ok ive had 2 rhinoplasty consults: 2 questions 1. md#1 says he must intubate me md#2 says he will not intubate me (iv sedation) so is it best to be intubated or not for rhinoplasty? 2. md#1 says he will not break my nose md#2 says he must break my nose how can they have such different techniques? md#1 says my nose is narrow enough not to need to be broken but md#2 says it is absolutly nessescary. both physiscans are experienced board certified thanks
Overwhelmed After my Nose Job Consults
Doctor Answers (29)
Confusion after Rhinoplasty Consultations
Selecting a surgeon will be the most difficult decision you will make. At this stage, I recommend that you see multiple results in patients that had noses like yours - that should be the most important parameter. Don't worry about things like the surgeon's preference for delivery of anesthesia.
Help on deciphering opinions about your planned Rhinoplasty
Rhinoplasty is a very delicate and personal procedure. Every patient is different as is every surgeon. Finding the right surgeon for you can be a difficult task, since all surgeons have their own sense of aesthetics in addition to yours. Because of this a rhinoplasty can be approached from many different angles, giving very different results. It is best to make sure your surgeon knows as precisely as possible, what you are looking for and explains to you how he is going to achieve this. Bringing in pictures of noses you like is a helpful way to communicate. Also look at a surgeon's before and after book to get a sense of each surgeons personal aesthetics. Not all surgeons are for all people, especially when it comes to cosmetic surgery.
Overwhelmed after nose job consults
It is best to have general anesthesia for a rhinoplasty. It is the safest way to undergo an anesthetic so that the blood does not pool in the back of the throat, down into the trachea. Patients do not need to be intubated for general anesthesia, but they will need an LMA, which protects the airway from blood. As far as osteotomies or breaking the nose, these are performed only after the hump has been removed. A very small hump removal will not require breaking of the nasal bones. A moderate to large hump reduction will absolutely require breaking the nasal bones to prevent the flat top open roof nasal deformity. Make sure that you are having the procedure done in an ambulatory surgery center that is certified (such as Medicare) and that your M.D. anesthesiologist is board certified. You also need to discuss the pros and cons of both open and closed rhinoplasty with your respective surgeon.
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Pick the surgeon that you feel comforable with - honest about his work
The consultation with a surgeon gives you a chance to get some detailed information about the procedure we are interested in. The amount of that information can be overwhelming at the time. In many situations we seek a second consultation to compare surgeons’ answers. You have to remember that even though they are both board certified plastic surgeons, their approach can be very different. It does not mean one is better than the other. The most important for the patients is to communicate about their expectations as far as the final results. Always ask for lots of the before and after pictures. The decision will come naturally. You will find a confidence and trust in a surgeon of your choice.
If you're confused about your nose surgery after 2 consults, get another opinion.
Not only should a surgeon give you an opinion, there should be a rationale that makes sense to the patient. If it doesn't make sense maybe another opinion would help. I use video imaging to educate the patient and sometimes myself. If you're confused about infracturing, you can do a nose operation on the computer with and without infracturing to see how it looks.
Overwhelmed After my Nose Job Consults
Different surgeons have different philosophies, different techniques, and even a different aesthetic eye. We are lucky to live in a time when technology can help in these situations. I often use computer imaging (that is, morphing photographs) to show patients what my goal for surgery would be for them. In this way, we can come up with a common goal, and I can tell patients what is realistic and what is not. A picture is worth a thousand words.
Method Not As Important As Outcome
There is more than one way to get a result with rhinoplasty. I would not be as concerned with how the procedure is to be done as ensuring that you and your surgeon are on the same page as to the desired outcome. If the surgeon can image what things might look like that would be helpful.
Surgeons tend to do what they are most comfortable with, and that can vary, but many times, that's all chaff. The wheat is the results, but you won't know it until you get the surgery! The problem is that people think cosmetic surgery is a consumer good, and you can essentially shop around like any other consumer good. That may be true, but you can't so easily return the product once you bought it!
There is a lot of nuance in this field, and it took us years to get good at it. When you add that perfectly good and competent surgeons do things different ways, that adds another layer of complexity. It's a tough decision. One thing is certain though, you generally have to pay for a good result. Don't go on the cheap, so to speak. Although paying more will not guarantee you a great result, discount surgery is a bad idea.
Get opinions, educate yourself, ask questions, and don't let price influence you...
In general, I believe most anesthesiologists and plastic surgeons prefer general anesthesia with rhinoplasty in order to protect your airway. Please don't feel overwhelmed - rhinoplasty is an art. Every surgeon like every sculptor may have a different plan to get you the look you want. There is no necessary right or wrong answer. The most important thing is for you and your surgeon to have a good understanding of what you personally would like your nose to look like. You can bring different examples of pictures, or look at your surgeon's pictures and say what you like or dislike about each of them. In the end, you should feel 100% comfortable going into surgery and it's ok to keep asking questions until you feel that way.
Dr. Cat Begovic M.D.
Rhinoplasty anesthesia and nose fracturing
The type of anesthesia a surgeon likes to use depends a lot on their personal preferences/experience and on what maneuvers need to be done. Minor refinements can be done under local anesthesia (numbing injection) if the patient wants. I prefer using general anesthesia for most of my rhinoplasty cases. Most are extensive enough that I like to have the airway protected.
The question of whether osteotomies need to be done is better answered after seeing your nose. They are typically done if the nasal bones are crooked or if they will be seen as too wide once any hump is removed.
Rhinoplasty surgeons will often have different specific plans. If you like the long term (at least a year from surgery) results of a particular surgeon I would trust their judgement.
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.