In One of my Rhinoplasty Consults the Doctor Gave Me an Unsure Answer. Should This Be a Red Flag?

I have met with 2 plastic surgeons so far and sadly still don't feel comfortable or reassured. One said I would need spreader graphs, and the other told me he wouldn't know if I needed them, until he was actually in there doing the surgery because apparently he couldn't tell by looking at me. Plus he didn't even examine my nose. Should a good surgeon be able to tell if I need the spreader graph before I go in for surgery?

Doctor Answers 12

You should be concerned that your nose was not examined during your consultation for Rhinoplasty Surgery.

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I read your concerns:

Sounds like you will need to keep searching till you find someone you're comfortable with. I routinely examine my patients' noses that desire nose job surgery. I feel the thickness of the nasal skin, and the firmness of the nasal cartilage. I also examine the nasal septum and nasal airway in everyone. If you met a surgeon that did not touch your nose, you should consider that a red flag, in my opinion.

The "spreader graft" issue is less concerning to me as there is controversy when they should be used. Some RealSelf experts use them rather routinely. I use spreader grafts to correct an indentation of the upper lateral cartilage, which is the supporting cartilage in the mid-bridge of your nose, and this is typically obvious to me before surgery is performed.

Hope this is helpful for you.

Dr. Joseph

West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Uncertainty about technical details

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Whether or not spreader grafts are needed during surgery is not always known ahead of time, although many times it is.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Unsure answer at rhinoplasty consultation

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The determination of needing a spreader graft is usually made at the time of the consultation in the majority of cases.  On a rare occasion during the surgery a spreader graft might need to be added at the end of the case if there is an asymmetry present that pops up during the procedure itself.  Most experienced rhinoplasty surgeons who perform spreader grafts usually know beforehand when they will put them in either on one or both sides.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

A Nasal examination is needed for all Rhinoplasty Consultations

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Yes this is a Red Flag for yours you have not met a level of comfort with either of your consulting Plastic Surgeons. Secondary Red flag no examination and surgical plan.I personally do a nasal examination on every Rhinoplasty consultation so that I may properly inform the patient what procedures they will need performed. I would make a few more consultations and when you feel comfortable and have a good repore with the surgeon and staff, the proper diagnosis is made and a thorough examination is performed you will feel comfortable to schedule your procedure.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 218 reviews

Questionable Responses During Rhinoplasty Consultation

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Unsure responses are a red flag. You need to get additional consultations. An experienced rhinoplasty surgeon will provide clear answers to you questions, explain the problem, and discuss alternatives before describing the operation and establishing reasonable expectations.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Unsure of rhinoplasty surgeon

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I would be most concerned that the surgeon didn't actually examine your nose during your consultation. A thorough nasal exam is an important part of the consultation process.

Often we know in advance if spreader grafts are needed. This is especially the case if a relatively large hump is removed from the bridge or if there is pre-existing narrowing in the middle third of the nose.

If you're not comfortable with either surgeon that you have met with you should look for another surgeon to find someone you feel more confident in.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Uncertainty When Choosing The Right Surgeon

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Dear Turk123,


Being uncertain about a surgeon means that there is something wrong and you did not develop the required trust for the given surgeon to perform on you.

That being said, I believe that you should consult with additional surgeons as far as they are Board Certified with ample experience.

In your case, the surgeon should be able to tell you if spreader grafts are needed before the surgery.

Please remember that commendable results require an exceptionally skilled surgeon to perform the surgery and settling for anything less than that increases the chances of corrective surgeries dramatically.

I hope this helps.
Thank you for your inquiry.
The best of luck to you.

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 205 reviews


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Keep checking different experienced Rhinoplastic Cosmetic Surgeons until you find one that can elucidate your concerns and help you feel good about your choices.  You will know when this happens!

Robert Shumway, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 12 reviews

Red flag

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You have answered your own question. You need to go for additional consults. A rhinoplasty is a very customized procedure whose result is out there for everyone to see. You have to be absolutely confident in and trust in the surgeon you choose. I always have a detailed written step by step plan for every patients rhinoplasty before we get to the OR. Sometimes the steps change during the surgery if the result is not looking like it should, but it is never left to chance and always meticulously planned in advance. Good luck!

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

Choosing a surgeon for rhinoplasty

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Without photos or a face to face examination it is impossible to say whether or not spreader grafts are indicated in your case. I would be very reticent to have a surgeon do a rhinoplasty without a preoperative examination of the nose and plan for surgery. Going into surgery without a plan and deciding what to do during surgery depending on what the surgeon sees or thinks during surgery can be problematic. In the absence of a preoperative plan the surgeon cannot wake the patient up ask permission to do something not agreed to beforehand then put the patient back to sleep and continue surgery.

If the surgeon says the decision for a spreader graft is made during surgery the next questions should be what specifically are the deciding factors and where specifically is that cartilage going to come from.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles 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.