Psychology of the Revision Rhinoplasty Patient

The revision patient is an individual who sought elective cosmetic surgery and, having understood the risks of a complication, is faced with a result that falls short of his or her expectations in some respect. All rhinoplasty surgeons have complications. The literature reports complication rates in the range of 8 to 15%.1-8 Complications can occur despite surgery that has been technically well performed.

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Figure 18-1 Significant improvement in appearance after revision rhinoplasty. This patient required vertical dome division with excision of tip cartilage. She also underwent reconstruction of her overresected lateral crura; alar batten grafts were used. (A,C,E,G) Preoperative and (B,D,F,H) postoperative photos.

Regardless of the cause of a complication, it is important that complications be recognized and forthrightly addressed when they occur. Generally, a complication is correctible to some degree; on rare occasion, no improvement is possible.

Revision patients who seek care from their primary surgeon have retained confidence and trust in their surgeon. Revision patients who seek care from someone other than their primary surgeon have, by definition, (and whether fairly or unfairly) lost confidence in their initial surgeon. These patients often require emotional support.

Revision patients often experience significant distress because of their unfavorable outcome. Generally speaking, these are people who sought elective, cosmetic rhinoplasty and understood that there was a risk of an unfavorable result. Faced with an unsatisfactory result, some revision patients feel angry with themselves for “not having done more research.” Each time they look in the mirror, they are reminded of their “bad decision.” Having placed their trust in a surgeon, they now find it difficult to go through this process again. They seek not only to regain a favorable appearance but also to regain control.

It is fairly common that, early in an initial consultation for revision rhinoplasty, patients cry as they describe their condition to me. During the office visit, I directly address my observations as to the emotional effect that the unfavorable outcome has caused. I have found that patients appreciate knowing that I understand how they feel.

An occasional patient will benefit from psychiatric consultation as a part of his or her overall care.9 I have found that patients have been responsive and have accepted this recommendation from me when I have made it.

Patients seek emotional support on their own, often from other patients. The emergence of Internet chat rooms and message boards has provided an outlet for patients to exchange ideas, information, and experiences. These patients provide non-professional reassurance and emotional support for each other – as people with a “shared experience” – as they proceed through the revision process. I have observed that this can be a favorable support, but more often it creates considerable anxiety in patients. Although this arena is largely outside of the surgeon’s control, it is important to have some understanding that this sort of interaction occurs with increasing frequency.

For patients who have made a decision for surgery, we make available the opportunity to speak with former revision patients. This is optional. We explain that the intention is to provide an opportunity to find out about a “typical” surgical experience fr om someone who “isn’t wearing a white coat.” We make it clear that this is a happy patient who has had successful revision rhinoplasty. I do not make this opportunity available until after a decision to proceed with surgery is made. I have found this offer to be useful in helping some patients understand the revision process from start to finish. In addition, it may help allay some of the new patient’s anxieties and worries, once the decision for surgery has been made.

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