What to Expect

An office consultation is an exchange of information. You and the surgeon are interviewing each other! Your job is to assess whether he is the right surgeon for you. His job is to decide whether he thinks you are a good candidate for surgery.

What should I bring to my first visit?
Come with some thoughts about what you would like changed about your nose. Come with a written list of questions. Be prepared to tell us your medical history, any past surgeries (including all prior nasal surgeries), current medications, drug allergies, and so forth.

The Surgeon’s Evaluation of You

Questions the surgeon has for you:

Medical history – most of this will have been filled out by you in the form, and will be reviewed by the doctor with you. I want to be sure you are healthy, that you are medically fit for surgery.

What you don’t like and why? This is the "thesis statement" – the reasons you want surgery. Of all the things you tell the doctor, this is the most important information.

An example in primary rhinoplasty: "Doctor, my nose is too big for my face. Also, my tip is bulbous, and I don’t like my hump. There are some other things, but these are my major concerns."

An example in revision rhinoplasty: " Doctor, too much was taken in my last rhinoplasty – from my bridge, and from my tip. My nose is twisted, my tip is pointy looking and unnatural. Also, my profile is uneven. Also, I can’t breathe through my nose."

This should be your lead-off statement to the doctor! Everything else you discuss with him, he will have your goals foremost in his mind. This approach will surely allow you to get the most out of your consultation.

Some patients like the doctor to look at their nose and tell them what is wrong with it. It is fine to proceed this way, but just make sure that at some point, you tell the doctor what you don’t like, what you want addressed!

Do you have Reasonable expectations This is discussed above, and is an important part of the evaluation.

What are your specific questions or concerns regarding the surgery process? Everyone has certain things that are particularly on their mind. Write these down, and discuss them with your doctor. Common questions/concerns are logistical, relating to the type of anesthesia, what recovery will be like, etc…

The Physical Examination

Question:Can you provide an example of a specific patient and your analysis of their nose and what you did for them?

Answer: Shown below is a patient who came to me in hopes of improving the appearance of his nose because he felt it was too big for his face and because he had trouble breathing. My first impression of the nose was that it was, indeed, too big for his face. When I examined his nose from the side, I discovered that he had a large nasal hump and that his nose was overprojected (it stuck out too far from his face). On a positive note, the length of this patient’s nose is just right, neither too long nor too short, and, from this angle, the nostrils have a normal shape.
Though the patient is not interested in a chin implant, I did notice that his chin was a bit underdeveloped. In fact, that’s likely why he chooses to wear a goatee as it adds a bit more prominence to the chin and facial balance.


A very subtle twist to the nose was seen after careful examination of the front view, though the patient himself had never noticed it before. Though some twist may persist, we planned to make every effort to improve this. The front view also shows that the nasal tip is a little full, which can be enhanced with some conservative refinement of the nasal tip. Also determined at this time was that the patient’s skin was of medium thickness and that his nose was of normal width.


I then examined the nose from the base or bottom view which reiterated that this patient’s nose sticks out too far from his face. Again, we found that the nose was not too wide for his face, but that the tip was a little full or bulbous. By feeling, or palpating, the outside of the nose, I discovered that he has relatively short nasal bones and relatively long upper lateral cartilages, which comprise the nose’s middle portion. It is important that we know this in order to provide the cartilaginous ‘middle portion’ of the nose with some extra support.

Question:Can you describe how a surgeon analyzes a patient’s nose, and how it deviates from the ideal?
Answer:
A surgeon will first consider the ‘first impression’ of the nose, such as whether it’s too big, twisted, has a large hump or has been over-operated on. Often times, this first impression is what bothers the patient as well. The surgeon will also find out from the patient exactly what it is that he or she dislikes about their nose.

Next, the surgeon will examine the nose from the front. He will make a note of whether the nose is straight or twisted, whether the nasal tip is asymmetric, bulbous or otherwise abnormal, and whether the nose is too wide, too narrow or normal. The surgeon will also examine the skin to determine its quality, whether it is thick, thin or medium.

The nose is also examined from the side. This will allow the surgeon to determine whether the nose is too short or too long and if the profile of the nose has a hump or is a ‘ski slope’. At this time, the tip of the nose is also examined so the surgeon can determine if it is overprojected or underprojected or just right. The surgeon will also see if there is too much nostril show present.

The nose is examined from all angles in order to provide important information about the nasal anatomy that is crucial to the planning of a successful surgery. In addition, the surgeon will feel the nose.

Question:Can you provide an example of a specific patient and your analysis of their nose and what you did for them?
Answer:
Shown below is a patient who came to me in hopes of improving the appearance of his nose because he felt it was too big for his face and because he had trouble breathing. My first impression of the nose was that it was, indeed, too big for his face. When I examined his nose from the side, I discovered that he had a large nasal hump and that his nose was overprojected (it stuck out too far from his face). On a positive note, the length of this patient’s nose is just right, neither too long nor too short, and, from this angle, the nostrils have a normal shape.

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