Is it normal to not have any pre-op testing done before a rhinoplasty?

Question

I’m supposed to have my rhinoplasty/septoplasty done in less than 3 weeks. All I had was a telephone visit to go over my health history (I live out of state), and that’s it. No blood work, ekg, scans, anything required. I’m not sure if this is sketchy. The surgeon does work in a hospital. I am 25, no known health conditions. I’m also worried because he seems to buy a lot of followers/likes. He is board certified and has good credentials, but idk if these are red flags.

Eric M. Joseph, MD · Answer

That said, we do order a complete blood count and a basic metabolic panel on all of our patients before performing rhinoplasty surgery. That is our personal preference, however, it is not necessarily indicated. We operate on patients who live out of town, however, we would not commit to performing surgery on anybody until we examine them. The reason for this is that it is impossible to examine somebody's Airway with either photographs or a video conference. We require a consultation with examination and computer Imaging before committing to operate on anybody. You have not met your surgeon, consider visiting him for a consultation, in person, and I believe any insecurities you may be experiencing may go away. When it comes to rhinoplasty surgery and consultations, I always recommend to go with your gut. I hope this helps, and thank you for your question. Sincerely, Dr Joseph

Anil R. Shah, MD · Answer

Yes, if you are under a certain age requirement (usually 55yo) or do not have any pre existing medical conditions it is normal to not have any testing required pre procedure. A telephone call to go over health history is required but if you are young and healthy you may proceed with no testing at all!

Jeffrey M. Darrow, MD · Answer

Routine testing is usually not done in young healthy people. Testing would only be done if there were health conditions that warranted it. Once people get to 65 years or older an EKG, CBC and a letter of medical clearance from the patient’s primary care doctor is a safety measure as older patients may have health issues that could affect their safety at surgery. At the age of 25 you’re likely to be very healthy and rhinoplasty should be a very straightforward simple operation.

Rajaie Hazboun, MD, MBA · Answer

Thank you for posting your question here!
embarking on a nose transformation journey through rhinoplasty is a big decision so congratulations on making that decision, I am sure that you feel nervous which is normal before any surgery. To address the issue of testing before surgery, keep in mind that I am not privy to your medical history but given your age and for the sake of answering this question I am assuming that you are relatively healthy. 
When it comes to ordering pre-operative tests, most surgeons/physicians will take into account your medical history including your family medical history , previous labs, your current health condition and the surgery you will be undergoing (what is the anticipated blood loss is, how will the surgery stress your system) and use that to formulate your pre-operative testing plan. This can range from not ordering anything to extensive workups and medical clearance consult. In addition to what I mentioned most physicians utilize other guidelines from medical and anesthesia societies or the NIH.
That being said, I do meet with all my patients including out of town patients prior to their surgery to establish rapport , set expectations and to answer any questions which usually eases their anxiety, so you might want to ask for an appointment or meeting at least the day before surgery.
I hope this answer helps, best of luck in your upcoming surgery !

Peter Chang, MD · Answer

Thank you for your question!

As long as you were honest about your health history and disclosed all information you should be fine. When you're young and healthy preliminary testing is usually unnecessary. I certainly wouldn't consider it to be a red flag. I would recommend you calling the surgeons office to get clarification as to why they are opting to forgo testing. Maybe this will better put your mind at ease? Its best to have full confidence in your doctor before undergoing any surgical procedure.

Best of Luck!

Ronald J. Edelson, MD · Answer

It has been shown that getting lab work on a young healthy individual like yourself has very little or no value for a routine procedure such as rhinoplasty.  It’s not at all a red flag

Gary M. Horndeski, MD · Answer

At 25, if you are healthy then we are not required to do an EKG, chest x-rays, scans or blood work unless there is underlying health conditions. Routinely in women, we do a pregnancy test but that is all that is needed.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Oakley Smith, MD, FRCSC · Answer

Hi, It is better for you to consult with your facial plastic surgeon who can examine you and give you opinion based on examination. Healthy and young patient, usually labs not necessary.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Safety should always be the number one priority. I always have all patients get medical clearance and labs from their primary doctor prior to surgery.  If you are having doubts, here is some general advice when selecting a surgeon:

I highly recommend that my patients focus much more on real longterm before and after photographs rather than 3D imaging.   I encounter so many patients in my practice who see me for revision rhinoplasty who previously had surgery elsewhere who feel like they were mislead into surgery by surgeons who relied heavily on 3D imaging without adequate real before and after pictures to back it up.  Photoshop is easy but real surgery is very different.

I always recommend that you carefully evaluate your surgeon’s online before and after gallery on their website for both quality and quantity of results. Make sure that there are hundreds of real before and after pictures which demonstrate long-term follow up results. If your surgeon is posting mostly on table results without real long-term follow up results, that is usually a major red flag.  If a surgeon is posting mostly just splint removal day videos without longterm follow-up pictures, that can also be a red flag.   Long-term results are much more meaningful than on table results or 1 week post-op results.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Steven M. Denenberg, MD · Answer

If the doctor works in a hospital, it will probably be a hospital anesthesiologist who handles your anesthesia, and that person will insist on evaluating your health, so that will probably be done the morning of surgery. You could always call the doctor's office and ask why no blood tests, etc., and hopefully they would give you that same answer.

Now, I know that you didn't list, in your question, *everything* you know about the doctor, but it concerns me that you *do* list that he is board certified and "has good credentials." Neither of those things is any indication that the surgeon can do a nice rhinoplasty. I don't know what good credentials are, but the board certification exams never evaluate the quality of a surgeon's rhinoplasty results.

How did you find and select your surgeon? You must see his before and after photos -- that's how you know if he has the skill to operate on your nose. Maybe you already did good research along those lines? If you didn't, and especially if you haven't seen his before and afters, I'd put the brakes on your plans real fast.

By the way, how can one tell if a doctor is buying likes. I guess I've never heard of that before.

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