Private Practice vs Teaching Hospital for Revision Rhinoplasty?

Question

I had a revision 20 years ago and it did not go well. I'm told the graft was not placed properly causing asymmetry, pointy tip, and obstruction in one nostril. I also have a deviated septum and difficulty breathing through my nose. I found a nationally recognized surgeon for revision rhinoplasty (this would be a 2nd revision)but he runs a teaching hospital. Should I be concerned that fellows, students, residents will be a part of my surgery? I had a consult and he said they wouldn't be but from my research, he wouldn't really have a say even if I pay privately instead of using my insurance for the functional part. He's ABPS and ENT board certified. Does it make better sense to have surgery done by a surgeon who has a private practice and ENT and ABFPS certified in order to guarantee that only his experienced hands would be handling the surgery? I guess I'm wondering how teaching hospitals work in practice and how that would effect the aesthetic outcome of my 2nd revision rhinoplasty which I'm told would be a difficult one. Thank you so much for any information you can provide.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Here is my best advice when selecting a surgeon:   I highly recommend that my patients focus much more on real longterm before and after photographs rather than 3D imaging.   I encounter so many patients in my practice who see me for revision rhinoplasty who previously had surgery elsewhere who feel like they were mislead into surgery by surgeons who relied heavily on 3D imaging without adequate real before and after pictures to back it up.  Photoshop is easy but real surgery is very different.

I always recommend that you carefully evaluate your surgeon’s online before and after gallery on their website for both quality and quantity of results. Make sure that there are hundreds of real before and after pictures which demonstrate long-term follow up results with standardized lighting and standardized background. If your surgeon is posting mostly on-table results without real long-term follow up results, that is usually a major red flag.  If a surgeon is posting mostly just splint removal day videos without longterm follow-up pictures, or all patient selfie’s without real longterm in-office formal pictures that can also be a red flag.   Long-term results are much more meaningful than on table results or 1 week post-op results. Selfie’s can also be fun to look at, but these can often have a filter and do not represent true longterm results because of this and are not as valuable as real longterm in-office before and after photographs on your surgeon’s website with standardized lighting and standardized backgrounds.

Make sure you are going to a surgeon with hundreds of long-term before and after pictures on their website with standardized lighting and standardized backgrounds. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D. FACS
Harvard-trained board certified plastic surgeon

Randal Haworth, MD, FACS · Answer

A second revision for a misplaced graft, tip asymmetry and a blocked nostril is one of the more demanding operations in nasal surgery, so your question is a fair one. In an academic setting, residents or fellows may assist, and how much they do varies by surgeon and institution. You are entitled to ask exactly who will be in the room and who will perform each part of the operation, and to have that written into your consent. Certification by either surgical board can be appropriate; what matters more is how many secondary rhinoplasties the surgeon does, his comfort with structural grafting (often ear or rib cartilage when the septum has already been used), and whether breathing and appearance are planned together. Ask to see his revision results, and consider a second in-person consultation with a surgeon who focuses on revision rhinoplasty before deciding.

Private Practice vs Teaching Hospital for Revision Rhinoplasty?

Answers (2)

More Revision Rhinoplasty Questions

2.5 years post rhinoplasty - tip swelling periodically. What can cause this and how can I fix it? (Photos)

Is there any way to widen my alar base after it was excessively cut during my first rhinoplasty? (Photos)

Can a stitch come loose 5 years post revision? (Photo)

Is it possible to widen the base after an alar plasty? (Photos)

Worried about revision rhinoplasty following consultation today - what can I expect from my results? (Photos)

Nose is small for my head - Is this revision rhinoplasty result possible? (Photos)

WE SEND PRETTY
EMAILS