal obstruction
• These issues are frequently seen when structural grafting is omitted.

💡 Key Takeaway

The middle vault must be actively reconstructed — not ignored. Proper treatment is essential to preserve both nasal function and long-term aesthetic outcomes.

🎧 Listen & Subscribe

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🔥 Social Media Teaser

The middle vault is where many rhinoplasties fail 👃 Dr Dan explains how it should be treated, why reconstruction is mandatory, and how skipping spreader grafts leads to collapse and breathing problems. A must-listen episode.

🎙️ Dr Dan Behind the Scalpel – Episode: Dorsal Hump Reduction

Dorsal hump reduction is one of the most recognisable components of rhinoplasty — but it’s far more complex than simply “shaving down a bump.” In this episode, Dr Dan revisits what forms a dorsal hump, explains the different surgical approaches to reducing it, and highlights the critical reconstructions required to avoid long-term deformities.

🔎 What You’ll Learn in This Episode:

• What structures form a dorsal hump and why it varies between patients.
• How dorsal hump reduction is performed surgically.
• The difference between traditional hump reduction and dorsal preservation techniques.
• When augmentation of the middle third is required, particularly in saddle deformities.
• Key structural considerations surgeons must address after hump reduction.
• Important post-operative precautions following surgery.

🗝️ Key Notes

• A dorsal hump is formed by a combination of:
  • Nasal bones
  • Septum
  • Upper lateral cartilages
• For a more detailed anatomical breakdown, listeners are referred back to Episode 4, where dorsal humps are discussed in depth.
• Dorsal hump reduction can be performed using:
  • Osteotomies to remove bone and reshape the nasal dorsum
  • Dorsal preservation techniques, which maintain the natural dorsum while lowering it
• In cases of a saddle deformity, the middle third may need to be augmented rather than reduced.
• After hump removal, the mid-vault becomes disarticulated and must be reconstructed.
• Failure to reconstruct the middle vault can result in:
  • Open book deformity
  • Widening of the nasal dorsum
  • Functional breathing problems
• Proper reconstruction helps restore both nasal width and valve function.

Post-Operative Considerations

• Patients must be mindful when wearing glasses after surgery.
• Pressure from glasses can affect healing and final shape.
• Specific post-operative guidance is discussed in this episode (see attached reference).

💡 Key Takeaway

Dorsal hump reduction is not just about removal — it’s about reconstruction. Long-term success depends on restoring mid-vault support, preserving function, and respecting nasal anatomy.

🎧 Listen & Subscribe

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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:

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

⸻

🔥 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

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🎙️ 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.

🎙️ Dr Dan Behind the Scalpel – Episode: The Inferior Turbinates

Blocked nose keeping you up at night? It might not just be your septum — your inferior turbinates could be the cause. In this episode, Dr Dan explains what turbinates are, why they swell, and how they can be treated when they become a problem.

🔎 What You’ll Learn in This Episode

• What inferior turbinates are and why they’re often mistaken for nasal polyps.

• The role of turbinates in airflow sensation, humidification, and the nasal cycle.

• First-line treatment with steroid sprays (safe and effective for long-term use).

• When surgery (turbinoplasty) is needed, what it involves, and why it’s safe.

• The importance of post-op saline rinses to ensure recovery.

🗝️ Key Notes

• Inferior turbinates are normal structures, not growths or polyps.

• Swelling often worsens at night or when lying down due to venous congestion.

• The nasal cycle (every ~6 hours) naturally causes alternating blockage.

• Steroid sprays should always be trialled before surgery.

• Turbinoplasty safely reduces turbinate size without affecting nasal function.

• Post-surgery saline rinses for 3 months are key to full recovery.

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