Trish: Good morning everyone. It’s Trish from Plastic Surgery Hub and Transforming Bodies, and I’m here today in Melbourne, having a chat with Dr. Allan Kalus, who’s from Avenue Plastic Surgery in Melbourne. We’re gonna have a talk about rhinoplasty, which is a nose job, or it can be a septoplasty. There are a whole lot of different quote, nose jobs out there. We’re gonna talk about the different types, what they are, the open procedure, the closed procedure, what they mean, and what he actually does, and who goes to have these surgeries. Thank you so much for joining us today, Dr. Kalus.
Dr. Kalus: Hi there. It’s a pleasure, Trish. It’s lovely to be here speaking with you.
Dr. Kalus: First, I have to compliment you on your blog and your website.
Trish: Thank you.
Dr. Kalus: I think you’ve helped so many people around Australia understand a little bit more about what plastic surgery is and what we can do. You’ve made it just so accessible to so many people.
Trish: I think it’s nice for people to hear it from a normal person’s point of view. I don’t know if I’m normal, but the average person’s point of view.
Dr. Kalus: That’s right. I think with rhinoplasty surgery … It’s interesting when one looks at the reasons why someone has rhinoplasty. Overwhelmingly, I think people have it because their nose makes them self-conscious. They’ve got an anxiety related to their nose. It could be for many reasons. It could be too large for their face. They could have a prominent hump. It could be crooked. They could have trouble breathing. Often, they’ve thought about it for many, many years.
In fact, it often goes back to school days. The nose grows at about puberty. That’s a time when people start to develop a sense of self and awareness, and where they fit in with society and with their colleagues. Often, it’s a time when children can be cruel, and they can bully and tease other children. If a girl or a boy’s nose grows at puberty, and someone then teases them about it, it’s amazing how that feeling never goes away. It often stays with them for many, many years.
I even had one man who came to see me at the age of 65. He used to work as a cleaner in a school. He told me that when he, himself, was at school, he was teased about his nose, and he always said, “When I retire, I’m going to get a nose job.” He waited until he was 65.
Trish: Well done.
Dr. Kalus: I think most people don’t wait that long. Most people are happy in their late teens, or maybe early twenties, to make inquiries. It’s so wonderful, such a privilege, to be able to help people to achieve their goals at that early stage. Some people, of course, their nose affects them so badly that they just become a recluse, and they don’t go out. They feel that everyone’s looking at their nose. They hate having their photo taken.
There was one girl, she was engaged to be married, and she was dreading her wedding because she hated having her photo taken. It’s very hard to be a bride and not have your photo taken. There are all sorts of reasons why people come along to have their nose operated on. Because they’re so self-conscious about their nose, one thing they all say, is that they don’t want anyone to know that they’ve had a nose job. Here we have this delicate balance between achieving a beautiful nose for them and still not making it so obvious that everyone knows that they’ve had it done.
Trish: It’s right there.
Dr. Kalus: It’s in the middle of the face. One thing that’s interesting, is the nose the most important feature or is it not the most important? Da Vinci said that the nose, because it’s in the middle of the face, it sets the whole character of the face. We know the ethnic nose, Italian nose, or the Lebanese nose, certainly has certain characteristics. But, it’s not the most important facial feature. The most important facial feature is the eyes, followed, I think, by the smile. The reason is, is that the eyes and the smile, that’s how we communicate. We communicate non-verbally. People are always looking at the eyes for a cue of how you feel about them, and so on. I think that’s where your natural beauty is, very much in your eyes and smile. I think people can have confidence in that, that that’s really where their attractiveness is. That’s where their soul and the heart is.
The problem with the nose is, because it’s in the middle of the face, if it’s large or crooked, even if there’s a pimple on the nose, it attracts attention, and it takes attention away from the eyes and the lips. What we try to do, is to make the nose blend in with the face, just to neutralise it. The way I go about it, is I’ve got an imaging programme where I can take a photo of the nose and put it up in the computer, and we can make changes on the computer and see if we make the tip a bit smaller, reduce the hump a little bit, make the nose a bit shorter. What do we need to do, the minimal that we need to do, to make the nose blend into the face?
It’s amazing just after a few seconds, really a few quick movements on the screen, and my patient will say, “Wow. That’s wonderful.” Then I can click between the before and after images and they see that only a few millimetres of change make such a profound difference to the way they look. I think this is the art in rhinoplasty. You often don’t have to do much. Less is more. The minimalist approach is the best approach.
How I like to do it, I think the technique that I have developed, is what’s called a closed rhinoplasty. It’s all done from inside the nose. There’s no cut on the outside of the nose. Lately, it’s been popular to do a procedure called an open rhinoplasty, where you cut along the columella, which is just at the base of the nose. You can open the nose right up that way, and get a good view of everything. If you’ve had a lot of experience with nose operations, you can actually get a very, very good view all from inside the nose, as well, by making the appropriate decisions and using the right lighting and instrumentation.
Trish: You do all of these surgeries through the nostrils?
Dr. Kalus: All done through the nostrils.
Trish: No cutting?
Dr. Kalus: No cuts. It’s like a miracle, because it’s a true minimally invasive operation. What it means, also, is at any point I can stop and step back and look at the hump, and look at the balance of the nose, the balance between the tip and the bridge of the nose and so on. I think it’s a very precise way of doing it. The other advantage is, if we avoid the cuts on the skin of the nose, you don’t cut blood vessels and nerves, so you have a lot less swelling of the tip afterwards, so the recovery time is a lot faster. For many reasons, I prefer this, what I call the endonasal, or the closed approach.
The operation can be done as a day case. Patients come in the morning. They can go home, really, within a few hours. They wear a small plaster for a week. Really, there’s minimal bruising these days. There’s a little bit of bruising around the eyes sometimes. Very little bleeding. We don’t put packs inside the nose, so people can breathe through their noses. Really, it’s a matter of maybe, for a week, taking some time off work, because you’ll have a plaster on. After a week, the plaster comes off and you have your new nose. It may be a little bit swollen still, but essentially, it’s all there after a week.
Trish: It takes about a year for the swelling to go down. You’re not gonna have a fat nose, but it takes about a year for you to receive your true nose, is that right?
Dr. Kalus: I think really by six months you’ve got a pretty good idea of how it’s going to be. You’re quite right, it continues to soften and settle up to about a year. This is where, of course, the closed rhinoplasty does settle a lot faster than an open rhinoplasty. It’s an amazing operation, and what I ask people when they come back for their six week appointment, is how they feel about themselves. Often they say, “I used to think about my nose every day, and now I just don’t think about it anymore. It’s not on my mind at all.” That’s really the result that we’re trying to achieve.
I also ask, “Have your friends noticed?”
They say, “Well, that’s the funny thing. Not really.” Sometimes a very close friend will have noticed, but often they think, “There’s something about you. You look rested. You look well after your holiday.”
Trish: You look better.
Dr. Kalus: “You just look better.”
Trish: I know when I had
Dr. Kalus: More vivacious.
Trish: When I had my nose job, first of all, when one of your colleagues that you know did it, James Katsaros in Adelaide, when he took of the thing, I just looked at myself and I cried because I still looked like me. I just had a better looking nose. Nobody knew I had a nose job. When they saw that plaster on my nose, they thought I’d had an accident. No one knew I had a nose job. I had to tell people.
Dr. Kalus: Understandably, it’s such an emotional experience for a person. Right in the middle of your face. Who are you going to trust to really change, then? Once I’ve done the imaging, I always say to patients, “It’s all very well to do this on the computer, but the question is, how good am I? How good is the surgery? Can I produce this result that I’ve shown you on the computer?” The answer is, that I’m at least 95% accurate to that computer image, at least. The image really helps me to … It shows how little I have to do, often, with the nose, and rather than going in there and just doing more and more and more and more, and then finally, you’ve just done too much. It’s taught me that.
It’s a very emotional experience for the patient. That’s why when the plaster comes off, so many people just cry, that release of emotion because, finally, they’ve got a nose that they’ve always wanted. It fits into their face. They look more vivacious because they notice their eyes and their lips more. It looks normal. It doesn’t look like it’s been operated on.
Trish: That’s the best nose job, the one that doesn’t look like they’ve had a nose job. I have seen those jobs that look like someone had a nose job.
Dr. Kalus: Absolutely.
Trish: That’s just when the wrong thing’s been done, whatever that is. You do quite a few rhinoplasties, don’t you?
Dr. Kalus: We do hundreds every year. It’s one of my specialties, the rhinoplasty.
Trish: It’s always really hard for people to work out who to go to, because who does a lot of rhinoplasties?
Dr. Kalus: For me, it’s the most rewarding operation of all the surgeries that we do, because it’s in the middle of the face. Often, they’re young people having it done, and you’re making a difference for their whole life. It can be transformative.
Trish: Totally. Thank you so much. I think you’ve answered all my questions. Thank you so much.
Dr. Kalus: Thanks, Trish.
Trish: Ladies, and guys out there, if you’re in Melbourne, you’re looking for someone to do a rhinoplasty, nose job, go and have a consult with Dr. Allan Kalus. He’s at Avenue Plastic Surgery. You can google it or send us an email to firstname.lastname@example.org. Thanks, Dr. Kalus.
Dr. Kalus: Isn’t that great?