Had consult with facial surgeon #2 who does 4 rhinos a month but he only sat behind a desk and did some morphing. He only has 3 photos in his book and a couple online. Huh?? Thinking about going back to facial dr #1 in spite of the "I'm on tv a lot" ego as I know he does good work. Any advise on dr #2?
Should I Be Concerned That Dr Didn't Look Up or Touch my Nose During Rhinoplasty Consult?
Doctor Answers 20
Choosing a nose surgeon
This is simple......Choose a surgeon who has lots and lots of photos of surgery "HE" has done and whose results you like. A good rhinoplasty surgeon does 1-2 or more rhinoplasties every week. Nothing beats experience and reliable results. Just find someone of this standard and forget all the other nonsense. Also any good surgeon would look in the nose to make sure all was OK and certainly feeling the nose lets you know alot about the cartilages and the tone of the skin. Would a good mechanic not lift the hood or listen to the sound of the engine before offering to fix you car?
Nasal examination before rhinoplasty
You haven't bonded yet with your prospective surgeon.
It would be unusual to design a nasal surgery without looking into the nose to see the status of the septum, the airway, and the internal anatomy.
You may want to seek a few more consultations with reputable board certified plastic surgeons (preferably ASAPS members) who can evaluate your nose and come up with a reasonable plan that makes sense.
Most experienced surgeons have many before-after photographs to show their work and demonstrate their aesthetic style.
Doctor Did Not Touch Nose During Rhinoplasty Consult
Methods of examination differ based upon concerns that a patient wants addressed. I think that the best thing you can do is see lots of before and after photos. However, I must admit that a surgeon not examining your nose at all is not the usual practice. Kenneth Hughes, MD Los Angeles, CA
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Nasal evaluation during rhinoplasty consultation
It is a red flag that your rhinoplasty surgeon did not look up your nose or touch your nose during the consultation. Four rhinoplasties a month is a small rhinoplasty practice and you should look for someone who is doing 4 to 6 a week, especially if you have a difficult or complex rhinoplasty.
Concerned I may have had an inadequate consultation
Rhinoplasty is a very complex procedure that balances aesthetics with function. This requires a detailed physical examination in which both the external and internal anatomy of the nose is thoroughly evaluated. I would also look at before and after pictures to get a better idea of what to expect. If you are dissatisfied with both surgeons I would keep doing consultations until you find a surgeon who you are satisfied with.
Nasal Exam Essential During Rhinoplasty Consultation
Consultations vary greatly from practice to practice and as a patient, it can be hard to know what to look for. Your challenge is to evaluate your consultation, try to sift through the marketing (many surgeons will list rhinoplasty as a procedure on their website even if they don't specialize in it) and carefully select the best surgeon for the job.
A visual nasal examination is critical for evaluating the relevant anatomy and discovering potential breathing problems. Evaluation of the nasal septum and upper lateral cartilages allows for planning of hump reduction techniques. For example, narrow angles between the upper lateral cartilages and nasal septum (the internal valve area) may predispose to the patient to post operative breathing problems and may require special techniques to help prevent those problems from occurring. Also, it is very important in general to have a thorough intranasal exam to rule out the possibility of any medical conditions that might otherwise go undiagnosed. I once found a cancer inside someone's nose as I consulted them for rhinoplasty. Needless to say, it was not a good time for cosmetic surgery.
The attached article provides some more tips on assessing your consultation, and the video talks about the importance of that consultation.
How to choose a good rhinoplasty surgeon
A seasoned and experienced rhinoplasty surgeon will examine the internal and external nasal anatomy to assess for proper surgical technique that would help patients. It is crucial to improve the function and aesthetic at the same time. An expert rhinoplasty surgeon makes most of the planning for a nasal surgery during the initial examination. Having a good rhinoplasty requires a nose specialist and a skilled surgeon. You also want to take into account whether you feel comfortable with the surgeon, as well as the doctor's experience and other qualifications. Be sure to check his before and after pictures to get a feel for the results the doctor has previously produced for other patients.
I would look for Dr #3, or #4 until you feel fully satisfied. Why settle???
If you live in an area that does not have enough choices, I would travel.
Examining the Nose during Rhinoplasty consultation
Yes, as other plastic surgeons have already stated, it's important to fully examine the nose during the rhinoplasty consultation. Every surgeon's rhinoplasty consultation will be a bit different. Some surgeons may even obtain further testing such as CT scan. However, most rhinoplasty surgeons will touch the nose and look on the inside. While most perform computer simulation or morphing, this portion of the consultation maybe more variable. Ultimately, you are developing a professional relationship with the physician and staff. If you feel uncomfortable for any reason, then it may be wise to seek another opinion. Best of luck.
I typically tell patients in the consultation that you have to be comfortable with both me and my office staff because we will have a relationship for some time to come including throughout your recovery. With that in mind, it is typically the doctor's job during the consultation to fully inform the patient about the procedure at hand (including but not limited to all reconstruction work that will be done and any grafting harvest locations). During a rhinoplasty consultation I do typically examine the internal and external structures of the nose to rule out any deviation that might exist. Generally, I refer patients out to get facial CAT scans prior to booking any surgery.
Following the consultation, my office staff will go over previous patient pictures. As you were already told, it is not every patient's wish to have pictures published in the doctor's reference gallery, and therefore, the gallery could possibly be short in some areas. I would definately do some online reasearch as there are a lot of websites such as vitals, healthgrades, and yelp that allow patients to write small testimonials about their interaction with the doctor and the office staff. If you at anytime question any part of the process it is my advice that you continue seeing doctors on consultations. As I stated there has to be a fit mutually between you and the doctor and I stress the importance of this during my consultations with all new patients.
I hope this helps you and good luck
Fadi Chahin MD, FACS
Plastic and Reconstructive Surgery
Diplomat, American Board of Surgery
Diplomat, American Board of Plastic Surgery
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.