My daughter wants to have Rhinoplasty and found a board certified plastic surgeon that she wants to use. However, her ENT said that she is better off going to a doctor who is both an ENT and a plastic surgeon so that he can better address both her issues. I am concerned that, although this plastic surgeon has a great eye and hand in being able to give my daughter a great nose, he may not be able to perform Septoplasty in the same way as an ENT can. Is this true?
Should a Rhinoplasty or Septoplasty Surgeon Also Be an ENT Doctor?
Doctor Answers 17
Rhinoplasty Surgeon Qualifications
Rhinoplasty and septoplasty are delicate operations which require experience and an aesthetic eye. Both otolaryngologists (ENT doctors) and plastic surgeons receive some training in these operations during training. The experience of these doctors after they enter practice can be quite different, with some performing many rhinoplasty procedures, and others almost none.
Therefore it is essential to find out who in your community does these operations both frequently and well. If there are significant functional problems it would be wise to enlist a doctor with training in these areas, usually someone with an ENT background and facial plastic surgery training.
Septoplasty and rhinoplasty
The topic and operation "rhinoplasty" (nose job) is quite complex. There are different schools of thought. A lot of rhinoplasty techniques weaken the structural framework of the nose, possibly leading to cosmetic and functional problems of the nose in the long-run. It is therefore essential that the nose is being supported structurally with cartilage grafts (septum, ear, or rib), with the septum being by far the most favorable donor site. Ear or rib cartilage is typically only utilized if septal cartilage is insufficient or not present at all due to prior surgery, trauma, cocaine use, etc. It is therefore commonly recommended that a septoplasty is performed in conjunction with a rhinoplasty, not only to straighten the septum and thereby improve nasal breathing, but also to utilize the harvested septal cartilage to stabilize the nose to prevent pinching and collapsing from occurring in the long-term. While all Facial Plastic Surgeons have a background in ENT and hence are trained and equipped to perform septoplasties, not all Plastic Surgeons perform septoplasties, although many do. Therefore, instead of focusing on the specialty (Plastic Surgery vs. Facial Plastic Surgery), I would have a frank conversation with the surgeon(s) you consider whether or not he or she performs septoplasties. Also, you should look at pre-OP and post-OP photos of actual patients and decide if you like the surgeon's aesthetic preferences. And furthermore, you need to be comfortable with and confident in your surgeon! Whichever surgeon you choose, if no nasal endoscopy is performed during your consultation, chances are that this surgeon does not perform many (if any) septoplasties, as the entire septum cannot be evaluated unless a nasal endoscopy is performed in the office. At the end of the day, there are many opinions and preferences among rhinoplasty surgeons, and there is no right or wrong way. The consensus among the surgeons seems to be, though, that some sort of structural grafting is necessary for a successful rhinoplasty operation. Whether or not such is performed by a Plastic or Facial Plastic Surgeon is secondary.
Rhinoplasty and Septoplasty; General Plastic Surgeon or ENT?
Way to stir up the old specialty "wars".
ENT, Facial Plastic, and General Plastic Surgeons all perform septorhinoplasty. The surgical procedure is not a commodity, but an operation that combines the skill, experience, training, creativity, and aesthetic sense of beauty of the surgeon to achieve an attractive (cosmetic) as well as an excellent breathing (functional) result.
There are surgeons of all of the above cited specialities that perform the operation very well, and there are surgeons who do not. It is important to choose your rhinoplasty surgeon carefully. Ask questions, speak to previous patients, take your time.
The surgeon is more important than the speciality.
Good luck and be well.
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Experience matters, so be inquisitive
The more experienced and talented a surgeon is, the more likely he or she will produce a favorable result for you. The reality is that expertise in rhinoplasty can be found in either a plastic surgeon, an ENT surgeon, or a facial plastic surgeon with a background in ENT surgery. Likewise, it is also the case that any one of these specialties may have surgeons who are not particularly skilled in rhinoplasty!
Therefore, its really important to take your time, shop around, and do your homework. Undeniably, the training in septoplasty procedures is most extensive for those surgeons who spend their years in ENT residency programs. The treatment of nasal obstruction is a big part of this field. However, the training and expertise in rhinoplasty surgery - the outside changes - is less consistently better in one vs the other of these disciplines. It really depends on the individuals experience.
So, try to find out: how many septoplasties does the surgeon you are considering do every year? How many rhinoplasties? I do think it makes imminent sense to choose a surgeon who treats both nasal obstruction, and does aesthetic nasal surgery, routinely.
Rhinoplasty outcome depends on credentials, experience, and photos.
When considering Rhinoplasty and Septoplasty, your surgeon's credentials and personal experience is critical.
You should find a board certified surgeon well trained in the art of nasal surgery. You should see many favorable before and after photos before proceeding. A frank discussion with your surgeon about your daughter's nasal airway will alleviate any concerns. Experienced nasal surgeons routinely correct septal deviations during Rhinoplasty, and also routinely harvest cartilage grafts from the septal cartilage to support the tip. If you have any doubts or concerns, get a second opinion from another board certified rhinoplasty surgeon with the criteria I listed above.
Best of luck.
Rhinoplasty and correct surgeon
A board certified plastic surgeon or a qualified facial plastic surgeon(ENT) can handle both septal work and cosmetic rhinoplasty work. The key is to find someone who has experience.
Experience is king
The ability to perform a quality septoplasty in addition to a rhinoplasty really depends on the individual's training and experience. In general Facial Plastic Surgeons have ENT training prior to facial plastic surgery and learn the nose and sinuses inside and out. However, many Plastic Surgeons are also qualified and experienced in septoplasty.
What is important is how well trained and how often your proposed surgeon performs both septoplasty and rhinoplasty; both as combined and separate procedures. Did the proposed surgeon even look inside your nose? Did they use a special headlight and nasal instruments. Even the exam can be an indicator of how comprehensive the nasal surgeon is that you have found. I am amazed when seeing consults for revision surgery, patients often state that their original surgeon never even looked inside their nose.
It depends where you are
Both ENT doctors and plastic surgeons are trained in nasal surgery, usually both functional and external nasal surgery. But the training programs and experiences of each doctor may vary greatly. In some communities it appears that the ENT doctors do most of the nasal surgery and in other places the opposite is true.
You can not make a blanket statement that one is better than the other. I would question each doctor about their experience and their recommendations and base your decision on who you feel most comfortable with. Also, any rhinoplasty surgeon with a lot of experience should be able to show you literally dozens of before and after pictures of their own work.
It depends on the surgeon and the surgery.
It will depend on how many septoplasties the surgeon has done and how good he is at doing noses! In general, your doctor is correct. Usually ENT training is more extensive in nasal surgery issues. Having said that, you can find good and bad of both types of surgeons. Ask how many of these operations your doctor has done and what is his training in them.
Septorhinoplasty by plastic surgeons vs. facial plastic surgeons
The answer to your question is based on the training and experience that your particular surgeon has. Plastic surgeons complete a 3-5 year training program in general surgery where they have no exposure or experience in performing septoplasty. Then, they complete a 2-3 year training program dedicated to plastic surgery. They may or may not have a large experience in performing septoplasties or rhinoplasties during this time.
Whereas, facial plastic surgeons who complete 1 year of training in general surgery then 4 years in head and neck surgery (ENT) training prior to their fellowship training in facial plastic surgery have a lot of experience and training in both septoplasty and rhinoplasty.
So as a general rule, facial plastic surgeons usually have more experience in septoplasty than plastic surgeons. That being said, you should address this issue with your plastic surgeon and only go to the surgeon who your daughter is most comfortable with and has excellent results both in septoplasty and in rhinoplasty. I hope that helps. Best regards.
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.