Question 1

Why I exclusively use the endonasal technique.

Accepted Answer

I perform all corrections using the particularly gentle endonasal technique. It is essential for me to leave the connective tissue structures of the tip of the nose largely untouched in the particularly sensitive central area. These areas are easily deformable and contribute significantly to the natural softness of the tip of the nose. The paired veins and accompanying lymph vessels of the nasal columella drain the tissue of the dorsum and tip directly following gravity and are therefore particularly effective. The endonasal procedure allows me to preserve these veins and vessels. This means that the drainage of tissue fluid and swelling remains unaffected, which in my experience leads to faster healing. This allows me to avoid taping and, in the vast majority of cases, cortisone injections into the nasal skin during follow-up treatment. I also use the endonasal technique in very complex cases, such as revision surgery, corrections of cleft lip and palate, and reconstructions using rib cartilage.

Question 2

Computer simulation

Accepted Answer

Computer simulation allows us to simulate the possible outcome of a nose correction (rhinoplasty, nose surgery) using photos. I always perform these simulations when you come in for a consultation regarding rhinoplasty with cosmetic correction. The simulation allows me to show, for example, the correction of a hump on the nose, a drooping tip, or a saddle nose. The simulation provides a good, but not absolute, indication of the changes that are possible and realistic with rhinoplasty. Of course, it must be pointed out that the actual result of a rhinoplasty may differ from the simulation photos for various reasons. I will explain the possibilities and limitations of the method in detail during a comprehensive consultation. The possible changes can be clearly shown in a side view, but not always ideally in a front view. Very complex surgical nose corrections, e.g., for cleft noses or complicated asymmetries, can be simulated only with limitations.

Question 3

Endonasal correction of a crooked nose

Accepted Answer

When correcting a crooked nose, it is often necessary to make the bones of the nose movable by making incisions. The piezo instrument, together with the use of particularly fine diamond burrs, allows for gentle bone cuts, the best possible protection of the soft tissue and thus a reduction in the postoperative swelling phase.

Question 4

Piezo technology: Gentle correction of the hump and bridge of the nose

Accepted Answer

Piezo technology allows for gentle correction of the bony parts of the nose. This instrument files and cuts the bones of the nose using ultrasonic waves. Fine diamond burs can also be used in a minimally invasive manner to contour and cut the bone. I completely avoid the traumatic use of hammers, pliers, and chisels.

Question 5

Correction of the tip of the nose

Accepted Answer

Correcting the tip of the nose requires particularly delicate and gentle surgical techniques. Almost all reasonable changes to the shape of the nasal tip can be achieved. These changes include a snub nose, a broad or drooping tip of the nose, or asymmetries of the tip. I perform corrections of the tip exclusively endonasally. For this purpose, I have developed a special endonasal approach that has found routine use in other major centers: “The endonasal complete release approach.” This approach not only avoids a scar on the columella. It also aims to avoid an unnaturally stiff nasal tip and reduce the removal of cartilage material from the nasal septum.
In principle, swelling can sometimes remain a little longer in the area of the nasal tip than on the dorsum. As a rule, you can go out in public without attracting attention about 10 days after nose surgery. The swelling will slowly subside over the following weeks and months. Swelling of the dorsum will come down more quickly than the tip of the nose. After about 8 to 12 weeks, the tip of the nose may therefore appear slightly more swollen. The swelling will have largely subsided after about 6 months and will have almost completely disappeared after a year.

Question 6

Rhinoplasty for cleft lip and palate

Accepted Answer

Children born with cleft lip and palate can now usually be treated successfully in several surgical stages during their early years. The focus is on restoring speech and swallowing functions and closing the cleft lip. In early adulthood, the appearance of the nose becomes increasingly important.
The cleft has a significant impact on the development of the nose. It usually leads to a narrowing of the nostril on the cleft side and a bending of the nasal septum toward the other side. Other changes include a flattening and bending of the tip of the nose and changes in the shape of the base of the nose. These changes should be corrected after the growth spurt of puberty to prevent further deformities caused by growth disorders.
I have developed a special method for the effective correction of cleft noses, which has been adopted by other large centers. Using the “foundation graft” technique, the base of the nose on the cleft side can be raised and thus made more symmetrical. Examples are shown in the “Before and After Photos” section. I usually recommend endonasal correction of a cleft nose in adulthood after the age of 17 years.
Surgery for a cleft nose is considered challenging. Correcting the asymmetry of the skin and soft tissue covering the nose poses a particular challenge. Reconstructing the cartilage structure also requires special measures. Minimally invasive, endoscopically assisted removal of rib cartilage through a short incision in the lower lateral chest is often necessary. In particularly complex cases, a two-step surgical procedure may be required. I plan the treatment with you in great detail and adapt it to your individual anatomical situation. It often makes sense to correct the lip scar during the same operation. In my experience, endonasal correction of a cleft nose has significant advantages. For example, there is no tension on the wound on the columella. Nasal packing is usually not necessary, and the nasal cast remains in place for about 10 days. After 10–14 days, you will usually be able to resume your normal social activities.

Question 7

Endonasal improvement of nasal breathing

Accepted Answer

The treatment of nasal breathing obstruction first requires a very careful clinical and endoscopic examination. Causes that can be treated with medication, such as allergies or sinusitis, must be ruled out or treated if necessary. Only when nasal breathing obstruction has not responded to medication can surgery be considered. I make a special effort to use gentle surgical techniques when treating nasal breathing obstruction. These are often performed during the same operation as the cosmetic correction.
First of all, it is particularly important to make an accurate diagnosis of the nasal breathing obstruction. Three factors often play a role. A deviated septum is very often associated with nasal breathing difficulties. It should be noted that even a healthy septum is not usually perfectly straight. It is therefore important to analyze exactly which areas of the septum cause significant resistance to the airflow in the nose.
The turbinates can also contribute significantly to nasal breathing difficulties. The turbinates are elongated structures on the inner side wall of the nose. They perform important functions: they warm and humidify the air we breathe. Their function can sometimes be impaired, e.g., in women after menopause. I make a special effort to preserve the functional tissue of the turbinates completely. I only remove parts of the bone from inside the turbinates. This reduces their diameter and allows them to nestle against the nasal wall, creating more space for air to flow past. The parts of the turbinates that warm and humidify the air we breathe—the mucous membrane and underlying soft tissue—are completely spared.
Another important cause of nasal breathing obstruction is what is known as nasal valve stenosis. The nasal valve is formed by the cartilage of the ala, about half a centimeter above the lateral edge of the nostril. Here, the soft tissue can be drawn into the nasal airway during inhalation, narrowing it. This cause of nasal breathing obstruction must be diagnosed with particular care and its correction integrated into the surgical plan. I perform nasal valve correction in the majority of functional rhinoplasties, for example using the “stairstep graft” technique I have described. In difficult situations and in certain revision surgeries, it may be necessary to support the cartilage of the nasal septum and nasal valves with rib cartilage grafts. These can be harvested from the lower chest in a minimally invasive, endoscopically assisted manner.

Question 8

Minimally - invasive turbinate correction

Accepted Answer

I use special techniques for turbinate correction that make it possible to avoid the use of nasal tamponades. These techniques involve gentle treatment of the turbinate without removing functional mucosal tissue. I only remove bone tissue from the inside of the turbinate in a targeted manner. This prevents an open wound surface in the nose. I also make fewer incisions inside the nose and suture all incisions. All these measures are aimed at minimizing the risk of bleeding. The probability of needing a nasal tamponade after nose surgery is less than 1%.

Question 9

Gentle techniques in rhinoplasty – preservation

Accepted Answer

Piezo technology allows for gentle correction of the bony parts of the nose. This instrument files and cuts the bones of the nose using ultrasonic waves. Fine diamond burs can also be used in a minimally invasive manner to contour and cut the bone. I completely avoid the traumatic use of hammers, pliers, and chisels. This procedure also protects the soft tissue.

Question 10

Scar-free rhinoplasty

Accepted Answer

For various reasons, I use the endonasal approach exclusively, even in complex and difficult cases. In difficult and complex operations, such as revisions and corrections of cleft noses, closed techniques allow the surgeon to work on less scarred tissue, which makes the procedure less traumatic.
I agree with the vast majority of international experts that excellent results can be achieved with both approaches. The skill and experience of the surgeon are much more important factors than the choice of approach. No study has ever been able to reliably attribute a higher complication rate or lower success rate to one approach over the other. Therefore, statements that one approach is fundamentally superior or inferior to the other cannot be considered justified.

Question 11

Avoiding nasal packing

Accepted Answer

I do not use nasal packing; you will usually be able to breathe through your nose as soon as you wake up from the anesthesia. Swelling and bruising can be reduced using gentle endonasal techniques. My patients often show only modest signs of swelling or bruising when the splints are removed after 10 days. Treatment with tape to reduce swelling can be avoided. The procedure is performed on an outpatient basis, without incisions on the columella and without lifting the skin at the tip of the nose, i.e., solely through the nostrils. All sutures are self-dissolving.

Question 12

Nose surgery for professional athletes

Accepted Answer

As a passionate athlete myself, I understand the needs of physically active patients. I treat prominent athletes, including professional soccer players, former boxers, endurance athletes, and tennis players.
Professional athletes have a variety of special requirements. They often want to resume training as soon as possible. The risk of contact with the nose often cannot be avoided for months, and impaired nasal breathing can reduce performance. This is particularly the case in endurance sports. Some medications that are prescribed in many countries to improve nasal breathing (e.g., phenylephrine) are on the list of banned enhancing substances. The medicinal treatment of nasal breathing in professional athletes also tends to reach its limits sooner than in patients with average physical fitness. Maintaining the physiological mucosal function of the nose appears to be particularly important for endurance athletes. The humidifying and warming function of the nasal mucosa is particularly stressed when air flow is high. I make a special effort to take these aspects into account when treating nasal breathing in athletes with medication and surgery. If the external shape of the nose contributes to reduced nasal breathing, there are additional important aspects to consider. For example, after a sports accident or other trauma, the nose may be so crooked that the nasal airways are narrowed. Shape-changing surgery usually requires careful incisions in the nasal bone using a piezo instrument in order to reshape the nose as desired. It takes some time for the nose to regain sufficient strength. If the aim is to start training early after nose reshaping surgery, the risk of further deformation if the nose is struck must be carefully weighed up and discussed. It often makes sense to have a face mask made at an early stage and to start training early with this additional protection. For martial arts, I recommend having the nose reshaping surgery performed only after the end of your career. The risk of another significant nose injury is too high here.

Question 13

What to consider before rhinoplasty: FAQ

Accepted Answer

Three weeks before the operation, you should avoid medications and substances that can thin the blood. These include painkillers such as Aspirin®, Ibuprofen®, Diclofenac®, and Voltaren®. They also include ginkgo, garlic, ginger, and vitamin supplements.
Good condition of the nasal mucosa optimizes the conditions for the operation. Applying a moisturizing skin cream or nasal oil inside the nostrils once a day for about a week before the operation nourishes the mucosa.
Exposure to strong sunlight and visits to a tanning bed can cause inflammation of the skin and swelling. These should therefore be avoided for 10 days before the operation. Nicotine reduces blood flow to the tissues and can delay wound healing. Smoking should therefore be avoided for at least one week before and two weeks after the operation. All makeup should be removed the evening before the operation. If possible, trim your nose hair with small scissors with rounded tips, taking care not to injure the inside of your nose. We ask men with beards to shave their upper lip.

Question 14

What should you bear in mind in the first few days after nose surgery?

Accepted Answer

You should cool the area around your eyes in the first few hours after the anesthesia. Compresses (sponges) moistened with ice water are ideal for this. Elevating your upper body, e.g., with a second pillow, also helps to minimize swelling. You can usually get up a few hours after the operation. You should avoid strenuous activities in the first two days after the operation; relaxation and bed rest help to reduce swelling. You should avoid any activities that cause your blood pressure to rise in the first few days after nose surgery.
As no nasal packing is required thanks to the gentle surgical technique, you may occasionally experience slight secretions from the nostrils or minor nosebleeds in the first few days after the operation. You can dab these away with a clean cloth.
You can shower and wash your hair with assistance the day after the operation. The nasal splint should not get wet if possible. As long as you are wearing the nasal splint, you should avoid wearing clothing with tight collars, as these could rub uncomfortably against your newly operated nose when you put them on. You can use decongestant nasal sprays three times a day until the nasal splint is removed. A greasy nasal ointment should be applied regularly for at least two weeks. You can use other substances or medications, such as arnica, from the second day after the procedure.
I usually remove your nasal splint after about 8 days, carefully using an adhesive-dissolving liquid. The nose will still be swollen inside and out. The swelling will decrease significantly in the first 1-2 weeks and will largely disappear within 8-12 weeks. As a rule, the nose will appear normal to the casual observer after about 10 days, but you yourself will still notice the swelling for longer. Minor swelling of the bridge of the nose may still be palpable after three months, and swelling of the tip of the nose may persist even longer (up to 6-12 months). You will usually be on sick leave for one to two weeks after nose surgery.
Sometimes the skin on the bridge of your nose may still be a little sticky after the cast is removed. Of course, you can wash your nose after the cast is removed. However, you should proceed very carefully at first: lukewarm water, mild soap, and gentle dabbing with a soft towel are suitable for cleaning. A mild makeup remover can be used after removal of the splint.

Question 15

Follow-up examinations after nose correction

Accepted Answer

I attach great importance to providing you with individual care and treatment. It goes without saying that I perform the procedure myself. I also usually carry out the follow-up examinations after nose surgery myself. Several follow-up examinations are usually necessary after the operation at the following times: after one day, possibly after 2-3 days, after 10 days to remove the cast, after 3 months, after 1 year, after 2 years, and possibly after 5 years. You will receive your before and after pictures after one year upon request.

Question 16

When can I go to the sauna, solarium, or out in direct sunlight after nose surgery?

Accepted Answer

Extensive sunlight, saunas, and solariums can increase swelling and should be avoided for6 to 12 weeks after rhinoplasty. Mild to moderate sunlight is usually in order.

Question 17

When can I wear a protective mask (mouth and nose mask, “corona” mask) again after nose surgery?

Accepted Answer

A protective mask, e.g., to protect against “corona” viruses on public transport, can be worn after the splint has been removed. It is important to ensure that a soft mask is worn. This should not exert any significant pressure on the nose. An airtight seal at the sides is not necessary; the function of these masks is simply to catch droplets exhaled towards the front. Harder masks (FFP 2 or FFP 3) should be avoided for 3 months after nose surgery.

Question 18

When can I wear glasses again after nose surgery?

Accepted Answer

Wearing glasses can affect the cosmetic result of a nose correction. To minimize this risk, it is recommended that you wait at least 6 weeks before wearing glasses again. If possible, wearing contact lenses is recommended for the first 4–12 weeks after the operation. In individual cases, it may be possible to deviate from this schedule. I will give you precise recommendations during the consultation.

Question 19

Do sutures or tamponades need to be removed after nose surgery?

Accepted Answer

I generally only use suture material that dissolves on its own. An incision and therefore a suture of the outer skin of the nose is avoided. The sutures are located inside the nose and disappear on their own within the first 2–6 weeks. If a transparent suture causes discomfort or itching in any way, you can carefully cut it off yourself with nail scissors after consulting with me. Nasal tamponades are not necessary due to the special surgical technique used.

Question 20

Do I need a new passport / ID card after nose surgery?

Accepted Answer

Modern passports and ID cards require biometric photos. These photos can be recognized by computers using facial recognition software and compared with the actual face. This happens, for example, when entering the USA. This can actually cause problems, as the software may detect differences between the previous photo in the passport and the face with the operated nose. This could lead to additional checks being carried out, for example. It is therefore advisable to apply for a new passport after nose surgery. The photo should be taken no earlier than 3 months after the nose surgery.

Question 21

When can I blow my nose or use a nasal douche after rhinoplasty?

Accepted Answer

The delicate cartilage at the tip of the nose is usually held in place with thin sutures until it has healed properly. To prevent these structures from shifting, you should avoid pressing your nostrils together for four weeks after nose surgery. If your nose is blocked, you can clean it by rinsing it with lukewarm salt water (1 teaspoon or 4.5 g to half a liter of water). After a nasal douche, a moisturizing substance should be applied to the nose, e.g., nasal ointment or nasal oil. Experience has shown that patients hardly ever sneeze after surgery, even during hay fever season. If this does happen, I recommend sneezing through your open mouth. As a rule, you do not need to worry about damaging your newly operated nose by sneezing.

Question 22

When can I resume sports activities after nose surgery?

Accepted Answer

The nose remains sensitive during the first few weeks after nose surgery. Strenuous activities that raise blood pressure can lead to increased swelling or delayed decongestion. Therefore, you should only resume sports activities after a break. Gentle sports activities (e.g., cycling) can be resumed after 2 to 3 weeks and then gradually increased. Sports involving maximum exertion and forced breathing should be avoided for about 6 weeks. Sports in which there is a risk of being hit in the nose (soccer, handball, school sports, etc.) should be avoided for at least 6 months.

Question 23

Swelling after nose surgery – how long does it last?

Accepted Answer

Swelling of the nose always occurs to some degree as a result of the operation. The severity of this swelling varies and depends on various factors. These factors include the surgical technique, the patient's predisposition, and the extent of the necessary changes. In follow-up operations, swelling usually lasts longer than after initial operations. I make a special effort to minimize swelling by using a gentle endonasal surgical technique. The vast majority of my patients are socially presentable again by the time the nasal splint is removed after 8-12 days. The remaining swelling slowly subsides and is usually reduced by about 85% after 3 months. Swelling of the tip of the nose can sometimes subside less quickly than swelling of the dorsum. The impression that the tip of the nose feels firmer or foreign can last up to 12 months, but usually disappears completely after initial surgery. Taping the nose can usually be avoided, as the veins and lymph vessels of the columella have been preserved, thus counteracting the tendency for so-called “supratip” edema.

Question 24

Prospects of success in rhinoplasty

Accepted Answer

The success of nose surgery can be determined using various parameters. For me, your satisfaction with both the external shape and the quality of your nasal airways is the most important criterion. Of course, a nose cannot be changed arbitrarily. It is therefore particularly important to discuss with you in detail during the extensive consultation which changes are possible and realistic given your anatomy. If expectations do not correspond to a realistically achievable result, surgery should not be performed.
The frequency of a revision operation can only be used as a relative measure of the quality of the result. Some particularly experienced surgeons report a slightly higher rate of revision operations. This is because some surgeons offer relatively revision surgery even for minor deficiencies. The frequency of such revision operations described in international literature is around 5–10%.
For noses that I have operated on for the first time, the frequency of follow-up corrections is around 5%. I perform almost all of these minor revision procedures after my primary procedure under local anesthesia and/or sedation anesthesia, and I am forthcoming with the cost. As a rule, you should wait a year before undergoing corrective surgery. This allows the tissue time to heal.
It is very important to me that you are ultimately satisfied with the result. Given the relatively large number of rhinoplasties I perform each year, there is naturally a small number of patients who request a revision correction and a very small number of patients (less than 1 per year) who require a second revision operation. I make a special effort to care for these patients until a satisfactory result has been achieved.

Question 25

Cost of rhinoplasty surgery

Accepted Answer

Corrections to the inside of the nose to improve nasal breathing may be partially covered by private health insurance. A certain portion of the costs must generally be covered by the patient. We will provide you with a transparent and calculable breakdown of these costs. Functional corrections include straightening the nasal septum, correcting the turbinates, and widening the nasal entrance (the so-called nasal valves). These medically indicated corrections do not usually result in a change in the external shape of the nose. The costs of functional corrections to the internal nose (self-pay) and shape-changing corrections to the external nose depend on the complexity of the respective procedure. This is based on many different aspects, e.g., whether it is a first or follow-up operation, whether ear or rib cartilage grafts are necessary, and how complex the changes to be corrected are estimated to be. The price of a nose operation is an important decision criterion for many patients.
It goes without saying that safety standards and the experience and expertise of the surgeon must meet the highest standards in order to ensure that this investment yields the most attractive, functionally satisfactory, and lasting surgical results possible. Many experts agree that low-cost offers (especially from abroad) and particularly high prices should be examined very critically. Based on photographs, we can provide you with an indicative estimate of the cost of an operation. Please take the pictures with a digital camera from a distance of about 2 m in front of a plain background. The pictures should show the nose and face straight from the front, at a 45° angle, and in profile from the side. The face should fill most of the photo, and the crown of the head and chin should be visible. Please send the photos as a printout or as an email attachment to praxisteam.gassner (at) gmail.com. Please note that we cannot be held liable for the data security of information and images transmitted by email.

Question 26

Who will perform your nose surgery?

Accepted Answer

I will perform your procedure myself. This is an important part of my commitment to quality. I am generally available for you before, during, and after your procedure. Part of my center's quality standards is that I train experienced colleagues who have completed their specialist training. These so-called fellows usually spend a year at my center, learning highly specialized techniques and treatments through observation and assistance. I always perform the actual procedure myself.

Question 27

Before and after photos of nose surgery

Accepted Answer

For many patients who are considering having rhinoplasty, before and after photos are valuable. The results of reconstructive rhinoplasty are shown in the “Before and after photos” section. According to current German law, comparative photographs of the results of cosmetic rhinoplasty may not be published freely on the Internet. Of course, we respect this requirement, which is intended to protect the privacy of patients. If you would like to see the results of cosmetic nose surgeries, please send an email to VorherNachherGassner (at) gmail.com with your name, age, gender, and a brief description of your specific treatment request. We will then respond to you individually.

Question 28

Preliminary inquiry for nose surgery

Accepted Answer

If you send us photos of your face, I will be happy to provide you with a brief, non-binding assessment of the procedure and costs. The photos should be taken in front of a neutral background, from a distance of about 2 m, from the front and from the side, with your face and neck filling the frame. Please send the photos to praxisteam.gassner (at) gmail.com Please also provide your name, gender, date of birth, address, and treatment request. I will respond to you personally. Please note that by transmitting data electronically, you signify your consent to receive your response electronically and that the transmission of data in both directions is at your own risk.

Question 29

Expertise in rhinoplasty

Accepted Answer

Internationally recognized expert in endonasal nose correction.
No. 1 in Germany on the Jameda patient portal when searching for “nose operations” (2024)
Regularly invited speaker on the topic of nose correction at high-level international conferences.
Regular demonstrations of endonasal surgical techniques at surgical courses.
Director of the surgical course “The European Course in Endonasal Rhinoplasty,” one of the largest European surgical courses for nose surgery.
Frequently cited publications and book chapters on the topic of nose surgery.
Experience of over 4000 endonasal nose operations over 20 years.
Approximately 40% difficult external revisions/reoperations.
Prominent patients, nationally and internationally.

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