Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney
A rhinoplasty consultation isn’t a “design your new nose” appointment. It’s a clinical assessment. Two things often surprise patients who arrive expecting otherwise. The first: the assessment considers what’s anatomically achievable for the specific nose in question, not what’s been pre-selected from photographs online. The second: a significant portion of patients who think they have a purely cosmetic concern turn out to have a breathing issue that’s contributing to the appearance, and vice versa.
The consultation is also where the regulatory pathway begins. Under current Medical Board and AHPRA cosmetic surgery guidelines (July 2023), rhinoplasty involves at least two pre-operative consultations, body dysmorphic disorder screening using a validated tool, and a seven-day cooling-off period after the second consultation and informed consent. The pathway is designed to support considered decision-making, not to be navigated quickly.
This article walks through what actually happens at a rhinoplasty consultation in Canberra: the external and internal nasal assessment, the cosmetic vs functional distinction (including Medicare considerations), what to bring, the difference between the first and second consultations, and what the consultation may change about what you thought you needed. Dr Scott J Turner is a Specialist Plastic Surgeon (FRACS) consulting at the Campbell clinic in Canberra and at Sydney clinics in Bondi Junction and Manly.
For the full cosmetic and functional rhinoplasty overview, including technique options, recovery, risks, and Canberra-to-Sydney logistics, start with the Rhinoplasty Canberra page. This article focuses specifically on the consultation process.
Booking a rhinoplasty consultation in Canberra? This article covers what to expect from the assessment itself. For the broader procedure overview including techniques and recovery, the Rhinoplasty Canberra page is the right next step.
What the consultation covers
A reference for what gets assessed:
| Consultation component | What’s assessed | Why it matters |
|---|---|---|
| Medical history | Health conditions, medications, allergies, smoking and vaping, previous surgery | Affects surgical suitability and risk profile |
| Cosmetic concerns | Bridge, profile, tip, nostrils, asymmetry, facial balance | Helps define realistic goals based on anatomy |
| Functional concerns | Nasal obstruction, sleep disturbance, exercise breathing, one-sided blockage | Identifies airway issues that may need treatment |
| External nasal exam | Skin thickness, cartilage support, bone shape, deviation, tip support | Determines what’s anatomically achievable |
| Internal nasal exam | Septum, turbinates, nasal valve, airway narrowing | Reduces risk of missing breathing issues |
| Photographs | Standardised planning views | Supports surgical planning and communication |
| Options and limitations | Open vs closed, septoplasty, turbinate reduction, grafting, revision complexity | Helps patients understand why a specific plan is recommended |
The consultation typically runs longer than patients expect. There’s no quick version of this assessment because each component matters for the surgical plan.
External nasal assessment
The external assessment evaluates what the nose looks like and what’s possible to change.
Skin thickness matters because thicker skin tends to hide fine cartilage definition, while thinner skin shows the underlying framework more clearly. Cartilage support, bone shape, deviation, and tip support determine the structural starting point. Asymmetry is assessed in the context of facial balance rather than as an isolated metric. Photographs are taken in standardised views to support surgical planning and to allow comparison through recovery.
What can be changed depends on the starting anatomy. Some changes are well-supported by the underlying structure. Others require grafting or structural modification to achieve. The assessment identifies which category each goal falls into.
Internal airway assessment
The internal assessment is the part patients sometimes don’t expect.
The examination covers the septum (the central cartilage and bone wall dividing the two nasal passages), the turbinates (the soft tissue structures inside the nose that warm and humidify air), and the nasal valve (the narrowest part of the internal nasal airway). Each of these can contribute to breathing problems, and each requires different surgical management.
Nasal valve obstruction is particularly important because septoplasty or turbinate reduction alone may not fully improve breathing if valve collapse is the main problem. Published literature describes patients who undergo septoplasty or turbinate reduction without significant symptom relief when nasal valve obstruction isn’t recognised pre-operatively. The internal assessment is designed to identify these issues before surgery, not after.
A NOSE Scale (Nasal Obstruction Symptom Evaluation) score may be documented to quantify breathing symptoms. This is used both for clinical assessment and for documentation if Medicare item criteria become relevant.
Cosmetic vs functional rhinoplasty
Rhinoplasty cases fall into three groups: purely cosmetic, purely functional, or combined cosmetic and functional. The distinction matters for both the surgical plan and the Medicare implications.
Purely cosmetic rhinoplasty addresses external appearance only, with no underlying functional issue. Medicare doesn’t cover cosmetic rhinoplasty.
Functional rhinoplasty addresses breathing or nasal structural issues. Medicare benefits may apply when the relevant MBS item criteria are met and clinical need is documented. MBS rhinoplasty items can apply when the indication is airway obstruction with a self-reported NOSE Scale score greater than 45, or significant acquired, congenital, or developmental deformity, with photographic and/or NOSE Scale evidence documented in the patient notes (MBS item 45641). Septoplasty item 41671 may also be relevant when septal surgery is performed in conjunction with rhinoplasty.
Combined rhinoplasty addresses both cosmetic and functional concerns in the same operation. Medicare considerations apply only to the documented functional component.
Rebate eligibility can’t be confirmed before assessment because it depends on symptoms, examination findings, documentation, and the relevant MBS item criteria. The consultation determines whether the case meets functional criteria; it doesn’t pre-determine the answer. The Rhinoplasty Canberra page covers cosmetic and functional rhinoplasty in Canberra in more detail.
What the consultation may change
Patients often arrive with a specific plan in mind. The consultation may change that plan in ways including:
- A cosmetic concern may have a functional cause underlying it
- A breathing issue may require septoplasty, turbinate, or nasal valve assessment rather than the procedure originally requested
- Thick skin may limit tip definition compared with what reference images suggest
- Weak cartilage may require grafting to achieve the proposed change
- Previous nasal trauma may change the surgical plan
- A closed approach may not be suitable for complex changes
- Revision surgery may be more complex than initially expected
- Surgery may not be recommended if goals are unrealistic or risks outweigh likely benefit
The consultation is the point where the gap between what patients hope for and what’s anatomically achievable gets clarified. That’s not a negative outcome of consultation. It’s the purpose of it.
First consultation vs second consultation
Two pre-operative consultations are required under current cosmetic surgery guidelines. They serve different purposes.
The first consultation focuses on assessment and information gathering: medical history, external and internal nasal examination, photography, discussion of goals, airway assessment, risks, and whether surgery may be appropriate. A surgical plan may be discussed, but surgery isn’t booked or paid for at this stage.
The second consultation refines the plan, addresses further questions, confirms understanding of risks and alternatives, and progresses informed consent if surgery remains appropriate. Under current cosmetic surgery guidelines, surgery can’t be booked or a deposit paid until after the required two consultations and a seven-day cooling-off period.
Minimum total timeline from first consultation to surgery booking: 14 days. The pathway exists to support considered decision-making.
What to bring to a rhinoplasty consultation
Worth preparing before arriving:
- GP referral: required before cosmetic surgery consultation
- Medication list, allergies, and previous anaesthetic history
- Details of previous nasal trauma or nasal surgery: dates, circumstances, what was done
- Notes on breathing symptoms: one side or both, night-time obstruction, exercise breathing, allergy history, sleep quality
- Any previous ENT reports, CT scans, or imaging: if available, helpful but not required
- Specific cosmetic concerns written in your own words: more useful than reference images alone
- Reference images only if they help explain direction (not as a template for the result)
- Questions about open vs closed rhinoplasty, recovery, Medicare considerations, revision risk, and anything else relevant
For broader consultation preparation across all plastic surgery procedures, see the Plastic Surgery Consultation Checklist.
Open vs closed rhinoplasty
Both approaches use internal incisions; the difference is whether a small external incision is also used.
| Approach | What it means | When it may be discussed |
|---|---|---|
| Open rhinoplasty | Small columellar incision (under the tip of the nose) plus internal incisions for broader access | Complex reshaping, revision cases, grafting, significant structural work, combined functional and cosmetic planning |
| Closed rhinoplasty | Incisions inside the nostrils only | Selected cases where changes are less complex and access requirements are limited |
The approach should be chosen for access and precision, not because one term sounds less invasive. Both leave the same internal incisions; the difference is whether a small columellar scar (typically fading well over time) is also part of the plan.
Risks and revision considerations
Rhinoplasty is surgery and carries surgical risks. Specific risks worth understanding:
- Bleeding (early or delayed)
- Infection
- Prolonged swelling (rhinoplasty swelling can take 12+ months to fully resolve)
- Asymmetry
- Visible or unfavourable scarring (particularly relevant for the columellar incision in open approaches)
- Septal perforation (a hole in the septum, can affect breathing and produce whistling)
- Persistent or worsened nasal obstruction
- Altered sensation (numbness or hypersensitivity in the nose or upper lip, usually temporary)
- Dissatisfaction with appearance
- Need for revision surgery
Revision rhinoplasty is more complex than primary rhinoplasty because cartilage, bone, skin envelope, and scar tissue have already been altered. Surgical planning, recovery, and risk profile all differ from primary rhinoplasty.
Smoking and vaping are particularly relevant. Nicotine impairs blood supply and wound healing, which is significant for rhinoplasty because tip skin healing depends on adequate blood flow. Cessation before and after surgery is required per practice protocol.
Consultation pathway under AHPRA cosmetic surgery guidelines
The Medical Board and AHPRA cosmetic surgery guidelines that came into effect in July 2023 apply to rhinoplasty when performed for cosmetic indications.
Current requirements:
- GP or eligible specialist referral before cosmetic surgery consultation
- At least two pre-operative consultations with the operating surgeon, with at least one in person
- Consent forms can’t be requested at the first consultation. Informed consent is finalised at the second
- Cooling-off period of at least seven days after the second consultation and informed consent before surgery can be booked or a deposit paid
- Psychological screening for body dysmorphic disorder and other relevant factors using a validated tool, with further independent assessment recommended where clinically indicated
For functional rhinoplasty with documented MBS criteria met, the regulatory pathway differs in some respects but referral and assessment requirements still apply.
For Canberra patients: consultation, Sydney surgery, recovery
Consultations occur at the Campbell clinic. Surgery is performed at accredited private hospital facilities in Sydney. Most rhinoplasty patients arrive the evening before surgery and stay 2 to 3 nights in Sydney accommodation before returning to Canberra, with longer stays for more complex or combined procedures.
The cast or splint is typically removed at around 7 days. This may require a separate return trip to Sydney or extended initial stay, depending on individual planning. Subsequent reviews are planned through the Campbell clinic where appropriate, with Sydney review arranged when needed based on procedure complexity and healing.
For travel logistics, accommodation, and support person planning, see Travelling from Canberra to Sydney for Plastic Surgery.
Where to go from here
For the full procedure overview including techniques, recovery, and Canberra-to-Sydney logistics, visit the Rhinoplasty Canberra page.
For consultation preparation across all plastic surgery procedures, see the Plastic Surgery Consultation Checklist.
For travel and accommodation logistics, see Travelling from Canberra to Sydney for Plastic Surgery.
To arrange a consultation, contact the practice online or call 1300 437 758. A GP referral is required before any cosmetic surgery consultation. Consultations at the Campbell clinic are held on Fridays by appointment.
Canberra Clinic: G24/6 Provan Street, Campbell ACT 2612 Email: [email protected] Consultations: Fridays by appointment
The practice doesn’t endorse, partner with, or recommend any specific loan providers or BNPL services.
Frequently asked questions
What happens at a rhinoplasty consultation in Canberra?
A rhinoplasty consultation includes medical history, discussion of cosmetic and breathing concerns, external nasal assessment, internal airway examination (including septum, turbinates, and nasal valve), standardised photographs, review of possible surgical options (open vs closed, septoplasty, turbinate reduction, grafting), risks, recovery, Medicare considerations, and next steps. The consultation is a clinical assessment, not a procedure-design appointment.
Can Medicare cover rhinoplasty?
Medicare doesn’t cover cosmetic rhinoplasty. A Medicare benefit may apply to a functional component only where relevant MBS criteria are met, such as airway obstruction with a self-reported NOSE Scale score greater than 45, or significant acquired, congenital, or developmental deformity, with photographic and NOSE Scale documentation in the patient notes (MBS item 45641). Septoplasty item 41671 may apply where septal surgery is performed in conjunction with rhinoplasty. Rebate eligibility can’t be confirmed before assessment.
What is the difference between the first and second rhinoplasty consultation?
The first consultation focuses on assessment: medical history, external and internal nasal examination, photography, discussion of goals, airway assessment, risks, and whether surgery may be appropriate. The second consultation refines the plan, addresses further questions, confirms understanding of risks and alternatives, and progresses informed consent. Under Medical Board and AHPRA cosmetic surgery guidelines (July 2023), surgery can’t be booked or a deposit paid until after the required two consultations and a seven-day cooling-off period.
Will imaging show exactly what my nose will look like after surgery?
No. Imaging or simulation may be used as a communication tool to discuss direction and proportion, but it isn’t a guarantee of the final result. The actual outcome depends on individual anatomy, skin thickness, cartilage structure, healing pattern, and surgical execution. Reference images can help describe goals but shouldn’t be treated as a template for the result.
How long should Canberra patients stay in Sydney after rhinoplasty?
Most rhinoplasty patients arrive the evening before surgery and stay 2 to 3 nights in Sydney accommodation post-operatively before returning home, with longer stays for more complex or combined procedures. The cast or splint is typically removed at around 7 days, which may require a separate return trip or extended initial stay depending on individual planning. Timing should be confirmed based on procedure complexity and recovery.
