Keeping Rhinoplasty Complications to a Minimum

PHILADELPHIA-It’s a moment that rhinoplasty surgeons dread: They’ve performed a surgery, the operation is over, then they realize that something has gone wrong. To fix it, there will have to be another surgery.

Experts in the field, gathered at Rhinology World 2009 here, discussed ways to try to avoid complications in rhinoplasty, offering tales of caution as well as guidance on how to handle those delicate times when they have to break bad news to a patient.

If you do enough surgery, you will get complications, there’s no question about it, said Eugene Kern, MD, Professor Emeritus at Mayo Clinic, who has performed rhinoplasty for more than 40 years. Complications occur. They occur in the most sophisticated hands, and they occur in beginners, and they will occur throughout your entire career.

Cemal Cingi, MD, Professor of Otolaryngology at Osmangazi University in Turkey and the moderator of the panel, said doctors should always keep learning, but should also know their limitations. Let’s learn all the methods, set the ones that you can do successfully, and do not try your new ideas on your cases, Dr. Cingi said. Be honest to yourself and to your patients.

Clear Communication Is Crucial

Dr. Kern said one of the keys is clear communication-both with the patient and with the patient’s significant others. I would almost always demand that the significant other-which might include parents-be present at the consultation, he said. If they’re not present at the first consultation, I would not operate on that patient. I would like to see the rest of the family.

He pointed to studies showing that patients’ biggest complaint about doctors is that they felt they didn’t have enough time for them. You don’t want to have that complaint about you, he said.

A seemingly basic step that will go a long way toward avoiding missteps- although it is a step that is sometimes overlooked-is to really listen to the patient, always asking, What is it that you don’t like about your nose?

Dr. Kern told a story about a big, tall, husky man from Iowa who was a farmer and whose two brothers and father were also farmers. He said he had undergone an operation by another doctor for a breathing problem. When Dr. Kern asked him how his breathing was, he said, My breathing is perfect. The problem was the nose itself, he said, although Dr. Kern thought it was a good, masculine-looking nose.