Medical & Surgical Facial Aesthetics (03) 95100714

What is revision rhinoplasty?

What is revision rhinoplasty?


Revision rhinoplasty is a surgical procedure to change the bony and cartilaginous skeleton of the nose which can be performed for either functional (breathing concerns), aesthetic concerns or both functional and aesthetic purposes following the initial (primary) rhinoplasty.
A full reconstructive revision rhinoplasty can go for as long as 6 hours, compared to an initial rhinoplasty which on average goes for between 2 and 3 hours. Revision rhinoplasty surgery is very challenging surgery as the surgeon may have very little to work with after the initial operation. It is important to understand that there are limitations to what can be realistically achieved in any rhinoplasty, be it primary surgery or revision.

How many rhinoplasties can one person have?

It is extremely important to get the initial rhinoplasty surgery right, however, 5 to 10 percent of rhinoplasty patients worldwide require revision surgery. Some revision rhinoplasty surgeries may require just small changes, whereas other cases may require full reconstruction of the nose to improve the breathing functionality as well as the overall aesthetics. In general, revision rhinoplasty is more extensive and requires a lot more time and skill to achieve a good outcome. With each subsequent rhinoplasty, it is more difficult to get the desired outcome (this is because the nose of a person undergoing a revision rhinoplasty will usually have less cartilage available to rebuild the structure of the nose from the inside). It is more likely that a graft from a distal site such as rib will be needed in a revision case. Mr Patrick Walsh sees many rhinoplasty revision patients and generally finds that although each nose needs to be assessed on its own merits, the chances of improving the nose significantly decrease after the third rhinoplasty.

What is a graft in revision rhinoplasty?

With less tissue and cartilage available to work with in a revision rhinoplasty, a rib cartilage graft may be required to substitute lost or severely deformed cartilage. This involves a small incision in the crease under the breast and this is essential to be able to restore the structure to allow for a nose that breathes well and looks good. A rib graft can be quite painful and extend the initial recovery period. Special arrangements for pain relief at the rib graft site such as a local anaesthetic infusion are employed. Fascia grafts may also be required and are often taken from above the ear in the hairline to pad the soft tissues of the nose under the skin. This gives the nose a smooth appearance, particularly in thin-skinned people. Rarely, ear cartilage is used for specific grafts in the septum and tip of the nose.

Considering having revision rhinoplasty?

Mr Walsh has performed many revision rhinoplasties and many have been extensive. If you have had a previous rhinoplasty in the past and have issues with breathing or the appearance of your nose then a consultation may help you decide whether or not this is something that you would like to proceed with. Mr Walsh uses the latest 3D imaging technology during the consultation which allows you to see the sort of result he believes could be achieved for you surgically.

Anti wrinkle injections: How to get better results

Anti wrinkle injections can have visibly amazing results, however some people don’t always get the results they are hoping for. Here are some tips to help you get the best outcome from these non-surgical wrinkle treatments.

1. Have regular anti wrinkle injection treatments

By having anti wrinkle injection treatments every 3-4 months, you are more likely to get optimal results. When the muscles are not allowed to get back to their full movement, the skin on top will not be exposed to too much repetitive movement that causes the wrinkles. This way you can stay on top of the lines that are caused from dynamic facial movements, as well as prevent any lines at rest (aka static lines) from deepening further.

2. Don’t give up too quickly on anti wrinkle injections

Ok, so you have a few lines at rest already. You have anti wrinkle injections in that particular area but you’re NOT seeing much, if any, improvement. Do you give up because you are no longer getting the wow factor two weeks after your treatment? You could, however, find the static lines may get worse over time if you do nothing. It may just be worthwhile to continue a regular treatment with the mindset that you are simply preventing more lines from forming and the current lines from deepening and extending.

3. Dermal fillers may be your friend

Dermal fillers can also be used as a treatment for deep lines and wrinkles. Great for improving lines that are at rest by pushing the line out to the surface from underneath. Usually it is recommended to team up the dermal filler treatment with anti wrinkle injections. This improves the longevity of the filler as the continual movement of the muscles can cause the filler to break down much faster.

4. Quit smoking

No one likes to be told, but let’s discuss the elephant in the room! Anti-wrinkle injections mixed with cigarettes are not a great combination. Although you are likely to still see benefits from the anti-wrinkle injection treatment whilst continuing to smoke, it does appear to be slightly counteractive. Smoking cigarettes will contribute to those pesky fine lines which will make it difficult to get great results.

5. Don’t wait too long to start having anti wrinkle injections

The ironic thing with anti wrinkle injections is that they work better on younger skin. Prior to static lines forming, you are more likely to see the wow factor two weeks after your treatment. Some muscles when left untreated really build and become quite strong. With regular treatments, these muscles will start to atrophy and visibly shrink in size. Unfortunately, very strong and large facial muscles need higher doses of the product which can also be costly. Preventing these muscles from strengthening in the first place saves the trouble of having to use high doses of the product later down the track and perfect results can never be guaranteed.

6. Have a consultation

Having a discussion with your clinician prior to having any sort of non-surgical treatment is essential, whether it be for anti wrinkle injections, dermal fillers or a combination of the two. It is important to discuss what you are hoping to achieve from any of these treatments and an experienced clinician should be able to guide you through what results you may expect, although the true effects are never going to be known until after your treatment.

5 Things you MUST know before having rhinoplasty

Before going under the knife, read these 5 things you must know before having rhinoplasty.


1 What the surgery involves

When going under the knife it is good to have an understanding of what is going to happen during the procedure. Ask your surgeon whether you will be having an open or closed approach and just how your new look is going to be achieved. The more information you have, the more empowering it is, however, the surgeon is the expert and if things change during the procedure, it is usually for a good reason.

2 The recovery period

Most surgeons will advise you to take two weeks off work to recover post-surgery. There is likely to be some bruising, and swelling is almost unavoidable. In most cases, there will be a splint on your nose for the first 7 days so you will probably want to lay low during that period. For most people undergoing a rhinoplasty, the post-operative swelling is usually the last side effect to completely subside following surgery. Unfortunately, in some cases this can take 12 months or more to completely dissipate.

3 The fees

If you are having your surgery in a private hospital you can expect to pay up to three separate accounts. These include the surgeon’s fee, the anaesthetist’s fees and the theatre/hospital fees. If you have private health insurance that covers cosmetic surgery, then the hospital fee will either be covered by the insurer or you may be asked to pay an excess or co-payment. If there is a functional component to your surgery, then sometimes there may be a rebatable amount for both the surgeon’s and anaesthetists fees. This should be discussed at the time of your consultation and you will be provided with a quote that will estimate any rebatable amount, if eligible.

4 The potential risks

All forms of surgery carries a number of potential risks. It is your surgeon’s job to ensure that you understand the specific risks for your case so that you are able to make an informed decision when consenting to the surgery.

5 Your surgeon

It is important to feel comfortable with your chosen surgeon. There needs to be a clear line of communication so that both yourself and your surgeon are on the same page when it comes to the desired outcome of your procedure.

Recovering from rhinoplasty surgery

Any surgical or invasive procedure carries risks.  Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

What to expect while recovering from rhinoplasty surgery

If you are considering having nasal surgery, you are likely to have many questions about recovering from rhinoplasty surgery. In this video blog, our Melbourne based surgeon, Mr Patrick Walsh explains what you can expect after your rhinoplasty surgery. This includes the initial period from hospital up until one year after your surgery. Watch as Mr Walsh explains that the recovery from rhinoplasty surgery occurs in stages and can last up to 12 months. Click to watch the video above to discover what else you should know prior to your surgery so you can be best prepared for your surgery.

Mr Walsh performs many cosmetic rhinoplasty surgeries as well as revision rhinoplasty surgeries in several private hospitals in and around Melbourne. He is now using 3D imaging technology for his patients during consultations to allow for better visualisation of the predicted surgical outcome. If you would like more information on recovering from rhinoplasty surgery or to book a consultation with Mr Patrick Walsh, please get in touch with our St Kilda clinic staff on (03) 95100714.

The difference between a septoplasty and a septorhinoplasty

Any surgical or invasive procedure carries risks.  Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Have you ever wondered what the difference between a septoplasty and a septorhinoplasty is?

Our Melbourne based surgeon, Mr Patrick Walsh answers this common question that patients often ask in this video blog: What is the difference between a septoplasty and a septorhinoplasty? Although they sound very similar, they are quite different operations on the nose and both are commonly confused or mistaken for one another. Mr Patrick Walsh regularly performs septoplasty and septorhinoplasty procedures in several private hospitals in and around Melbourne.

Watch this video blog to find out his explanation. If you require a consultation in regards to either a septoplasty or a septorhinoplasty procedure, contact Mr Walsh’s St Kilda Clinic on (03) 95100714.

How Lip Fillers Should Look


Are you considering lip fillers?

Enhanced lips do not need to look fake or overdone. Many of our clients are interested in having lip fillers but worry about looking fake and duck-like! There is no need for this (unless you actually prefer that look!). When performed right and by using a great product, fuller and natural looking lips can be achieved with lip fillers. If you use too much product, then it is easy to look unnatural! So the key is not to go overboard.

What a lip enhancement should do:

– Bring back and improve definition to the lips

– Plump out fine lines

– Give an anti-aging affect as lips tend to thin with age

What a lip enhancement should NOT do:

– Look unnatural

– Be disproportional to your face

– Your top lip should not be bigger than your bottom lip.

It’s all about bringing back some definition to tired or older lips using lip fillers. I’m noticing more and more that people are forgetting what they looked like prior to their treatment which runs the risk of overdosing (so to speak) on filler! Take a selfie before and after having any sort of dermal fillers so you can see the difference and you will less likely feel the need to go too far.


This procedure is not suitable for everyone and it is important to get the right advice prior to having lip fillers or any other procedures for that matter. For more information on lip fillers or to arrange a consultation in our St Kilda Clinic, contact our friendly staff on (03) 95100714.

Click here to watch a video of a lip filler treatment performed in our clinic.

Natural looking lip fillers

Any surgical or invasive procedure carries risks.  Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Video blog on “Natural Looking lip fillers”

Click above to see our latest video blog on “Natural looking lip fillers”. Have you been considering having lip fillers but you were wondering what is involved? The procedure is performed in the clinic by our CCRN, Lauren Walsh. Beautiful and natural results are what we pride ourselves in at our Subtle Transformations clinic. The before and after results below speak for themselves. There are many different techniques for this procedure, however we have chosen this technique for this client to achieve a natural result.

If you would like some profession advice as to whether or not this procedure is suitable for you, contact our St Kilda clinic to arrange a consultation on (03) 95100714.

A close up image of a woman's face before and after having dermal lip fillers
A close up image of a woman’s face before and after having dermal lip fillers

Pros and cons of anti-wrinkle injections


Thinking of trying anti-wrinkle injections?

It might be a good idea to find out some of the pros and cons of anti-wrinkle injections prior to having a treatment. Having a list of the pros and cons of the procedure could help you decide whether or not this treatment is for you. Anti-wrinkle injections for the face are becoming more and more common in developed countries and fewer and fewer people feel the need to keep it a secret. What does the future hold for these procedures? Some suggest it will become as common as going to the hairdressers. However, it is a medical procedure and like all medical procedures, there are benefits and risks. So let’s look at the pros and cons of anti-wrinkle injections to help you decide if this treatment is something you would choose.


  • The obvious positive to having anti-wrinkle injections is the improvement to or total loss of wrinkles in a particular area on the face.
  • Prevention of future lines and wrinkles is a benefit, particularly in younger people.
  • Looking younger for longer is also a major benefit. This can also make us feel younger as well.
  • If we perceive ourselves as looking more attractive, then we feel more attractive and our confidence can be boosted.
  • There are a number of other things you can do with anti-wrinkle injections such as a non-surgical brow lift, elongate the chin, prevent the corners of the mouth to droop downwards, lengthen the upper lip to treat gummy smile or create a slimming effect to the width of the face with treatment to the jaw (masseters) and decrease the nose from moving downwards when talking and smiling.
  • The results are not permanent, so if you don’t like the look, it’s not forever.
  • There is no downtime. The quick procedure can be performed on a lunch break without anyone even noticing.


  • Although you can treat wrinkles on the neck with anti-wrinkle injections, neck wrinkles are still difficult to treat and you are at risk of having a visible discrepancy between a treated face and a neck.
  • When ”over done” with anti-wrinkle injections, there is always the risk of a lack of expression, which leads to a lack of communication and understanding. There is a fine line between a great result and being “over done” or frozen.
  • The older the person is, the less likely that anti-wrinkle injections will make much of an improvement (if at all) and surgery may be the ideal option.

7 Top Tips for Preventing and Reducing Lines and Wrinkles

Would you like to improve your skin? Here are 7 top tips for preventing and reducing lines and wrinkles.

1. Protect your skin from the sun.

The top cause of wrinkles on the skin is UV rays. Do your best to keep out of the sun for as much as you can, wear SPF sunscreen of at least 30 plus all year round, avoid solariums and never ever sunbake. Hats and sunglasses are great to protect your face from direct sunlight, particularly in Summer. So remember to slip slop slap!

2. Quit smoking.

Smoking causes premature aging to the skin by reducing the oxygen supply to this organ. The free radicals from cigarette smoking also damage skin proteins which reduces skin tone. Improvements can be seen shortly after ceasing. Twin studies have shown a dramatic difference in the quality and texture of the skin and the results cannot be denied.

3. Drink less alcohol.

Drinking excessive amounts of alcohol can have a drying effect on the skin and lead to the development of wrinkles and dark circles under the eyes. Once again, alcohol causes dehydration to the body including the skin so it is recommended to keep drinking to a minimal amount.

4. Get plenty of sleep.

The human growth hormone is released when we are sleeping which helps to maintain cell growth which includes the growth of skin cells. As we age, the turnover of skin cells declines so it is important to sleep well, especially as we age.

5. Moisturise.

By keeping our skin hydrated on the surface, the outer layer of skin cells are more easily removed. As dehydration can speed up the aging process, it is best to keep the skin well hydrated inside and out.

6. Drink plenty of water.

Keeping our skin hydrated from the inside is essential to keeping our skin looking great and to help keep wrinkles at bay. Keeping the skin cells hydrated by drinking at least 8 glasses of water per day, will improve lines and wrinkles as dehydrated skin is more prone to wrinkle development.

7. Exfoliate.

We can either exfoliate with an exfoliation cream, chemical peels or other means. The aim is to remove the outer layer of skin cells which is where fine lines start to appear. This way brighter and newer skin cells can then be seen.

What is a vampire facial? Platelet Rich Plasma Injections explained…


After Kim Kardashian tweeted a photo of her face covered in blood, treatments involving blood came into the spotlight. Many people have been asking the question, what is a vampire facial? Platelet rich plasma (PRP) injections have been used in sports medicine for many years to treat injuries and now it is full steam ahead into the cosmetics industry with a major emphasis on skin rejuvenation!

How do PRP injections work?

Your own blood is taken from your arm and spun out in a machine called a centrifuge. This causes the red blood cells to separate from the white blood cells, platelets and plasma. The red cells are then discarded and the platelet rich plasma and white cells are injected into the dermis in the area to be treated. Once the PRP has been injected into the tissue, on a cellular level, a cascade of events start to occur. This includes a release of growth factors to initiate tissue rejuvenation, and stimulation of new dermal cells. The result is smoother skin.

What are the benefits of PRP injections?

As the product comes from your own body, it is much safer than injecting foreign materials. This is a particularly desirable treatment for people that that do not want to inject chemicals into their system. The benefits include improvement in skin tone and colour, improvement in pigmentation and skin elasticity, and improvement in fine lines and wrinkles. It can be performed on any area on the body that needs rejuvenation, however areas that are commonly treated include: around the eyes, around the mouth, scars, neck and décolletage.

Who is suitable for PRP injections?

It is important to have a specific area which needs treatment as this is generally not used as a preventative treatment. This is a medical treatment, therefore it should be performed by a trained clinician. If you would like to find out if the treatment is suitable and can be of benefit then it is important to have a consultation prior to the treatment. At Subtle Transformations, we only perform treatments that will benefit and are best suited to your needs, so speak to a trained clinician first.