Rhinoplasty is the most difficult cosmetic surgery procedure to perform.  For this reason, it is essential that someone looking to have this surgery performed be well-educated and armed with the information they need to make a good decision.  As a board-certified plastic surgeon specializing in rhinoplasty surgery here in Denver, I feel that it is important for patients to ask questions of me when they consult with me about their choice for rhinoplasty.

Here are my Top 10 Questions to Ask a Rhinoplasty Surgeon…

1. “Are you board-certified?”

Board certification by the American Board of Plastic Surgery and/or the American Board of Facial Plastic and Reconstructive Surgery shows that your surgeon has completed accredited training in an ACGME accredited residency program and has passed both a rigorous written exam and an oral exam that tests them on their actual patients clinical care and outcomes.  Maintenance of Certification status further acknowledges that your surgeon continues to stay at the forefront of knowledge in their specialty.

2. “Is rhinoplasty a significant part of your cosmetic surgery practice?”

There are lots of different procedures that a plastic surgeon can perform.  While every surgeon claims that they perform rhinoplasty, the fact is that this procedure is not all that common in most practices.  Breast surgery and liposuction are more common procedures to ask for, and so surgeons are more commonly performing those procedures.  Rhinoplasty is not something you dabble in.  For the greatest chance of success with your rhinoplasty, I always recommend that you consult with a rhinoplasty specialist.  Rhinoplasty makes up roughly 25-30% of my practice.

3. “How many rhinoplasty procedures do you perform each year?”

In the U.S. the average ASAPS (American Society of Aesthetic Plastic Surgery) member performs between 6-12 rhinoplasty procedures/year.  I am an ASAPS member and I average around 50 rhinoplasty procedures/year.

4. “What is your revision rate?”

Rhinoplasty surgery is a very complex operation.  Some patients have more difficult noses than others.  For this reason, there is always a chance that a revision operation might be necessary after a nose heals from an initial surgery.  Most patients getting revision surgery really are getting touch-up or finesse surgery to get the best result possible.  A smaller percentage of patients have revision surgery because the initial procedure did not turn out well.  Nationally, in the U.S., you can expect a 30-50% revision rate in primary rhinoplasty. Amongst rhinoplasty specialists, the average revision rate is closer to 10%.  My primary revision rate is in line with this.

5. “What is your preferred technique for performing rhinoplasty?”

Rhinoplasty surgery can be performed either as a closed or an open operation.  A closed rhinoplasty operation only has incisions inside the nose.  It tends to be a method that reduces trauma to the nose and lends itself to a quicker recovery.  However, in less experienced hands, this technique doesn’t allow for as much visualization of the surgical field making the risk of a suboptimal outcome higher.  That being said, those surgeons who prefer this method and have a lot of experience using it make beautiful noses.

An open rhinoplasty operation involves intranasal incisions and an incision across the columella (the fleshy divider of the nostrils). This technique allows for better visualization of the surgical field but does cause more trauma to the tissues and takes longer to recover from.  In modern rhinoplasty, more surgeons are adopting the open technique.

In my practice over 80% of rhinoplasty procedures use the open technique.  I reserve the closed technique for more minor rhinoplasty cases and some revision rhinoplasty procedures.

6. “What happens if I need a revision after one year?”

Luckily for you, your chances for revision surgery in the hands of a skilled rhinoplasty specialist are fairly low.  Most surgeons stand by their work.  If a patient isn’t happy and has reasonable expectations, a reputable surgeon will often not charge for touch-up surgery.  Patients may be required to cover the costs of anesthesia and facility charges.  It is best to enquire about your surgeon’s revision policy before you have surgery.  The same goes for having realistic expectations.

7. “Do you perform rhinoplasty  simulations?”

Rhinoplasty simulations are computer generated morphs of the pictures of your nose taken by a rhinoplasty surgeon at consultation.  They are used to help educate patients about possible changes that might be expected after rhinoplasty.  They aren’t a guarantee or warranty for a particular outcome, but they are helping in guiding your surgeon to the best outcome possible.  It is important that you remain realistic about your outcomes as simulations can be made to look like anything.

8. “Can I see before and after pictures of patients of yours?”

A surgeon’s before and after gallery is a portfolio of their work.  It should have a cross section of patient types to show that the surgeon has a broad range of rhinoplasty skills.  Though it is rare to see a patient matching your description, you might see someone who looks like you.  That being said, individual results will vary.  Don’t expect that your nose after surgery will look like anyone else’s, especially celebrity noses.

9. “What societies do you belong to?”

Medical society membership shows that a surgeon is interested in staying at the cutting edge of their field.  Continuing medical education is necessary to learn advanced techniques and apply evidenced based data to the practice of rhinoplasty surgery.  I am a member of the ASPS (American Society of Plastic Surgeons), ASAPS, ISAPS (International Society of Aesthetic Plastic Surgery), the Rhinoplasty Society, and the Royal Society of Medicine.  I have published in peer-reviewed journals, been interviewed for television and for online publications, and lectured nationally and internationally.

Other important societies include the AAFPRS (American Academy of Facial Plastic and Reconstructive Surgery) and the AACS (American Academy of Cosmetic Surgery).

Make sure that your rhinoplasty surgeon has similar qualifications.

10. “Doctor, are my goals realistic?”

This is a loaded question but an extremely important one.  The first rule of the Hippocratic Oath is “Do no harm.”  Patient safety, both from a medical and an outcomes-based point of view, requires that a surgeon be realistic when counseling a patient, especially with cosmetic surgery.  There is a lot of money to be made in cosmetic surgery so there has been a sharp rise in non-qualified practitioners offering cosmetic surgery procedures.  Patients get lured into having surgery often with devastating consequences.  I have no problem turning a patient away if I can’t deliver the results they are looking for.  What I have found is that these patient’s have expectations that no one will actually ever be able to fulfill.

 

Well, I hope you’ve enjoyed my thoughts on the questions to ask a rhinoplasty specialist at the time of your consultation.  If you have any questions, you can always contact me at (303) 708-8234 or drop me an email at info@drmanishshah.com.

Thanks,

Dr. Shah