Which is better - the patient telling the surgeon the changes they like or let the surgeon do what they think is appropriate?

Question

Best approach to nose changes during rhinoplasty. Which is better - the patient telling the surgeon the changes they would like to their nose OR let the surgeon do what they think is appropriate? Goal is to get the most aesthetically appealing nose that compliments my face.

Eric M. Joseph, MD · Answer

During a rhinoplasty consultation, we always ask our patients what is bothering them about their nasal appearances. Computer imaging is then helpful for establishing goals. Hope this helps! Dr Joseph

Cory Bovenzi, MD · Answer

I think the best approach is that you come to the goals of the rhinoplasty together as a team. The patient describes the parts of the nose they would like to change and the surgeon gives their recommendations for what are reasonable options- through a conversation you both come to a joint conclusion. This is the philosophy I use with all my patients and by having a similar goal it sets you up for success.
Best of luck!

Timothy Ortlip, MD · Answer

This is a wonderful question. Communication between you and your surgeon is the most important thing you can do to achieve the desired results. What you think looks good may not be consistent with the surgeons opinion and vice versa. I love getting input and feedback from my patients in terms of the changes they would like to see with their nose. It is the surgeons job to then direct the patient to what is reasonable/possible within the confines of surgery and the patients other facial features. I typically will do this through 1-3 rounds of morphed photos. If you can not come to an agreement with your surgeon it may be time to have consultation with a surgeon who shares the same aesthetic ideals as you. Hope this helps!

Lucian Ion, FRCS · Answer

This is a very valid question to which there is probably no perfect answer.

I have been using computer simulations ever since I started rhinoplasty surgery and noticed that there are significant variations between what patients perceive as their ideal outcome and what surgeons perceive as an ideal balance.

In my opinion, an interactive approach is the most valuable because the surgeon can highlight conflicts and misrepresentations included in the desired changes that patients describe. Feasibility is another item of discussion that is very important when patients express their preferences.

Either way, there are also variations between the project of change and the result and so she has not yet reached full control of the nasal shape.

One potential problem with following the goals described by patients is the influence of fashion and filtered photographs available online. These unfortunately can produce are combination of unrealistic expectations and nasal shapes that are suitable for an age band rather than for a lifetime.

Caner Kacmaz, MD · Answer

Thank you for your question. During my consultation wth my potential patient, my first question is what is their expectation and complaint? After I find out their expectations I give them my opinion. For example, if a patient has a long and narrow face very small nose will not suit her.  Most important thing is to give them a natural look that will complement their facial features. I recommend you bring some sample pictures that are close to what you like and let your doctor explain to you if it will be suitable for you. Take your time during the consultation and be open to suggestions from your surgeon. Best of luck to you.

Zoran Potparic, MD · Answer

Any surgery, in particular elective cosmetic surgery, will need at least  2 players, patient and a surgeon. Good communication between the two, exchange of questions and options, is the most important part of preoperative communication and postoperative support. Ask as many questions as needed. Good luck.

Stephen Kleid, MBBS, FRACS · Answer

The patient is the one that needs to be happy with the result.
But sometimes, the surgeon needs to guide the patient’s expectations.

Steven J. Pearlman, MD, FACS · Answer

I always start a consultation asking the patient what they don't like about their nose and what their goals are. It is not about asking them to design their surgery but more to see why they came in. I then examine the patient and use computer imaging to show what I see and what changes I suggest. Most patients are realistic about their goals. Computer imaging is  a great way to have a dialogue about realistic changes and what looks best on the patient. If the surgeon is honest and doesn't overdo the imaging it is very good for both coming to a mutual goal and also to weed out unrealistic expectations.

George Bitar, MD · Answer

To get the best results from rhinoplasty, you and your surgeon should be working together as a team.  You should tell the surgeon what changes you would like to your nose, so they can understand your desires and expectations.  In turn, your surgeon should tell you if your aesthetic goals are possible, given your specific anatomy.  With their rhinoplasty experience, your surgeon may offer alternative plans to ensure that the surgical results will blend harmoniously with the other facial features.  There should be open communication between you and your surgeon, so you can share and learn from each other to get you the best result possible.

Robert Ciardullo, MD · Answer

Should the patient or the surgeon determine the goals in Rhinoplasty? most of what a plastic surgeon attempts to achieve during a rhinoplasty is based on well-established norms of aesthetics in western culture. If you have an experienced nasal surgeon and don’t have an idea of what you are looking for he will know what is most beautiful and what best suits your face and other features. The good news is that there is very little choice for a female if the goal is to be as pretty as possible. This is different in men who can get away with all kinds and sizes of noses. That said, there is an element of taste and there is some slight variation between a really pretty nose that is somewhat understated and “natural“ in appearance versus a nose that is slightly more “done“ and perhaps a little smaller and cuter but less “natural The real choice isn’t “which nose?” But how much to trim your own nose; a little less, leaving it more “natural“ or a little more, making it a little smaller, cuter and slightly less natural. Ultimately that is a choice of the patient, But a choice which is made after a discussion of goals and a discussion of the type of look that the patient may naturally have or is seeking. Some are seeking a more striking look while others are seeking a more cute look. The patient’s overall size, height, and other facial features play important role in making that decision as well as the patient and the surgeon. But in the end if a patient is unsure, a good rhinoplasty specialist will usually have a very clear idea of what will give the maximum aesthetic improvement, assuming currently established western culture taste and norms.

Which is better - the patient telling the surgeon the changes they like or let the surgeon do what they think is appropriate?

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