When surgeons recommend procedures, where is the line between what the patient thinks they need and the most aesthetic result?

Will you just perform only what the patient thinks they want or will you tell them if additional changes are ideal? Korean surgeons recommended me blunt nose correction, bridge raised and alarplasty. Most American ones suggested just alarplasty and discouraged anything more. I told all that I don't know what's ideal, as long as it's conservative. There's understandably different aesthetic tastes and cultural beauty standards, but I'm wondering if surgeons feel refrained from suggesting more.

Doctor Answers 9

Who Has The Final Decision As To What Surgical Procedures Are Done - The Patient Or The Surgeon?

Thanks for this really difficult and complex question.  The obvious answer is that the surgeon and the patient collaborate in the decision process as to what surgeries need to be done to get the best aesthetic result. 

In today's world with the internet at everyone's disposal, very often patients come in with ideas as to what surgeries they want and how they want the surgeries done.  Very often, through research and talking to friends, patients come up with excellent ideas.  On the other hand, at times, they do not take every possibility into consideration and it is the surgeon's responsibility to let the patient know what surgeries would be best for the stated problem. 

I believe surgeons should have strong opinions, and that way, patients can know what surgeries each surgeon feels appropriate for that patient's particular problem.  The patient should choose the surgeon, and the surgeon should choose the procedure.  Very often, the patient and the surgeon agree as to what procedures would be most aesthetic.  On the other hand, an ethical surgeon will refuse to do a procedure if he or she does not feel it is in the patient's best interest. 

With reference to your question about surgeon's refraining from making suggestions, this truly depends upon the surgeon's personality.  Some surgeons will make multiple suggestions so as to get the most aesthetic result while other surgeons may feel it is inappropriate to talk about other areas not discussed by the patient. 

Who has the final decision? #plasticsurgery #managingexpectations

This is such a good question. I can not speak for other surgeons. I can only tell you what I do. I always give my patients and adequate opportunity to express their desires. Through my questioning I try to gain as good of an understanding as possible as to what a patient is trying to achieve. I then perform a thorough physical exam and make a plan. It is up to me to determine if what you are expressing and what I feel can be done in the operating room match or not. If I feel that a patient is being unrealistic with expectations the I try to tell them what they can expect. That is the best anyone can do. So, you need to see as many well qualified surgeons as it takes until you feel comfortable that what you are being told is legitimate.

Richard J. Brown, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 49 reviews

When surgeons recommend procedures, where is the line between what the patient thinks they need and the most aesthetic result?

Dear one,
Many thanks for one of the best questions that I answered on this website.
Yes ,the teachings of PS dictates that he should not tell the patient what he feels about his shape and try to get from the patient what he or she thinks is wrong with the shape.
If he suggests what is wrong and if the patient does not identify its not an ideal situation.
I can only tell what I do to circumvent this. My photographer takes her pictures and though photo animation I and patient reach a conclusion what he or she is looking for.
If this can be achieved I tell him and then tell him what surgical steps will be needed to reach the result.
I am sure most surgeons do it this way, if not they should.
I wish you good luck.

Rhinoplasty for nasal bridge augmentation and alar plasty

It is true that there is a fine line between the surgeon's  aesthetic goal and the patient's aesthetic goal. It is critically important that the patient and the surgeon  communicate their anticipated goals regarding the rhinoplasty procedure. Computer imaging can also help with the communication process. When patient's desire a surgical result that  is un-natural, we  will not perform that procedure for them. It is important to perform surgery and it looks natural, and not artificial.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Asian Rhinoplasty Suggestions

You may find that you're getting differing suggestions from American versus Korean surgeons based a bit on a combination of surgical comfort level and aesthetic standards. This may be the case especially if you're seeing American surgeons who don't do much rhinoplasty on patients of Asian backgrounds.

That being said I see a lot of Asian patients here in Seattle and quite commonly perform bridge augmentation along with alarplasty and other tip work if my patient and I concur that it would be helpful and in line with their goals. Not everybody gets the exact same work done in my practice -- it's quite customized.

There is no one "right" aesthetic goal when it comes to rhinoplasty. I do find that preoperative digital morphing is a hugely valuable tool in allowing my patients and I come come to a better understanding of what changes we want to achieve.

You can read more about Asian Rhinoplasty (and see some before and after photos) at my web reference link below. 

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 reviews


I think that you need to convey your concerns and desires to your surgeon. That is how I work with my patients. Their concerns are of paramount importance.

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

When surgeons recommend procedures, where is the line between what the patient thinks they need and the most aesthetic result?

   I think that are individual imprints that a surgeon makes on each rhinoplasty.   I think that carefully examining before and after results can give you some insight into this.  I only make additional recommendations if I feel that the changes requested by the patients will create an imbalance.

Kenneth Hughes, MD

Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews


I consider myself the "patient's advocate". I take my knowledge and my experience to give them the best advice possible.  Certainly in the case of noses I will take their photo digitally and then alter it with the patient's input so they can see a possible future result on their face.  Assuming that result is realistic I can then inform them how I might accomplish it.

Dr Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 62 reviews

Patient desires versus safety and surgeons opinions

Another good question.

Many times as a surgeon I am asked to perform a treatment that I do not feel safe or within my capabilities or in the patient's best interests.  This why a comprehensive consultation is necessary, laying all of the facts on the table. After discussing the facts the patient may want to get a second opinion.  It is important to go to reputable surgeons so the surgeon is not motivated by money rather than the patient's best interests

The nasal surgery is  challenging for a variety of reasons.  The results are very obvious even if they are not good. The circulation to the nose is compromised easily and can lead to problems with healing.  There is a paucity of soft tissue coverage to camouflage or soften grafts as are commonly used in ethnic nasal surgery.  Implanting synthetic material in the nose can lead to difficult infections, etc.

All of this being said, if the patient goes to a reputable surgeon who is experienced in the surgery that fulfills the need perceived by the patient, then the result will be happiness in everyone.

Richard O. Gregory, MD
Orlando Plastic Surgeon
4.6 out of 5 stars 12 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.