Keeping Rhinoplasty Complications to a Minimum

I missed it-now what am I going to say? he said. I had my tail between my legs and I said something, I don’t remember what I said. But I was embarrassed, and I had no words to explain to the patient that they still had a problem.

The lesson is that surgeons should always be prepared for how they will communicate with the patient should something go wrong. The words might be different for each surgeon, but I’m not happy has proven to be a useful, versatile phrase.

I’m not happy with how the operation went. There was a great deal of bleeding and I had to stop the operation, Dr. Kern suggested. Or, ‘I’m not happy with our relationship. I don’t feel good about our relationship and I think you need to see somebody else.’

Daniel Becker, MD, Clinical Associate Professor in the Division of Facial Plastic Surgery in the Department of Otolaryngology at the University of Pennsylvania in Philadelphia, said studying the cases of other surgeons is invaluable. The key is a lifelong study of rhinoplasty, of nasal anatomy, of analysis and techniques and rhinoplasty philosophy, learning from other people, he said. I have always gravitated toward revision books or complication books because I would always rather learn from someone else’s mistake.

He emphasized getting a deep understanding of what the patient wants. The only reason a patient seeks a rhinoplasty in the first place is that they’re unhappy about their nose, he said. So it behooves you to find out what they want.

He said that a devastating problem, but one that is also avoidable, are turbinectomies that have been handled too aggressively. A patient he saw had had one to clear a blockage in one passage but afterward was a nasal cripple because the mucosa had been damaged and he couldn’t feel air.

It’s important to be a little introspective when considering a procedure, he continued. Maybe I won’t do it at all. Or maybe I’ll be ever so conservative. I’ll be more conservative, and I’ll save somebody’s life.

He said that some surgeons might think that because they rarely have patients come in to report complications, such as a worse breathing problem after a turbinectomy, that they don’t happen very often. That could be a mistaken perception, Dr. Becker said. Maybe they didn’t come back to you, he said. You have to understand that this problem absolutely happens.