Choosing a Surgeon

The process of selecting a surgeon is a crucial decision, as, quite obviously, patients who have already undergone one or more prior rhinoplasty surgeries desire that their next surgery be their last. The best advice when considering a revision rhinoplasty (or primary rhinoplasty, for that matter), is to seek a consultation with at least 2-3 surgeons who specialize in rhinoplasty in your area. It may even be worthwhile to travel out-of-state to seek a revision rhinoplasty expert. The extra cost/expense would be worth it if the results are more favorable.

Is your surgeon board-certified?

The first step in selecting a surgeon is to make sure he or she is board certified (or at the very minimum, board-eligible) by the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS) or the American Board of Plastic Surgery (ABPS).
Find out if your surgeon is certified by the ABFPRS or is certified by the ABPS.

This board certification indicates that the surgeon has completed a residency/fellowship program in Otolaryngology, Facial Plastic Surgery, or Plastic Surgery. The board also requires the completion of a certain number of cases within the specialty within the first few years of the surgeon’s practice. Passing a rigorous board examination is also a requirement for certification.

The next step in selecting a surgeon is to carefully examine the before/after photos you see in his/her office photobook and professional website. Ask to see noses similar to yours and make sure you like the “after” photos you see. Some surgeons have a particular aesthetic and feel most comfortable creating a particular type of nose whereas others are more adept at customizing the nose based on the patient’s aesthetic goals.

Another consideration is insurance coverage. If you have difficulty breathing through your nose or have broken your nose, there is the possibility that your airway is obstructed for anatomical reasons. These may include a deviated septum, narrow internal valves (nasal vestibular stenosis), deviated nasal bones, or large turbinates. In such cases, insurance coverage may be attained for your revision rhinoplasty. You can contact your insurance company to find out if the revision rhinoplasty surgeons whom you are considering are in-network or out of network.

Overall, revision rhinoplasty is considered among the most challenging and specialized of plastic surgery procedures. First off, the surgeon must possess the knowledge and experience required to determine how to improve the shape of the nose. This requires both specialized training and years of experience evaluating patients, so that the surgeon can diagnose from the outside what is happening inside the nose. Considerations such as the availability of cartilage and the strength of the residual bone and cartilage and very critical.

During the surgery, the revision rhinoplasty surgeon must possess the patience and technical skill to perform this surgery. Revision rhinoplasty can take several hours, as there may be significant scarring between the cartilage and the skin. In particular if the framework of the nose was overly weakened or removed during the prior rhinoplasty surgery (or surgeries), the challenge is the restoration of the integrity of the structural framework of the nose. This often requires cartilage grafts taken from the septum, ear, or rib.

Close follow up care after surgery is very important in revision rhinoplasty surgery.
The surgeon must possess the experience to know when to intervene with maneuvers such as steroid injections, taping the nose, digital manipulation, or minor revisions, if needed. Ask your surgeon for the typical schedule of follow up visits and make sure that he/she is responsive to your needs and concerns after surgery. Talking to patients who have already undergone surgery with the surgeon you are considering can be very helpful.

Feel free to ask pointed questions about the number of rhinoplasty procedures the surgeon performs in a year and how many he or she has done in total over his/her career. It is important to know the percentage of these that are revision cases of other doctors’ work. Ask the surgeon how often revisions of his or her own work are required and what the financial policy is in these situations.

Finally, it’s important that you develop a rapport and like your surgeon as a person. A surgeon who is rushed or does not make time for his/her patients in the office may be equally rushed in the operating room. The choice of a rhinoplasty surgeon is a very important one and therefore the patient should be completely well informed, educated, and comfortable throughout the entire process, before and after surgery.