In order to elevate oneself to a high level of competence, any surgeon interested in performing rhinoplasty must make a commitment to study the rhinoplasty operation. This begins with substantial exposure to rhinoplasty during residency training. Residents should receive basic lectures on aesthetic and functional rhinoplasty focusing on principles of rhinoplasty. They should also learn how to analyze the rhinoplasty patient. In my practice, I see many patients who require secondary rhinoplasty, and most of the poor outcomes are due to errors in judgment or inaccurate analysis. Such problems can be avoided but require refinement of ones diagnostic skills. It is the responsibility of the training programs to provide substantial exposure to rhinoplasty during residency, as this is the most common aesthetic operation performed by otolaryngologists in practice.
Explore This IssueNovember 2006
More advanced training can be achieved through course work or an observational period with a busy rhinoplasty surgeon. Numerous rhinoplasty instructional courses are offered at our annual fall meetings. These courses provide the participant with a broad range of topics related to rhinoplasty analysis and surgical management.
Fellowship training is an excellent means of gaining exposure to rhinoplasty. Spending time in the office with busy rhinoplasty surgeons will be helpful because the fellow is able to observe the healing process from rhinoplasty in a number of patients. The fellow will also be able to see how the surgeon handles the occasional suboptimal outcome or the difficult patient. By sitting in on a consultation, the fellow can see how the experienced surgeon educates the patient and may also see how computer imaging can enhance the educational process.
It appears that there is a shift in rhinoplasty referral patterns with the Internet becoming a more prominent source for patients to gather information. This is also resulting in fewer rhinoplasties performed by less experienced surgeons. Unfortunately, this makes it even more difficult for these surgeons to sharpen their skills. The otolaryngologist and facial plastic surgeon have the unique opportunity to see many patients who are seeking correction of a functional problem or post-traumatic nasal deformity. I have seen numerous patients who were seeking correction of a functional problem and were left with cosmetic deformity as well as worsening of their functional status. As otolaryngologists and facial plastic surgeons, we must work very hard at correcting all functional problems and never compromise function for aesthetics.
How can we enhance our level of rhinoplasty expertise? I believe expertise in rhinoplasty is based not on years in practice or the number of rhinoplasties performed, but rather on one’s ability to apply objectivity to this operation. This requires making associations between cause and effect. By following one’s own rhinoplasty patients long-term, the surgeon can make associations between specific techniques and outcomes.