If Dr Does Something During Operation, Not Discussed Pre Op?

I had a nose job to fix the tip. My bridge was fairly straight, just a very small bump on one side. My surgeon said he would file down the bump. However, when I woke up after the surgery, he said he broke my nose to fix it. The result is I now have a wonky bridge. It curves inwards on one side, but straight down one side, creating an unbalanced appearance. I have another meeting with the surgeon in a few days. What should I expect? Is he obligated to fix this problem as not discussed beforehand?

Doctor Answers (7)

Doing the correct thing in surgery (even if not specifically described pre-operatively) is not going to get you a "free" re-do!

+2

If you had an unexpected blood vessel rupture and bleed during surgery, would you expect your surgeon to "let it go" since it was not explained to you pre-operatively, even if it took a longer incision or second scar to stop the bleeding and save your life? Come on, you know the answer, and trying to have your dissatisfaction with your result be somehow "tied" to unmentioned osteotomies as a way of "obliging" your surgeon to perform a "free" re-operation is wrong.

Osteotomies are a routine part of most rhinoplasties, especially ones where a dorsal hump is removed. Whether mentioned or not, osteotomies in this setting are not only appropriate, but NOT performing them would likely (in your surgeon's judgement--which you paid him to use) have yielded an unsatisfactory result that required re-operation--just for a different kind of unsatisfactory result.

The real problem is that you have a less-than-perfect outcome, and you feel (perhaps rightly) it occurred because of the bones being broken and healing undesirably. This is no more your surgeon's "fault" in the "doing," than YOUR "fault" in your "healing!"

Revision surgery, touch-up surgery, or re-operation policy should have been discussed or written about in your surgical consultation or scheduling and operative information. Yes, there is generally a cost for re-operation, but your surgeon will either charge no surgeon's fee (or a reduced one), and you are responsible for operating room and anesthesia costs, regardless of where the surgery was performed. Usually a surgeon's own office facility costs are MUCH less than a hospital's or free-standing surgicenter, so if this is the case, be thankful for small favors!

Remember, YOU chose your surgeon for his surgical skills, experience, and the whole package of care, and you paid for performance of rhinoplasty, NOT for a "guaranteed outcome." No reasonable surgeon (or patient) can honestly claim 100% perfection, nor should it be expected.

What you should expect is a surgeon who will ask you to wait for up to a year for the swelling to diminish, and scar tissue to soften and mature, and sensation and circulation to recover, before re-operation. You should expect to pay OR and anesthesia fees, and little or nothing for surgeon's fee. I'm truly sorry you have a undesirable result and may have to undergo another procedure and additional costs. No surgeon wants this, but stuff happens.

But if your nose had turned out perfectly, would you be upset that your nasal bones had to be broken in order to achieve that great result? I thought so--of course not! So that's not the issue; focus instead on your area of dissatisfaction and explain this in a calm and non-accusatory manner to your surgeon, who of course wants you to have a good result almost as much as you do, and at the lowest possible cost in time and $$, even if it takes another surgery. I've even been known to reduce fees even more for a patient who is kind and "understands" that I did my best and things just didn't turn out as hoped for--by either of us--despite everyone's best efforts!

Thanking you surgeon for doing everything necessary to try to achieve your best result is much more effective at building towards a successful re-do than angry blaming, and trying to establish "breach of contract" or "lack of informed consent." Neither apply to proper surgery, even when there is an undesirable outcome. Best wishes! Dr. Tholen


Minneapolis Plastic Surgeon
5.0 out of 5 stars 118 reviews

Rhinoplasty

+2

Dear Sara411,

Surgeons don't explain every step of a surgical procedure.  Instead, they describe what they will address and briefly explain how they may accomplish that.  They can't explain every nuance or detail.  Remember, your surgeon spent many years learning to be a surgeon - they can't provide you with all of that knowledge.

With a dorsal hump reduction, if more than 2mm of rasping is required, a nasal bone in-fracture is recommended to prevent an open-roof deformity.  It sounds like your surgeon did what is a normal part of your surgery.

If you don't like the appearance of your nose, that's a separate issue.  You should discuss this with your surgeon.  

Best,

Asif Pirani, MD, FRCS(C)

Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
5.0 out of 5 stars 28 reviews

Rhinoplasty Bump Filing and Osteotomies

+1

    A dorsal hump that is filed sometimes needs oseotomies to reduce apparent width.  I am sure that the surgeon will revise the surgery after about 12 months if it needs a revision.   I would agree with everything Dr. Tholen wrote.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 193 reviews

You might also like...

Rhinoplasty plan sometimes has to be modified during surgery.

+1

Hi.  There are three separate issues here:

1)  If, during surgery, it looked to your surgeon that infractures would give you a better result, then of course he did that, whether he explicitly told you about it before surgery or not.

2)  You are not happy with outcome.  This may not be related to the infractures.

3)  What is your surgeon's policy about doing revisions?   This is what you need to discuss with your surgeon.  But don't blame him for breaking the bones.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Rhinoplasty

+1

Often when doing a rhinoplasty if the dorsum is shaved, it is appropriately infractured to recreate the natural bony pyramid shape.  Best to discuss things with your surgeon.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Rhinoplasty Choices

+1

I would like to thank Dr. Tholen for a very eloquent and informative answer.  Although I cannot comment on the appearance of your nose without pictures I can  give you some insight into why your nasal bones were broken during the procedure.  When a larger dorsal hump is removed, a convex surface (the dorsum) transforms into a wider flat surface. In order to avoid what we call a "book spine" deformity, osteotomies are used to fracture the nasal bone and narrow the dorsum.  This is a tried and true technique in Rhinoplasty, generally yielding good results.  As you have already planned, a frank discussion with your Surgeon about results and expectations is the best way to proceed. 

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
5.0 out of 5 stars 32 reviews

Unantisipated Fracture

+1

 Surgeons sometimes have to change a Plan of Surgery based upon what they find at the time of a procedure. It can be difficult to cover all the bases but, the major ones are usually included in the consent forms you sign prior to surgery. A good example is a Tummy Tuck patient that is discovered to have a hernia at the time of the procedure. Almost all surgeons are going to repair the hernia at the time of the Tummy Tuck and proceed.
 Consider asking your surgeon why they broke your nose. Express you surprise and confusion about not being aware of any discussion ( verbal or written) about that part of your procedure. Best,

Gary R Culbertson, MD, FACS

Gary R. Culbertson, MD
Columbia Plastic Surgeon
5.0 out of 5 stars 3 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.