Discussion with Patient of Surgery and Surgical Goals

If, after careful examination, the patient’s goals appear to be reasonable and realistic to this point, I will tell them so. I will let them know whether I feel this will be a routine or complex revision rhinoplasty in my hands. I explain technical details of the surgical plan to the patient.

Next, we undertake computer imaging. The office computer
network provides for imaging in each examination room. The patient’s photos are uploaded onto the computer screen in the examination room, and computer imaging is undertaken.

I explain to the patient that computer imaging is just a “video game,” that it is a way to communicate a shared surgical goal. I explain that of course this is not an “after” picture, that it is not a guarantee and should not be taken to even offer the slightest implication of a guarantee. It is simply a way to communicate the shared surgical goal. I do not provide the patient with printouts of the computer imaging.

I explain to the patient that I routinely print out the preoperative
photo and shared surgical goal photo and tape them to the wall in the operating room during surgery so that I can refer to the pictures as surgery progresses.

Typically, we are able to reach a shared surgical goal. If so, I then reiterate my impression that the goals are reasonable and realistic. We discuss technical details further. We review the potential benefits and potential risks of surgery. After we have concluded, I introduce them to my office manager for a discussion of logistical and financial details.

fig18-2

Figure 18-2 (A) This patient, with a distant history of rhinoplasty, had nasal obstruction secondary to severe nasal sidewall collapse. (B,C) Repair was undertaken with large alar batten grafts, as well as columellar strut and plumping grafts to strengthen nasal tip complex.

Patient Education

It has been my experience that, in general, the revision
rhinoplasty patient has researched the subject exhaustively. These patients generally feel that they did not do enough research for their primary rhinoplasty. A significant number of revision rhinoplasty patients avail themselves of the tremendous amount of educational material on the Internet. They are interested in learning about the procedure in general and are interested in preoperative and postoperative photographic images by their potential revision surgeon.

I believe that the best patient is a well-informed patient. In an effort to provide detailed information to those researching this subject, I created a Web site: www.RevisionRhinoplasty.com. In addition to the requisite logistical information, considerable effort has been
placed in providing a detailed educational tutorial at my Web site. Consequently, I have found that the patients I see in the office already know “what is wrong” with their nose and are already reasonably well-versed in my approach and philosophy.

Computer Imaging of Shared Surgical Goal

As stated previously, computer imaging is just a “video game.” It is simply a way to communicate a shared surgical goal. It does not generate an “after” picture. As I explain to patients, it is not a guarantee and should not be taken to offer even the slightest implication of a guarantee. I do not provide the patient with printouts of the computer imaging.

Having said this, I find computer imaging to be extremely useful. I routinely print out the preoperative photo and shared surgical goal photo and tape them to the wall in the operating room during surgery. I review my notes and these photos preoperatively and throughout surgery to keep the goal of surgery foremost in my mind as surgery progresses.

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