Dr refuses to provide a visual of desired nose design

Question

Visited a seattleplastic surgeon for a consultation. After waiting months to see them, we meet to discuss my Nose, an exam was done I was asked several questions then was shown “similar” work. I asked for a visual or some design guidance so I could get a sense of what she said is possible against what I envisioned. I was told they don’t provide any visual. How is this possible? How would someone spend thousands of dollars comfortably not fully understanding what the final outcome would be?

Eric M. Joseph, MD · Answer

We have been offering computer Imaging for 24 years, and in our experience this is a valuable tool for showing people what they can expect to achieve after surgery. If you don't have a good feeling about your consultation and surgeon, please consider visiting another reputable rhinoplasty specialist who does offer computer Imaging. I hope this is helpful. Sincerely, Dr Joseph

Lucian Ion, FRCS · Answer

Thank you for your question. There are two very different points of view on this matter and surgeons are divided in clear separate positions.

Some surgeons feel that since the operation cannot produce an exact replica of a simulation there is no value to the preoperative simulations. This is sometimes also because the decision about the final shape is made during the surgery based on the surgeon's experience and aesthetic vision.

The other point of view of course is that computer simulation can help with the decision process. In my experience, this can be valuable element of the preparation because understanding the nasal shape in the context of the facial features helps to qualify the impact of different changes.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.Some surgeons prefer not to prepare any simulation during the consultation because the final outcome won't be 100% the same. Anyway, with this information in mind you can contact any surgeon, and it is possible to prepare a simulation with photos taken by you. Anyway, the simulation would be in 2 Dimensions. With a virtual consultation you can have a simulation, no need to wait for months. 
Best regards!

Steven M. Denenberg, MD · Answer

Today, morphs are a tool that are not difficult to arrange. You need to see the doctor's morph, so you know whether what she is picturing for your nose is the same as what you are picturing for your nose -- were the same priorities addressed? Was enough done? Too much? It helps you find a goal that you like best, and it helps the surgeon know what the goal should be, too. You can never hit that goal exactly, but it's still very useful.

(Side note: in my opinion, morphs should really be done by the surgeon, or she should be directing an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Derek Fletcher, MD · Answer

Your questions are valid.  Our practice (Plastic Surgery Northwest in Spokane, WA) uses Vectra 3D imaging to help demonstrate the changes that can be achieved with a well planned and executed rhinoplasty.  I also demonstrate the changes I plan to make using 2D printed photographs of my patients (this is particularly helpful in the lateral view).  I want my patients to know exactly what I am planning to ensure that our goals are aligned.  If my patient has a different vision for their outcome, I absolutely want to know about that before surgery so that I can adjust my plans.  This is particularly important for the female nose when it comes to altering tip projection and the supratip break.  These discussions sometimes result in me telling the patient that I can't deliver what they want, which is just as important.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  A large portion of my practice is dedicated towards rhinoplasty surgery.  I do not perform morphing at my consultation.  I believe that the results on my gallery give the most realistic idea to the patients as to outcomes.  Although the morphine programs might provide the patient with some comfort, I believe they sales tool that might communicate an unrealistic result.  If you like the surgeon that you met with and are impressed by his or her results, then I would not be uncomfortable going to see that person.  Best wishes to you.

Ronald J. Edelson, MD · Answer

For some surgeons giving a computerized correction of your nose may seem like an implied guarantee. Different surgeons practice in different ways. I don’t see this as a red flag but if it makes you uncomfortable then get other opinions

Robert Ciardullo, MD · Answer

Computer imaging before rhinoplasty: some patients, like yourself, expect to see a computer image of the proposed “new nose“. Many surgeons, myself included do not believe that computer imaging is wise and serves the patient well. During computer imaging the perfect nose can be drawn every time. But this might not be possible on the operating table. some plastic surgeons feel that computer imaging is nothing but a promotional tool. Some studies have shown that twice as many people who come for a consultation will sign up for surgery when computer imaging is done. Some surgeons believe that computer imaging is helpful. Others feel that it is nothing but a promotional tool, that may even be considered deceptive advertising if the end result does not match the computer simulation. Older, more conservative surgeons may not do computer imaging for the above reasons. Some surgeons particularly younger ones who grew up with the computer use it more freely. I would caution a patient that computer simulations frequently do not give an accurate and true forecast of the end result. I have had people come to me for revisions that were done elsewhere, where the end result was nothing like the computer simulation they were given. So, frankly I agree with your surgeon and in my opinion consider commute computer imaging primarily a promotional toolwhich has the potential to miss lead it’s not done very realistically.

William Portuese, MD · Answer

In our practice, we routinely perform Digital computer imaging for patients undergoing a rhinoplasty procedure. We believe that is it is an educational to understand what your new nose would look like upon your facial features. Rhinoplasty is the most difficult procedure to perform correctly in the entire field of cosmetic surgery, so choose your rhinoplasty specialist very wisely based on extensive experience. Study your prospective surgeon's before and after rhinoplasty photo Gallery to make sure that it is extensive with results that you like, and the results look natural

Dr refuses to provide a visual of desired nose design

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