Rhinoplasty Anxiety- Can anxiety make the surgery more dangerous? (photo)

Hi I'm 14 and getting a MINOR rhinoplasty just to reduce a small bump. I have never had surgery but I am not scared of the pain or results whatsoever. I am only nervous for the anesthesia. Right now I am not nervous at all, but come time of surgery I know that will change. Can anxiety make the surgery more dangerous? Can it lead to complications? If I wait a few years this will not change because I have never had surgery. So basically what should I do about anxiety over my first surgery? I know that I will be really scared the week of surgery. I hate the idea of anesthesia and my main concern is what if I don't wake up? My parents have had no problems with anesthesia, I am super healthy, and I have an amazing NYC doctor. So what are the chances of something going horribly wrong?

Doctor Answers 3

Rhinoplasty and anxiety

A little anxiety is normal before surgery.  Some patients do yoga or keep busy with other things to avoid thinking about it.  If you have gone through the consultation process with your parents' consent and you are happy with the surgeon you chose, then trust him  to do a good job. Good luck.

New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Rhinoplasty complications.

Your questions raise many red flags. SInce you are 14, you must have parental consent for this elective procedure, or is one or both of your parents encouraging you? Since you have apparently scheduled surgery (hopefully with an experienced ABPS-certified plastic surgeon who is also a member of ASAPS), you must have surgical agreement that your nasal growth is complete and your anatomy is appropriate for surgical modification.

Not to mention assessment of your awareness of the risks, complications, and possible outcomes of this elective surgery (around 10% of patients will require re-operation), and belief that you are capable of informed consent.

If you are incapable of learning enough about this operation to overcome anxiety about dying (previous question) or anesthesia, and yet seem to have NO concern about pain or outcome, you may not be ready to request and agree to elective rhinoplasty surgery.

Furthermore, although there is indeed a difference between appendectomy and brain surgery (or rhinoplasty and gastric bypass), there is no such thing as MINOR surgery. Every surgery is surgery; and risks exist for each and every one. There is even risk from an IV being placed--I had to reconstruct the top of a gentleman's hand when his IV (placed in a vein on the back of his hand) infiltrated and caused the entire top of his hand skin  to die and slough off, exposing his extensor tendons. I had to place tissue expanders in the skin-grafted scalp of a baby whose scalp IV caused the entire skin on the top of his head to die. Small things are still a "big deal" and must be given their proper attention to detail.

I don't tell you these things to scare you, since you seem already scared by things that are standard parts of every elective operation. But you have to understand that everything in life has risks as well as cost/benefit ratio. And yes, lack of confidence CAN increase risks.

If you wait for surgery, it will still be your first operation, but you will be much more mature and capable of understanding the relative pros and cons, and risks and complications. As well as just what your selected surgeon does to minimize those risks. Do you know how many operations your surgeon has done during his career? And how many of his patients died, had a major complication, or required transfer to a hospital?

For example, I'll tell you mine: in the 27 years I have been in private practice here in Minneapolis, I and one or more partners have performed over 16,000 operations with 0 deaths, 0 heart attacks, 0 strokes, 1 blood clot (did fine), and 9 hospital transfers (for various reasons such as significant blood pressure deviations, EKG irregularities, drug reactions, or other concerning instability--all 9 of which did fine). But any of those statistics can change with the very next patient--a very sobering thought, and one which we strive to be aware of and prepared for each and every day, each and every operation!

Perhaps you should arm yourself with facts and statistics, but if you cannot achieve some degree of zen acceptance of the surgery you have requested, and the attendant risks (however low and "acceptable"), then perhaps you are NOT ready to undergo this procedure. However smart and mature you may be, you are still asking questions that show you may not be the best surgical candidate. Consider this carefully, and talk with your parents about your concerns. I assume they are paying for the procedure; consider also that paying for one's own operation gives a somewhat different perspective on the acceptance of risks and the "cost/benefit" ratio. Best wishes! Dr. Tholen

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

I have just written on the subject of preoperative anxiety before rhinoplasty and other procedures!

Dear BrooklynB:

You raise a very common issue, and for that reason my website's "Tip of the Month" for January, will match your particular concerns.

In my Tip, I talk about the technique that is used in my practice at the surgery centers where I work. All my patients receive medication upon arriving to the surgery center to relieve their anxiety and, frankly, if the anxiety builds before surgery, I believe the patient should also be treated with an antianxiety medication.

Some people are more worried or concerned or nervous than others. But you have been very forthright and open about expressing your concern. Interestingly, you are "not scared of pain or results whatsoever." Your concern really is about anesthesia. Remember that today anesthesia is safer than ever. The safety level is enhanced when the anesthesia specialist is a board-certified doctor anesthesiologist. That is who you want. I would not have any surgery without an MD anesthesiologist at the controls

The answer to your question, "can anxiety make the surgery more dangerous?" is yes. Why? Because people have come into the surgery center or hospital for a procedure and if they are particularly anxious, they may have elevated blood pressure, and that is not good. Now, the anesthesia doctor and your surgeon can certainly reduce the blood pressure, but you would like not to come in super-anxious. It is best when you are nice and tranquil in the holding area before the procedure with a nice slow pulse rate and low blood pressure. As a teenager, you should be an anesthesiologist's dream. It is tougher for anesthesiologists for older patients who are having face and neck lifts and other procedures because, typically, they are on medications for blood pressure or arthritis or high cholesterol. That tends to make the anesthetic perhaps a bit more challenging, although, today, with the very safe drugs and computerized monitoring, even older patients on many medications with significant other medical issues can safely have anesthesia.

My mother, who is now 96, has had three major orthopedic procedures in the last four years and cruised through all of them.The key is anesthesia.The key drug today is propofol. Don't be worried or anxious because Michael Jackson's doctor did not use it well. He was not qualified to use it and, unfortunately, he did not serve Michael well, but when you have an MD anesthesiologist using propofol, you will find that the wake-up will be very pleasant without nausea and vomiting, and the whole experience will be pretty good.

When you go for consultation, be sure to discuss the issue of your anxiety with the surgeon. If he brushes you off, look for another surgeon. you need a surgeon who cares about your concerns both physically, regarding the need for rhinoplasty, as well as your emotional needs.

Finally, you look like a great candidate for a rhinoplasty, so I hope you can have your wish fulfilled.

Study hard. Learn as much as you can .Read my books (listed below) and those of other doctors.They will be helpful. Visit my website and other websites because many are rich in information. Look carefully at the before and after photographs and the natural appearance of the "after" compared to the "before." Look at the results of the computer imaging, too.

I am big on computer imaging because I think the patient needs to see the predicted result of the surgery. The surgeon needs to show you something that he is comfortable with delivering, and you need to see the results so that you are not anxious about the result. I know you said that you were not concerned with the results, but still, it's important to know as much as you can about what can -- and cannot -- be done.

Best wishes,

Robert Kotler, MD, FACS
Over 4,500 nasal procedures performed

Robert Kotler, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 87 reviews

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.