Question: What kinds of things can a surgeon do to minimize the risks?
Communicate clearly with the patient, plan and perform the procedure with great care, and have a conservative approach. One of the ways a surgeon can decrease the risk of complications is by carefully studying and understanding the types of complications that can occur. Dr. Becker was asked to write the important chapter entitled “Complications in Rhinoplasty” in the Medical Textbook, Facial Plastic and Reconstructive Surgery. Dr. Becker was asked to share his knowledge of rhinoplasty, to help other surgeons understand some of the types of complications that can occur, so that they could possibly minimize the risk of complications in their own practice. To read this chapter, click here.

Question: What should I expect in the way of communication with my surgeon?
The rhinoplasty surgeon must take great care to minimize the incidence of both functional and cosmetic complications. Your surgeon should be willing to take the time to explain the steps they take to minimize the risks of complications.

After the surgeon has completed a careful examination, it is vital that he communicate his thoughts to the patient. While the patient must understand that surgery is not an exact science and the results cannot be predicted or guaranteed, the surgeon should convey realistic expectations about what the surgeon expects the nose to look like after surgery, and should also comment about nasal breathing. It is essential that the surgeon knows what the patient wants, and that the patient knows what the surgeon is planning. With this in mind, Dr. Becker has a clear conversation with his patients on this subject. Also, we review Computer Imaging with most patients to improve communication, to make sure the patient and surgeon are “on the same page.”

With computer imaging, Dr. Becker shows the patient an imaging result that is the goal for surgery, and he wants to be sure that the patient agrees to the goal. The patient understands that this is not a guarantee, but that this is our shared goal.

Question: What kind of planning does the surgeon do for my surgery?
It has been said that a rhinoplasty surgeon should “perform” the surgery at least 6 times: first (mentally) during the patient’s first office visit, again upon additional reflection, a third time after careful review of the preoperative photography, a fourth time just prior to the actual surgery, a fifth time is the ACTUAL surgery, and then the sixth (and more) times after the surgery as review, “post-surgery analysis.”

The patient should try to pick a surgeon who seems to care about and take a special interest in this unique operation, and who has demonstrated skill in the operation.

Question: How can I be sure he is a careful and conservative surgeon?
It is difficult to know for sure. However, one should seek a surgeon who demonstrates a conservative approach to rhinoplasty, who avoids over-aggressive resection maneuvers, who focuses on maintaining structural support, who seeks a natural un-operated appearance.

Question: What kinds of things can I do to minimize the risks?
See Choosing a Plastic Surgeon. Also, see Dr. Becker’s textbook chapter entitled Complications of Rhinoplasty

Question: What can I do before surgery to decrease the risk of complications?
Choose your surgeon carefully. Once you have chosen a surgeon, have a candid discussion with the surgeon regarding your goals and expectations of surgery. A discussion of the potential complications is critical, so that you understands the risks of a complication. Although most complications are relatively minor and correctable, more serious, debilitating, and uncorrectable complications do occur. Your surgeon will give you instructions for before and after surgery, be sure to follow them.

Question: If the surgeon does everything discussed here, can I be certain that I won’t have a complication?
NO. Even if your surgeon does things well, a complication can occur. Just as an airplane can encounter unexpected turbulence, unanticipated problems can occur during surgery that can lead to a complication. Surgery is not an exact science, and results cannot always be anticipated. Despite careful pre-operative analysis and meticulous attention to surgical detail, unacceptable results may still occur.

Question: If I ask my surgeon what percentage of his rhinoplasties are perfect, what answer should I expect?
A good surgeon is highly self-critical of his work. One famous master rhinoplasty surgeon was asked, toward the end of a career in which he had performed many thousands of rhinoplasties, how many “perfect” rhinoplasties he had done. After some thoughtful reflection, he replied, “two.”

With this in mind, you can imagine that in many cases the surgeon may notice a relatively subtle abnormality that is amenable to correction, but the patient may not even notice it or may not be concerned by it. So the answer is, there are better questions to ask your surgeon.

Question: What questions should I ask my surgeon?

Please see the section, Choosing a Plastic Surgeon. In addition to what is discussed in this section, a few questions to consider including in your list are added here:

  • What percentage of your patients are satisfied with your work?
  • I understand that even the best surgeons have complications. What is your revision rate?
  • What specific types of complications have you had in rhinoplasty?
  • Please give me examples of the types of revisions you have needed to do on your patients?
  • May I see examples of your work both primary and revision rhinoplasty?
  • May I speak with a patient who has undergone revision rhinoplasty by you in the last few years?
  • Will I need grafting material? Where do you expect to obtain this material?