In house procedure?

Question

So I had an open rhinoplasty 3 years ago, and I've been struggling to breath from right nostril and my nose is hanging again from left angle, and nose crooked from front. I had reach out to my rhinoplasty surgeon who did the surgery, he gladly agreed to do a small revision via in office but would only be charging me the supplies fees. I'm reluctant to do a revision with him. If I choose another doctor would I be charged more for this revision? Feeling very insecure about this.

Eric M. Joseph, MD · Answer

Many times, a droopy nasal tip appearance and nasal obstruction requires general anesthetic and tip plasty with cartilage reconstruction. If anyone ever has any hesitation about nasal surgery, it's always best to slow down and evaluate all of your options. I hope this helps and wishing you well moving forward. Sincerely, Dr. Joseph

David M. Kowalczyk, MD, MBA, FACS · Answer

Hello there. Yes, if you had another revision with a different doctor, you'd likely be charged whatever fee he or she feels is appropriate. Re-visiting with your surgeon is the best first option. But, if trust is an issue, you may have to consult elsewhere. Best of luck.

Steven M. Denenberg, MD · Answer

If you are having a revision, you should have everything that you don't like about the nose addressed. You don't want to have three operations. Any revision is a real revision, and it's almost impossible to elevate the tip of the nose reliably, or to correct asymmetries, in a small in-office revision. In fact, I don't know what "real" problem with a nose *can* be corrected in a small in-office revision. I've never done one in almost 40 years of practice.

A better idea is to figure out everything you want to change, and by how much, and have a surgeon assist you with pinning down the goal with morphs, and then decide whether to do that or not. If you have a small in house revision and nothing changes, then the real revision later is *not* a second operation: it's a *third* operation with the additional difficulties and risks of a third operation, and you'd have to wait almost a year after the in-house thingie to have it done.

I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct 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.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.

William Portuese, MD · Answer

Much more information is needed, such as a full set of facial photographs from all angles, and specifically identifying the issues that are bothering you on those photographs. In addition, a copy of the operative report would also be helpful to understand what surgical maneuvers were performed in the first surgery.

In house procedure?

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