Nasal Airway & Sinus Surgery

Endoscopic Sinus Surgery

Sinusitis affects all age groups, and is a common diagnosis. Satisfactory outcomes result when acute and chronic sinusitis is treated early with aggressive medical management. Endoscopic sinus surgery restores sinus health with complete or moderate relief of symptoms in 80-90% of patients with recurrent or medically unresponsive sinusitis.

The 4 pairs of paranasal sinuses drain through their ostia and the nasal cavity which is usually colonized with bacteria. Sinuses are typically sterile. Secretions, for a number of different reasons, may form inside the sinuses and these are predisposed to microbial infections (bacterial or fungal).

Acute sinusitis presents with fever and unilateral facial pain, purulent nasal discharge, pain during eating, anosmia (reduction in the sense of smell), headache, fever and tooth ache.

Chronic Sinusitis mostly develops in patients who have acute sinusitis that does not respond to treatment, or in those who have not received treatment.

Chronic Sinusitis usually presents with nasal stuffiness, nasal discharge, postnasal drip, facial fullness, discomfort, headache, chronic unproductive cough, anosmia, sore throat, halitosis, (bad breath) general malaise, exacerbation of asthma, visual disturbances, sneezing, stuffy ears, unpleasant taste and fever of unknown origin.

The predisposing / risk factors in chronic sinusitis are:

  • Structural - septal deviation, congenital abnormality, tumour, nasogastric intubation
  • Inflammatory - allergic rhinitis, non allergic rhinitis, nasal polyps, recurrent upper respiratory tract infections, dental
  • Environmental - smoking, pollution
  • Ciliary Dysfunction - Cystic Fibrosis, Primary Ciliary Dyskinesia, Kartagener Syndrome
  • Systemic diseases - Diabetes, Wegener Granulomatosis, Immunologic Disorders (eg.Common Variable Immunodeficiency, Immunoglobulin A Deficiency, Immunoglobulin G Subclass Deficiency, AIDS)

Investigations:

  • CT Scan - is the most useful and indicated after failure of medical therapy and before surgery.
  • MRI is rarely used unless neoplasms, orbital and intracranial complications, and fungal sinusitis are suspected.
  • Plain X-Rays and nasal swabs are of limited value.
  • Specimens Cultures can be obtained from sinus openings through an endoscope or during endoscopic sinus surgery.
  • Routine blood cell counts and sedimentation rates are generally unhelpful; however, these may be elevated in patients with fever.
  • Allergy testing is useful for atopic patients.
  • Associated chronic diseases require specific tests - Cystic Fibrosis, Immune Deficiency and Ciliary Dysmotility Syndrome.
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Treatments

Medical: Acute sinusitis – Symptomatic treatment and antibiotics (Amoxycillin and Clavulanate, Clarithromycin, Cephalexin) 10 – 14 days usually resolve most episodes. Up to 6 weeks may be required in some severe cases. Symptomatic measures include topical or oral decongestants (5 days only), topical or oral steroids, steam inhalations and nasal saline douches. Cases with severe pain, sepsis, or other complications may require surgical intervention.

Chronic sinusitis – Medical therapy is often considered as an adjunct to surgical treatment and is directed towards controlling predisposing factors and infections. When diagnosed early and if intensively treated with oral antibiotics, topical nasal steroids, short courses of oral steroids and decongestants, and saline nasal sprays, significant numbers of patients have relief from symptoms, and many can be cured.

Medication:

  • Antibiotics – Amoxycillin and Clavulanate, Clarithromycin, Cephalexin, Doxycycline
  • Topical Decongestants (short term less than 5 days only)
  • Topical Corticosteroids – usually more than 3 months
  • Others – immunotherapy

Surgical

When medical therapy is unsuccessful patients are referred for surgical evaluation. Functional Endoscopic Sinus Surgery (ESS) is the surgical procedure of choice for the treatment of chronic sinusitis. ESS facilitates the removal of disease in key areas and restores adequate aeration and drainage of the sinuses. ESS is successful in restoring sinus health, with complete or at least moderate relief of symptoms in 80-90% of patients. In children, surgical management is not as well established and should be reserved for complicated cases. Open sinus surgery is rarely used. Indications for Endoscopic Sinus / Nasal Surgery

  • Sinusitis – failed medical therapy, fungal, polyposis, antrochoanal polyps
  • Epistaxis management – cautery, sphenopalatine artery ligation
  • Cerebrospinal fluid (CSF) leak management
  • Sinonasal neoplasia
  • Congenital
  • Endoscopic reduction of fractures
  • Endoscopic decompression
  • Endoscopic dacryocystorhinostomy (DCR)
  • Sphenoidotomy and assisted pituitary surgery

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FEES AND INSURANCE

After conducting a thorough medical history, Dr Pham and his staff will offer information regarding anaesthesia, the surgical facility to be used, and the costs for the procedure. Every procedure is individual and unique to each patient. Because of this, determining your specific needs and the fees associated relies upon a variety of factors, such as the complexity of the operation, where the surgery will take place and type of anaesthetic to be administered.

Your Quote

A quote will be provided and is usually an estimate as the actual surgery may differ from the proposed treatment due to an unexpected finding. Dr Pham will never compromise your health or surgical outcome to conform to previously anticipated or communicated anaesthesia and facility time. Accordingly, if further treatment is required (either through complexity, unforeseen complications or additional procedures you request) then extra costs are likely to apply.

Total Fee

The total fee will comprise of

    • Surgeon Fee (Dr Pham)- this will be provided in the quote
    • Anaesthetist Fee- you will need to consult the Doctor / Anaesthetist involve for a quote
    • Hospital or Day Surgery Fee- you will need to contact the hospital involve for a quote

Consultation Fee

The fee for the initial consultation with Dr Pham is $190.00. Please remember that a referral letter from your General Practitioner will be required for a Medicare Rebate of $70.

Your first cosmetic consultation is free with a Nurse Coordinator.

Fees for cosmetic plastic surgery are paid prior to surgery.

Deposits

A non-refundable deposit of 10% or $500 is required once surgery has been scheduled. This deposit reserves the surgery date and is credited towards the balance due.

The balance of fees due is to be paid in full at the pre-operative appointment or three weeks prior to the scheduled surgery, whichever is first. Perth Facial Plastic & Cosmetic Surgery generally does not provide refunds. Once a procedure is scheduled and the fee collected, and you cancel or reschedule the surgery within 2 weeks, there will be a fee of 25% of the total cost. Of course, exceptions are made for life threatening emergencies or medical illnesses prior to the procedure. In these instances, the rescheduling fee does not apply.

Payment

Acceptable forms of payment include:

  • Cash
  • Bank Cheques
  • Visa or MasterCard

We do not offer payment plans

Health Insurance

As a rule, cosmetic plastic surgery is considered “elective surgery” and is not covered by most health insurance funds or Medicare. Some operations that have a significant functional aspect may be considered reconstructive rather than cosmetic and, as such, may attract a small rebate. These include Rhinoplasty for deformity or nasal obstruction, and breast reduction if the weight of your breasts causes pain or interferes with normal activities. Dr Pham will advise you to contact your health fund and Medicare if this is the case.

Because Facial Plastic & Cosmetic Surgery is artistic, on occasion, revisions may be necessary. Such revisions are performed within one year of the original surgery, and although there is generally a minimum charge for the surgery, facility and anaesthesia fees still apply for such procedures. Perth Facial Plastic & Cosmetic Surgery reserves the right to determine whether a revision is appropriate and what the procedure will entail. If you have any questions regarding this policy, please ask Dr Pham.

TABLE OF FEES

These prices are approximate only. You will be provided with a firm quote after consultation with Dr Pham. Most cosmetic surgery’s fee will attract a GST.

ProcedureDr Pham’s FeeAnaesthetist FeeHospital fee (Private Health Insurance may apply)Churchill Day Surgery fee
Rhinoplasty (Nose Reshaping / Nose Job / Nose Surgery)7000-7500

 

8000-9500  (costal/rib cartilage)

1500-20003500-45002500-3000 (selected case)
Mini Face Lift, Minimum Incision Facelift6000-7000 +GST2000-25004500-55004000-4500
Face and Neck lift9000-10,000 +GST2500-30006000-80005500-6000
Neck lift6000-7000 +GST2000-25004000-45003500-4000
Brow lift3500-4000 +GST1200-15002500-30002000
Eyelid Upper2500-3500800-10002000-25001800
Eyelid Lower2500-3500800-10002000-25001800
Eyelid Upper and Lower5000-60001500-18003000-40002800-3000
Mini-Face lift, upper & lower blepharoplasty10000-12,000 + GST2500-30006000-80005000-6000
Face Neck lift, upper lower blepharoplasty12000-14000 + GST3500-40007000-90006000-7000
Face Neck Brow lifts, upper lower blepharoplasty15000-16000 + GST4000-45008500-95007500-8000
Otoplasty / Ear Pinning / Prominent Ear5000-60001200-15002500-35002500-2800
Chin implant / Augmentation2500-3500 + GST Implant 700 +GST800-10002000-25001800
Cheek Implant / Augmentation3000- 3500 + GST Implant 700 +GST800-10002000-25001800
Breast Augmentation / Breast Enhancement5000-6000 +GST Implant 2000 +GST1200-15002500-35001800-2000
Breast Reduction / Breast Lift8000-90001500-22003500-4500NOT Available
Gynaecomastia – Male Breast Reduction4000-50001200-15003000-35002000-2500
Tummy Tuck (Lipectomy / Abdominoplasty)8000-90002000-35004000-5000NOT Available
Mini Tummy Tuck (Lipectomy /Abdominoplasty)4500-60001200-18002500-30002000-2500
LiposculptureDepends on area. Approximately 1000-1500 per area +GSTNeed quoteNeed quote. Each area include: Upper abdomen, Lower abdomen, Flanks, Medial thigh, Lateral thigh, Buttock, Axillae, Back, Upper armNeed quote
Chemical Peel2000-2500 +GST Depend on areaIf required sedation or general anaestheticNeed quote1000
Dermabrasion2000-2500 +GSTIf required sedation or general anaestheticNeed quote1000
Wrinkle Relaxer550-600 for 25-30 units or 300 per area +GST
Fillers – temporary- Juvederm650/ampoule +GST
Fillers – semi permanent1200/cc +GST
Platelet-Rich Plasma800-1000 + GST

 

YOUR AREAS of CONCERN

 

Brow and Forehead: lines, angry or tired, sad look
  • Wrinkle Relaxer
  • Wrinkle Fillers
  • Blepharoplasty / Eye lift / Eye lid surgery
  • Endoscopic Brow Lift /Forehead Lift
Eyes: hooded, droopy, puffy, fullness, block vision
  • Blepharoplasty / Eye lift (upper and lower eyelid reshaping)
  • Endoscopic Brow Lift / Forehead Lift
Eyes- crow feet
  • Wrinkle relaxers
Ears: protruding, batty, large, prominent ear
  • Otoplasty (Ear Pinning)
Jowls and Sagging Cheeks & neck
  • Face lift (Rhytidectomy)
  • Mini Facelift, S-lift, MACS lift
  • Face Neck lift
Neck: sagging, excess skin, bands, fullness
  • Neck Surgery (Neck Lift and Liposuction / Liposculpture)
Wrinkles and Lines
  • Wrinkle Relaxer
  • Wrinkle Fillers
  • Laser & Chemical Resurfacing
  • Dermabrasion
  • Platelet Rich Plasma
  • Skin Care Products

 

Nose: prominent, large, twisted, too small, nasal hump, too long
  • Rhinoplasty (Nose Surgery)
Blocked nose, crooked nose, fractured nose
  • Septoplasty / Septo-rhinoplasty (Nasal Surgery for breathing and deformity)
Cheeks: hollow
  • Implants – Cheek implant
  • Wrinkle Fillers
  • Fat transfer
Chin: small, protruding
  • Chin Surgery – Chin implant, Genioplasty / Mentoplasty
  • Wrinkle Fillers
  • Fat transfer

 

Cosmetic Breast Surgery: breast enhancement / implant, sagging breast, heavy breast, male breast
  • Breast implant / Breast enhancement / Breast Augmentation (Augmentation Mammoplasty
  • Breast Lift (Mastopexy)
  • Breast Reduction (Reduction Mammoplasty)
  • Correction of Enlarged Male Breasts (Gynaecomastia)
Body Contouring: sagging tummy, too much fat
·         Tummy Tuck (Abdominoplasty)

·         Mini Tummy Tuck (Lipectomy)

·         Liposuction / Liposculpture

 

Facial Reconstructive: scars, skin cancer, moles
·         Skin Cancer of the Face, Head & Neck

·         Mole Removal