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 on a variety of factors, such as the complexity of the operation, where the surgery will take place and the 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 unexpected findings. Dr Pham will never compromise your health or surgical outcome to conform to previously anticipated or communicated anaesthesia and facility time. If further treatment is required (through complexity, unforeseen complications or additional procedures you request) then extra costs may 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 an initial consultation with Dr Pham is $220. To be eligible for any Medicare rebates, you will need to have a valid referral from your general practitioner. Any follow-up consultations will incur a fee of $130.

Your first cosmetic consultation is complimentary 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.

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 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.

YOUR AREAS OF CONCERN

Brow and Forehead: lines, angry or tired, sad look
  • Wrinkle Relaxer
  • Wrinkle Fillers
  • Blepharoplasty / Eyelift / Eyelid surgery
  • Endoscopic Brow Lift /Forehead Lift/Open Brow Lift
Eyes: hooded, droopy, puffy, fullness, block vision
  • Blepharoplasty / Eyelift (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
  • Facelift (Rhytidectomy) – deep plane
  • 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

 

TABLE OF FEES

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

ProcedureDr Pham’s FeeAnaesthetist FeeHospital fee (Private Health Insurance may apply)
Rhinoplasty (Nose Reshaping / Nose Job / Nose Surgery)$8,500 – $10,000
$12 – $15,000 (complex case, costal/rib cartilage)
$2,500 – $3,000
$3,000 – $3,500
$5,500 – $6,500
Mini Face Lift, Minimum Incision Facelift$8,000 +GST$2,000 – $2,500$4,500 – $5,500
Face and Neck lift$10,000 – $12,000 +GST$2,500 – $3,000$6,000 – $8,000
Neck lift$8,000 +GST$2,000 – $2,500$4,000 – $4,500
Brow lift$4,000 – $5,000 +GST$1,200 – $1,500$2,500 – $3,000
Eyelid Upper$2,500 – $3,500$800 – $1,000$2,000 -$2,500
Eyelid Lower$3,000 – $3,500$800 – $1,000$2,000 – $2,500
Eyelid Upper and Lower$5,000 – $6,000$1,500 – $1,800$3,000 – $4,000
Mini-Face lift, upper & lower blepharoplasty$12,000 + GST$2,500 – $3,000$6,000 – $8,000
A Face, Neck lift, upper-lower blepharoplasty$14,000 – $15,000 + GST$3,500 – $4,000$7,000 – $9,000
Face Neck Brow lifts, upper lower blepharoplasty$16,000 – $18,000 + GST$4,000 – $4,500$10,000 – $12,000
Otoplasty / Ear Pinning / Prominent Ear$5,000 – $6,000$1,200 – $1,500$2,500 – $3,500
Chin implant / Augmentation$3,000 – $3,500 + GST
Implant
$900 +GST
$800 – $1,000$2,500 – $3,000
Cheek Implant / Augmentation$3,000 – $3,500 + GST
Implant
$700 +GST
$800 – $1,000$2,500
Breast Augmentation / Breast Enhancement$5,000 – $6,000 +GST
Implant
$2,000 +GST
$1,200 – $1,500$3,500 – $4,000
Breast Reduction / Breast Lift$8,000 – $10,000$1,500 – $2,200$4,000 – $5,000
Gynaecomastia – Male Breast Reduction$5,000 – $6,000$1,200 – $1,500$3,000 – $3,500
Tummy Tuck (Lipectomy / Abdominoplasty)$8,000 – $10,000$2,000 – $3,500$6,000 – $8,000
Mini Tummy Tuck (Lipectomy /Abdominoplasty)$6,000$1,500 – $1,800$3,000 – $4,000
LiposculptureDepends on the area
Approximately $1,000 – $1,500 per area +GST
Need quoteNeed quote. Each area includes the Upper abdomen, Lower abdomen, Flanks, Medial thigh, Lateral thigh, Buttock, Axillae, Back, Upper arm
Chemical Peel$2,500 +GST Depends on the areaIf required sedation or general anaestheticNeed quote
Dermabrasion$2,500 +GSTIf required sedation or general anaestheticNeed quote
Wrinkle Relaxer$550 – $650 for 25-30 units or $300 per area +GST
Fillers – temporary- Juvéderm$650 – $750/ampoule +GST
Fillers – semi-permanent$1,500/cc +GST
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