Is an Internal Nose Exam Standard Procedure at the Consult or Pre-op Before Rhinoplasty Surgery?

I underwent rhinoplasty 9 months ago to disastrous results. I was never given an internal nose exam prior to surgery and I'm wondering if such an exam is standard procedure. To be clear, my surgeon never looked up inside my nose through my nostrils until AFTER surgery during one of the post-op appointments. Is this normal? Many thanks for your time.

Doctor Answers 6

Internal nasal exam common before rhinoplasty

In my practice it is routine to examine inside the nose during the rhinoplasty consultation. It is important to fully assess both the functional and aesthetics aspect of the nose before surgery.


Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 reviews

Internal nasal exam

An internal nasal exam is an important part of the rhinoplasty consultation.  I am not sure why your surgeon did not perform this on you?

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Internal nasal exam before surgery?

During consultation for cosmetic rhinoplasty I always ask about the functional aspects of the nose--history of trauma, fracture, airway problems, sinus difficulties, snoring, allergies, etc. Many patients have none of these issues and simply want cosmetic changes to their nose. Of course I tell them that I will strive to not only achieve their cosmetic goals, but also maintain (or improve) their airway after cosmetic changes that is some cases MIGHT affect breathing. So sometimes septal or turbinate work is necessary, and I routinely perform this at the time of cosmetic rhinoplasty without additional charge to the patient. If it seems likely based on examination or history, I schedule additional time in the operating room accordingly.

But I must say that I don't actually do an internal nasal examination at every rhinoplasty consultation--I do that when the patient is asleep and maximally vasoconstricted, with me wearing a headlight and using a nasal speculum. Many patient find this uncomfortable during their consultation, don't want to be vasoconstricted, and the exam is often confined to the anterior third of the nasal passage. Incomplete exam equals incomplete information. If the history suggests an examination is valuable, then of course one is done. But to say it is "necessary" at the time of every consultation may be a slight overstatement! Looking after surgery can also be uncomfortable, and because of swelling, crusted blood, or mucous may yield little useful information.

Your unsatisfactory result is unfortunate, but is a result of poor surgery, poor healing, genetic scar tendencies, bleeding, or other issues, not because your surgeon did or did not do exams before and after surgery. Looking for medical negligence will have to be based on other facts, but not this. Sorry.

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Preop nasal exam

Yes internal nasal exam is part of preop rhinoplasty assessment. A surgeon must be aware of a patients internal nasal anatomy before reshaping the external nose.

Philip Solomon, MD, FRCS
Toronto Facial Plastic Surgeon
4.3 out of 5 stars 96 reviews

An internal nasal exam is routinely performed during a consultation for Rhinoplasty Surgery.

An internal nasal examination is an important part of the evaluation for Rhinoplasty Surgery. Many patients will have deviation of their nasal septum, or turbinate enlargement, and these functional issues may be repaired at the time of nose job surgery.

Dr. Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 421 reviews

Nasal exam prior to rhinoplasty

Internal nasal examination is absolutely a requirement prior to rhinoplasty. Even for cases where there is no concern about breathing, even small changes in nasal appearance can lead to difficulty breathing trough the nose. I would seek consultation with a surgeon experienced in rhinoplasty who can provide guidance.

P. Daniel Ward, MD
Salt Lake City Facial Plastic Surgeon
5.0 out of 5 stars 42 reviews

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