Show notes

Cleft palate rhinoplasty is one of the most technically demanding operations in rhinoplasty — and one of Dr Dan’s favourites. In this episode, he explains why these cases require extensive rhinoplasty experience, how unilateral and bilateral cleft deformities differ, and why reconstructing a stable septal framework is central to his approach.

The discussion focuses particularly on unilateral cleft rhinoplasty: the potential need for rib cartilage, complete removal of existing structural components where appropriate, osteotomies, and a substantial septal replacement graft rather than relying on a simple extension graft. Dr Dan also discusses the limitations of tensioning, his strong opposition to primary alar base reduction on the cleft side, and selective premaxillary augmentation.

These are the surgeon’s clinical views and operative preferences, rather than universal treatment rules. Individual anatomy and prior treatment determine surgical planning.

Key topics

Why cleft rhinoplasty is exceptionally difficult

Unilateral versus bilateral cleft nasal deformity

Rib cartilage and rebuilding structural support

Full explantation, osteotomies and the limitations of tensioning

Large septal replacement grafts versus extension grafts

Why Dr Dan avoids alar base reduction in primary unilateral cases

When cleft-side premaxillary augmentation may be considered

In this episode of Doctor Dan Behind the Scalpel, Dr Dan Robinson explores the relationship between nasal breathing, athletic performance and recovery.

Drawing on his experience treating elite athletes, including Troy Herfoss and Olympic swimmers, Dr Dan discusses how functional rhinoplasty may improve breathing, sleep quality and the ability to recover from demanding training sessions.

He also shares observations from a small, exploratory VO₂ max assessment, including why improvements in perceived performance don't always translate into measurable increases in aerobic capacity.

Topics covered:

· How nasal obstruction may affect exercise and recovery

· The potential benefits of improved nasal breathing during sleep

· Experiences of elite athletes following functional rhinoplasty

· Observations about VO₂ max and exercise tolerance

· Special considerations when operating on professional athletes

Key takeaway: Improved nasal breathing may offer meaningful benefits to sleep, recovery and perceived athletic performance, although stronger clinical evidence is needed to establish direct performance benefits.

Episode 19 – Podcast Show Notes

🎙️ Dr Dan Behind the Scalpel – Episode: The Roman Nose

The Roman nose is one of the classic nasal shapes that patients may seek rhinoplasty to address. Characterised by a prominent dorsal hump and a long, downward-pointing nasal tip, a Roman nose can make patients feel that their nose is too large or prominent for their face.

In this episode, Dr Dan explains what causes a Roman nose, why it often runs in families, and the structural changes that contribute to its distinctive appearance.

He also discusses the complexities involved in correcting a Roman nose, including hump reduction, nasal bone restructuring, rebuilding the middle third, managing tip position and addressing the nasal valve to ensure that both the appearance and function of the nose are considered.

🔎 What You’ll Learn in This Episode:

• What is meant by a “Roman nose”.

• The key features that characterise a Roman nose.

• Why a Roman nose can make the nose appear overly large or prominent.

• Why Roman noses often run in families.

• How overgrowth of the septal cartilage contributes to the appearance.

• How a large dorsal hump and tip ptosis develop.

• What columella show and a long alar can have to do with nasal growth.

• Why skin thickness is an important consideration when correcting a Roman nose.

• The role of hump reduction and nasal bone restructuring.

• Why rebuilding the middle third of the nose is important.

• How spreader grafts and septal grafting may be used.

• Why tip position and projection need to be carefully considered.

• Why some female patients may also require alar base reduction.

• How a Roman nose can be associated with nasal obstruction and nasal valve problems.

• Why addressing nasal function is an important part of Roman nose surgery.

• Why complex Roman nose surgery may benefit from an experienced rhinoplasty surgeon with a strong understanding of nasal valve anatomy.