What Questions Should You Ask Before Rhinoplasty?

In almost a quarter century of doing facial plastic surgery, facelift, neck lift, rhinoplasty, etc. When patients come in for consultations, they have a set of questions that seems to repeat itself. They get asked, are you board certified? But you know, those are easy questions to find.

And in fact, I have talked about this before as a previous examiner for the American Board of Facial Plastic Surgery, where I was testing new surgeons on safety and knowledge, etc. I would say board certification is extremely important, but it's the most minimal criteria. You have to build up on that. They have to be board certified, but that does not ensure satisfaction, great results, incredible skill and artistry, etc.

Board certification basically tests for knowledge and for safety mostly and dealing with complications, etc. So, what are some of the other questions? Well, when it comes to rhinoplasty, one of the questions that always comes up is, are you doing this open or closed? And it's a very, very common question.

And I tell patients that I started my career almost 25 years ago doing 70% open, 30% closed. Now I am doing probably 98% open, 2% closed. And it's because it's a better surgery. It's a better approach.

Now, there are plenty of surgeons that do great open. There are plenty of surgeons that do terrible open. So open or closed is not anything about results. It's just a tool.

You can give a hammer to a carpenter and he can use it with skill and masterful artistry, or you can actually wreck the furniture or cabinet or whatever he's building. It's just a tool. That's all it is. Just like ultrasounds, just like piezo devices, they're just tools.

What you do with them matters. The next question that comes up all the time is, are you breaking the bones? That seems to really scare people. And the answer is, 99% of the time the bones must be cut.

There's a variety of different techniques for cutting the bones. The traditional breaking is one of them. But again, the instrumentation matters. Sometimes we use piezo ultrasonic equipment.

Sometimes we use very tiny little instruments called micro osteotomes. And they're precise instruments for cutting the bone, moving it in. So those are important things. However, one of the things that you should really be asking, important stuff is what are you doing with my tip?

How much cartilage are you leaving behind? How much cartilage are you removing from my tip? How are you supporting my tip? What's your technique for tip support?

How are you reconstructing my middle vault? Are you doing preservation? Are you doing spreader graft? How are you going to prevent an inverted V deformity?

Are you touching my septum? What are you going to do with my septum? Do you have another person coming in to help with the septum because you don't understand the inside of the nose? Or do you have the skill to deal with the inside and outside altogether?

I have thick skin or thin skin. How are you going to deal with that? Those are the things you should be asking. Forget about open or closed.

Again, where are you doing the surgery? Is it in your office or is it a hospital-based surgical facility? Who's doing the anesthesia? Those are the questions you should be asking.