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Is an Internal Nose Exam Standard Procedure at the Consult or Pre-op Before Rhinoplasty Surgery?

I underwent rhinoplasty 9 months ago to disastrous results. I was never given an internal nose exam prior to surgery and I'm wondering if such an exam is standard procedure. To be clear, my surgeon never looked up inside my nose through my nostrils until AFTER surgery during one of the post-op appointments. Is this normal? Many thanks for your time.

Doctor Answers (6)

Internal nasal exam common before rhinoplasty

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In my practice it is routine to examine inside the nose during the rhinoplasty consultation. It is important to fully assess both the functional and aesthetics aspect of the nose before surgery.

You


Seattle Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

Internal nasal exam

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An internal nasal exam is an important part of the rhinoplasty consultation.  I am not sure why your surgeon did not perform this on you?

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

Internal nasal exam before surgery?

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During consultation for cosmetic rhinoplasty I always ask about the functional aspects of the nose--history of trauma, fracture, airway problems, sinus difficulties, snoring, allergies, etc. Many patients have none of these issues and simply want cosmetic changes to their nose. Of course I tell them that I will strive to not only achieve their cosmetic goals, but also maintain (or improve) their airway after cosmetic changes that is some cases MIGHT affect breathing. So sometimes septal or turbinate work is necessary, and I routinely perform this at the time of cosmetic rhinoplasty without additional charge to the patient. If it seems likely based on examination or history, I schedule additional time in the operating room accordingly.

But I must say that I don't actually do an internal nasal examination at every rhinoplasty consultation--I do that when the patient is asleep and maximally vasoconstricted, with me wearing a headlight and using a nasal speculum. Many patient find this uncomfortable during their consultation, don't want to be vasoconstricted, and the exam is often confined to the anterior third of the nasal passage. Incomplete exam equals incomplete information. If the history suggests an examination is valuable, then of course one is done. But to say it is "necessary" at the time of every consultation may be a slight overstatement! Looking after surgery can also be uncomfortable, and because of swelling, crusted blood, or mucous may yield little useful information.

Your unsatisfactory result is unfortunate, but is a result of poor surgery, poor healing, genetic scar tendencies, bleeding, or other issues, not because your surgeon did or did not do exams before and after surgery. Looking for medical negligence will have to be based on other facts, but not this. Sorry.

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 126 reviews

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Preop nasal exam

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Yes internal nasal exam is part of preop rhinoplasty assessment. A surgeon must be aware of a patients internal nasal anatomy before reshaping the external nose.

Philip Solomon, MD
Toronto Facial Plastic Surgeon
4.0 out of 5 stars 30 reviews

An internal nasal exam is routinely performed during a consultation for Rhinoplasty Surgery.

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An internal nasal examination is an important part of the evaluation for Rhinoplasty Surgery. Many patients will have deviation of their nasal septum, or turbinate enlargement, and these functional issues may be repaired at the time of nose job surgery.

Dr. Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
5.0 out of 5 stars 278 reviews

Nasal exam prior to rhinoplasty

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Internal nasal examination is absolutely a requirement prior to rhinoplasty. Even for cases where there is no concern about breathing, even small changes in nasal appearance can lead to difficulty breathing trough the nose. I would seek consultation with a surgeon experienced in rhinoplasty who can provide guidance.

P. Daniel Ward, MD
Salt Lake City Facial Plastic Surgeon
5.0 out of 5 stars 11 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.