There is both a science and an art to rhinoplasty.
It takes skill and experience to be able to examine a nose and deduce the anatomy – why the nose looks like it does.
Then, it takes skill and experience to decide on the surgical techniques that will give the best chance for success.
Just like artists, athletes, and virtually all professions in life, some surgeons are simply better at rhinoplasty than others. It is not enough to have a good forehand, backhand and serve – the surgeon must string them all together for a winning point, game and match!
But, how do you find the right surgeon?
There is no shortcut to choosing a rhinoplasty surgeon. You have to do your own research. A referral from a doctor, an aesthetician, from a friend/patient, or by "word of mouth" can help, but I would not suggest relying on them completely.
There are certain critical facts about the doctor and practice, such as how often they perform rhinoplasty, that you should know before undergoing surgery. There are a number of credentials that a doctor must have to perform facial plastic surgery, and there are a number of specialties within the field. Knowing which one (or ones) your doctor specializes in will help you to make an educated decision. For help finding a surgeon in your area, the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS) may be a useful resource. The ABFPRS qualifies facial plastic surgeons. The American Board of Otolaryngology also includes extensive training in facial plastic surgery, and is recognized to qualify facial plastic surgeons by the ABMS.
Once you find a doctor whose credentials you are satisfied with, you should meet with him or her to see if you feel comfortable. The doctor should be able to explain the procedure to your satisfaction, and instill confidence in you. You may wish to inquire into their status within the community, hospital and/or special societies. It is important to establish that the doctor has a special expertise in rhinoplasty.
It is important that you see examples of the surgeon’s rhinoplasty results. Many surgeons show these on their websites, and typically have them available in the office as well. This is not a guarantee of success, but it can give you an idea about the surgeon’s personal aesthetic and an idea about his ability. If you do not like the After Pictures that the surgeon has shown, pictures that he is proud of, then that is probably the wrong surgeon for you!
The web chatrooms may or may not help. Some patients have found them helpful, while some patients have said they can be misleading sometimes.
Your initial research may help you narrow your search down to a few surgeons, or to one surgeon. But, there is still the office consultation, the "Interview." In the office, you will get a gut reaction. Do you like the surgeon? Does he seem to have a passion for the operation? Does he take the time to explain the surgery, in detail? Does he listen to what you want, or does he tell you what he wants to do?
In the end, there is no guarantee. You cannot negotiate away the risk of surgery. If you are looking for a new car and do good research, most tend to arrive at the same great car companies that make great cars. But, occasionally, every great car company (like Lexus, or Mercedes, or Porsche) turns out a lemon!
If you do the right research, you should be able to find a "great surgeon." But, this assumes that your research is good! And, remember, even the best surgeon has a bad outcome every once in a while!
Training and Education
There are different paths to becoming a rhinoplasty surgeon. The 2 most common are described here:
After medical school, some surgeons do a 5-6 year residency in Otolaryngology (Ear, Nose, and Throat). This training alone qualifies these surgeons under the American Board of Medical Specialties (ABMS) guidelines to perform rhinoplasty. However, some surgeons do an additional year of training in Facial Plastic and Reconstructive Surgery. These surgeons spend an extra year of training focusing on facial plastic surgery including rhinoplasty. In general, these surgeons are more likely to perform rhinoplasty on a more frequent basis.
Some surgeons spend their 5-7 years after medical school doing a general surgery residency. This training alone does not qualify these surgeons to perform rhinoplasty. These surgeons, if interested in performing plastic surgery, undertake an additional 2-3 years of training in plastic surgery, in which they focus on plastic surgery throughout the body and including the face. This training qualifies them to perform rhinoplasty under ABMS guidelines.
There are other other surgeons who perform rhinoplasty as well. However, the majority of rhinoplasty in this country is performed by surgeons with the training described above.
State Licensure is a prerequisite to practicing medicine in every state of the United States. It is against the law to practice medicine in a State without licensure in that state. We recommend against surgery in the United States by any surgeon who is not licensed in their state.
Board Certification is an important aspect of choosing a surgeon. What does board certification mean? What exactly is a "board?"
A "board" is an organization that oversees an evaluation process. To be board certified means only that an individual has met all of the training and practice requirements put forth by that particular board.
The "main" board of all medicine in the United States is the ABMS, or American Board of Medical Specialties. This central board gives their seal of approval to many other certifying boards. Dr. Becker is board certified in the performance of facial plastic and reconstructive surgery by the American Board of Otolaryngology, an ABMS board and in fact one of the original ABMS boards. Dr. Becker is also certified by the American Board of Facial Plastic and Reconstructive Surgery. The ABFPRS is the only board that certifies surgeons exclusively for plastic surgery of the face.
Additional information about these boards is in the Appendix.
Experience in the Surgery
Experience begins in residency training. If the surgeon went to a training program where his plastic surgery teachers were world famous experts in facelift surgery, but only did an occasional rhinoplasty, that won’t help you very much!
Remember, just because a surgeon is good at one thing doesn’t mean he is good at another. A revision patient of mine told me that his mother had a facelift from a surgeon, and the result was great. When she asked him who would be a good surgeon to do her son’s rhinoplasty, he answered, "Me!" Unfortunately, he was better at facelifts!
Surgeons tend to have a "favorite" operation, one that they seem to have a passion or a knack for. This is something to keep in mind.
Does your prospective surgeon do a lot of this surgery? Who were his teachers – were they skillful and/or renowned rhinoplasty surgeons? Is your prospective surgeon active in their society, and up-to-date with the latest thinking on the subject? Are they teachers of their craft?
The Surgical Center
The Surgical Center should be an Accredited Surgical Center. A hospital-based surgery center is the most common.
Some surgeons perform surgery in their offices, in an office-based surgery facility. Personally, I favor a hospital-based surgery center for all surgeries requiring anesthesia. I have never performed rhinoplasty in an office-based facility. If you select a surgeon performing surgery in an office-based facility, at a minimum, you should be sure that this facility has passed a rigorous credentialing process.
The Surgical Team
There should be an anesthesia team, the surgeon, a scrub nurse, and a circulating nurse. In the recovery room, there is a recovery room team, which typically includes a doctor, nurses, and also nurse assistants.