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What are the differences between the big-name surgeons and the ones covered by my insurance?

I have a deviated septum+cosmetic problems. I'd like insurance to cover a portion of septo/rhino. I checked the list of surgeons that is covered my insurance, but they seem to be a different from those featured on RealSelf - they are ENTs who exclusively do facial procedures, they rarely have websites, and I can't find reviews anywhere online. What is the difference between a fancy surgeon from a PS center and an ENT who is affiliated with a hospital or has his/own, small practice?

Doctor Answers (6)

Subspecialization and experience matter

+2
Your question is a very good one.  Just because someone has a big name does not make him or her necessarily better for everyone, or best for you.  But reputations are earned.  I don't mean notoriety from TV appearances or big web sites or surgeons who blog all day--I mean those who are teachers, researchers, educators, and writers.  Their peers select them and learn form them.  Generally you will find a subspecialist who does rhinoplasty every day.  That has its advantages.

What is most important is finding a surgeon whom you trust and whose results and manner you like.  Most of my practice is secondary rhinoplasty--you only want to do this operation once.  Residency background is not critical--I am a plastic surgeon but many facial plastic surgeons do excellent work.  It is interest and skill that counts.

All the best.


Nashua Plastic Surgeon
5.0 out of 5 stars 20 reviews

Finding the right rhinoplasty surgeon

+1
Kate, visit several facial plastic or plastic surgeons based on their insurance participation with your plan (covers the functional portion of rhinoplasty). Get a feel for their experience with rhinoplasty, evaluate their work, have computerized imaging done, etc. This would be an excellent starting point. 

Grigoriy Mashkevich MD
New York Facial Plastic Surgeon

Grigoriy Mashkevich, MD
Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

You'll find someone

+1
Hi Kate:
Fortunately for you, most surgeons that do nasal surgery (plastic surgeons, facial plastic surgeons, ENT doctors) are well-trained in rhinoplasty.  Both the breathing and cosmetic aspects of rhinoplasty are difficult, depending on what the surgeon does more of.  In general, ENT surgeons are very good at straightening the septum, and some of them are well-trained at making cosmetic changes. Facial plastic surgeons and plastic surgeons are more likely to have the fancy websites and bigger names, as they are trying to attract patients willing to spend more money on the cosmetic aspect of the procedure.  Facial plastic surgeons do ENT before they sub-specialize in facial cosmetic surgery, so are typically very good at addressing the deviated septum also. Plastic surgeons sometimes have less experience straightening the septum, but many of the very best rhinoplasty surgeons (including the septum) in the country are plastic surgeons.  If the cosmetic changes are important to you, it is probably best to find someone that does cosmetic rhinoplasty and can show you some before and afters of their work.  If you require/need major changes, this is even more important.  If you can't afford a big name surgeon, you can try to find someone that does a more broad ENT or plastic surgery practice that has fellowship training in cosmetic surgery (even hospital or "doctor's rating" websites usually show if and where someone did a fellowship).  Most surgeons will split-bill for you, ie. bill insurance for the breathing parts and add a little cash charge on for the cosmetic part. The more famous the surgeon, the less likely they may be to do this.  Best of luck.

Garrett Griffin, MD
Minneapolis Facial Plastic Surgeon

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Septo-rhinoplasty for cosmetic and breathing improvement

+1
The septoplasty procedure is performed  to improve the airflow through the nose due to blockage of bone and cartilage in the back of the nasal cavity  that is blocking the airflow. This is performed for medical necessity and is billed to the patient's medical insurance.
The rhinoplasty procedure is done for purely cosmetic purposes and is not billed to the patient's insurance. Patients must pay for the  entire cosmetic portion of the procedure themselves. Both a septoplasty and rhinoplasty can be performed at the same time under one anesthetic The rhinoplasty procedure takes much longer than a cosmetic procedure.
Look for  double board certified ENT/ facial plastic surgeon who has extensive experience treating  functional as well as cosmetic nasal issues. A septo-rhinoplasty is typically not performed in a hospital setting but in in an outpatient ambulatory surgery Center setting. Many ENT/ facial plastic surgeons are located in private practice, not at a hospital

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 54 reviews

Big Name Surgeons vs. Insurance List vs. Qualifications

+1
Hi Kate,

I empathize with your dillemma. However, I believe you should be able to sort this out without too much difficulty. It will take a bit of time and effort on your part, but in the end you will figure it out.

A big name surgeon could be a good or bad thing depending on several factors. Most well known surgeons are highly talented and deserve their reputation. However, they may have that reputation for a surgery that is different from the one you seek and they may not be great at the particular operation you want. So, while it may help to cut through the noise a bit by going in that direction, it is by no means an absolute indication that everything will turn out the way you want.

The other physicians you are looking at are also probably excellent, but haven't achieved the recognition yet. Perhaps they don't market as well or don't work in a larger hospital system where the knowledge of their talents can be spread more quickly. They may also be a little younger and just haven't had the time to reach that level of recognition. In the NYC area, it takes a long time to be recognized as a top surgeon. They may also not be the best choice, since they may not specialize in what you are looking to accomplish. If you go that route, try to find someone with a clear emphasis on nasal surgery.

My advice: Pick 1 or 2 of each category and go to a few consults. You will have an idea of price differences and also have an opportunity to see their before/after work. You will also likely get a feeling about them on a personal level, which may help you to make a decision.

Hope this helps and best of luck.

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Don't emphasize where the surgeon works.

+1
There are excellent surgeons in private practice and at big medical centers.  And some of the best rhinoplasty surgeons I know don't have "fancy" offices or reputations (and some do!).  Most experience surgeons who perform the kind of surgery you will need do what's called "split billing", where they will accept insurance payment for the functional part of the surgery (e.g. the deviated septum), then will charge a separate fee for the cosmetic portion of the procedure.  What is key is to find a surgeon, and there are many, who is very comfortable with complex functional (breathing) and cosmetic rhinoplasty.  Good luck!

John Frodel, MD
Atlanta Facial Plastic Surgeon

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.