Top 12 list of questions relating to the revision surgery planned for your nose

 So you've been told by the revision nose surgeon that you need more support in your nose. Your last surgeon did too much reductive surgery and you need to have your nose built back up for either cosmetic and/or breathing issues. Here is a list of pertinent questions relating specifically to the surgery, which you need to ask.

1. Will the surgeon be using autografts (harvested from your own body) allografts (from cadavers) or alloplasts(synthetic material).

2. Assuming autografts will be used, where is the surgeon going to harvest the grafts from.Cranium, Rib, Ear, or Septum. If allografts, are they from an accredited tissue bank(which one?) and how have they been processed and stored. ie) irradiated, freeze dried, etc. If alloplasts whats the name of the material ie)medpore, gore-tex, etc..

3. What soft tissue material does surgeon use as filler or to wrap the grafts. ie) Deep temporal fascia, Perichondrium, alloderm. Will crushed or diced cartilage be used to fill out some area's..

4. What are the particular names of the grafts planned out for surgery. ie) alar batten grafts, rim grafts, spreader grafts, lateral crural grafts, butterfly graft, columella strut grafts, caudal extension graft, dorsal graft,.composite grafts.etc...

5. What steps does surgeon take to reduce the warping of rib grafts.

6. Will the surgery improve the function (internal valve &/or external valve) &/or cosmetic appearance (tip, bridge,asymmetrical issues) of the nose.

7. Will the surgeon be using sheets of soft tissue or skin tissue and from what source?  forehead flap, alloderm, enduragen, etc because you have damaged or thin skin

8. How long will surgery take and is it a closed or open approach.

9.  How many procedures has surgeon done similar to yours in a year or since in practice

10.  Is there an agreement form outlining that the surgeon will redo any necessary minor changes needed after surgery and is that an extra cost or is it included in the price of the original surgery.

11.  Is the surgeon planning to do anything to the turbinates (inferior or middle) ie)outfracture, resectioning, cauterize, etc...

12.  How long will the sutures remain inside the nose after surgery. Are they dissolvable.temporary sutures or meant to be the permanent type.

Remember you should find out before the surgery what the specific plan is for your surgery.  If you're not sure after you initial consult, call the surgeon's office and ask for a copy of the surgical plan proposal and doctors notes pertaining to your consult visit.

Important pre-surgical questions often overlooked

Many of us, who have had a bad surgical outcome and looking for a revision surgeon, are very focused on researching information about the surgeon and when in consultation, asking a lot of questions about the specific surgery. I have already covered some of those types of direct questions on other posts. However it is very easy to overlook questions that are indirectly related to your surgery. These are questions such as what are the qualifications of the anesthetists and is the facility an accredited facility. Ask the surgeon's office if they will help you make an Insurance claim if you have Insurance. If you have Insurance it may cover the functional portion of the surgery, however you may come across a surgeons office that is either not aware of this, or  simply refuse to offer their patients this available option. Even though your breathing problems were caused from a primary cosmetic procedure that does not exclude you from the possibility of being able to receive  coverage for the functional component of the surgery. If your insurance policy does not cover it and you need external financing, there are companies specialized in medical loans that you could approach.  Many cosmetic surgeons today will offer this service.

If your surgery is going to be in a clinic or surgical center, check whether it is accredited :

1. The American Association for Accreditation of Ambulatory Surgery, (888) 545-5222, (847) 949-6058, http://www.AAAASF.org

2. The Accreditation Association for Ambulatory Health Care, (847) 853-6060, http://www.aaahc.org

3. The Joint Commission on Accreditation of Healthcare Organizations, (630) 792-5005, http://www.jcaho.org

 Ask whether your surgeon uses a nurse-anesthetist or a board-certified anesthesiologist."An anesthesiologist is a fully trained professional who is dedicated to that patient and doesn't have to be supervised,"   But in many states, nurse-anesthetists do require supervision, and often times your plastic surgeon will be the one doing the supervising.

That's not to say nurse-anesthetists aren't competent, but it does mean you should ask additional questions — like what the anesthetist's experience is with outpatient aesthetic surgery. If your physician uses nurse-anesthetists and you prefer a board-certified anesthesiologist, ask if it's possible to have one.

If you are going to have general anesthesia, be sure your anesthesiologist is certified by the American Board of Anesthesiology, (919) 881-2570. If your surgeon uses a nurse anesthetist, check with the American Association of Nurse Anesthetists, (847) 692-7050.

Complications from anesthesia are far more likely to harm a patient than the surgery itself, as was the case with The First Wives Club author Olivia Goldsmith, who died  from anesthesia complications at the Manhattan Eye, Ear and Throat Hospital.

Make sure you can be rapidly admitted to a nearby quality hospital in the event of unforeseen complications.

Ask if you can receive a discount.

Hiring a surgeon to perform a tummy tuck isn't like haggling for a car; for the most part, prices aren't negotiable. But that doesn't mean you can't get a discount. Physicians want their operating schedules full, and they often pay for surgical facilities whether they're operating on three patients per day or six.Indeed, Kotler and Bolton say they have offered discounted rates of 10 to 15 percent off for patients who are willing to have their surgery on "standby" and be available on short notice if a surgical slot opens up. Another opportunity to save: the "Friends and Family" discount, when mother/daughter duos or friends schedule procedures for the same day.

Not all plastic surgeons are willing to offer such discounts, but most will reduce their fees when multiple procedures are done at the same time, such as a full facial rejuvenation comprising several separate surgeries. Since this also reduces the facility and anesthesia fees that would be spent on multiple visits, the overall savings can be as much as 35%. "Patients should ask, 'Can I work something out where I can save some money?'" Kotler says. "It's not demeaning or unprofessional."

http://www.smartmoney.com/spending/rip-offs/10-things-your-cosmetic-surgeon-wont-tell-you-16854/

http://rhinoplastyrecovery.net/do-you-have-a-nose-for-good-rhinoplasty/

Cosmetic surgeons paying marketing companies for positive comments and top ratings

I wasn't planning on writing this post, but after coming across some information today, I felt I had a  moral duty to report this. Some of you may be aware of this already. But for those consumers who are in the market looking for a cosmetic surgeon, this should be very enlightening.

Many people today use the Internet as tool for searching out the best cosmetic surgeon. You will find many doctor rating sites, and also websites rating the cosmetic surgeons website. But do you know how the surgeons sites are rated??? By what scientific study??? By what public voting system??? Well one of them that I had looked at to register my blogs site, gave me options in different purchases. The more you pay the better and higher on the list your website will be rated. Wow!!! I chose not to complete my registering. But many recognizable cosmetic surgeons are on that site marketing themselves. I have nothing against surgeons marketing themselves, but I do have a problem with misleading advertising.

On some doctor ratings websites,  former unhappy patients have accused some posters as being impostors, giving raving reviews to a particular surgeon. They believe the raving reviews are posted by the surgeons office staff, or possibly the surgeon themselves. On flip side it is possible that some of the negative posts are posted by people that aren't even former patients. That's a whole other  issue I will discuss in another post.

However would you believe that some of the glowing posts on  message boards and rating sites are posted by professional marketing companies hired by cosmetic surgeons? Here's some information from the blog of deceased plastic surgeon, Dr. Frank Ryan.

"I recently met the CEO of a web marketing company who described a type of marketing that his company does in which he and his team get paid by doctors to regularly log onto all the plastic surgery message boards and rave about those doctors. The CEO’s employees pose as patients and rave about what a wonderful surgeon so-and-so is and how they wouldn’t go anywhere else and how the doctor changed their lives, etc. The more the doctor pays, the more time the team will spend posting glowing reviews about the doctor. The CEO said", “If you visit some of these web sites, you will see names of doctors you never heard of with rave reviews and ten stars out of ten. You will also notice that some of the top doctors have fewer rave reviews, fewer stars and often more negative comments.”

This is where I feel the line has been crossed between ethical and unethical marketing. There are as some of you may already know, some cosmetic surgeons who are demanding rating doctor sites to remove negative comments and asking new patients to sign 5 year gag orders. It would be hypocritical for any of those doctors to do so, if they are involved in any deceptive marketing strategy's mentioned above. Even legally they would probably have a hard time suing a poster for negative comments that aren't warranted,  if they themselves are engaging in such deception. Hopefully there aren't too many cosmetic surgeons involved in such practices. So next time you see a cosmetic surgeon with all high marks, and raving reviews, you may want to take it with a grain of salt.

One of the best methods for finding a credible and competent surgeon is to get a referral from another surgeon or doctor.  If you can't get one in your city, then one site that you can is called Realself.com They are cosmetic surgeons who answer your questions, and will recommend a surgeon in a certain region or State. Another thing you can do to protect yourself somewhat is when your on message boards/forums is ask another poster who has commented on a surgeon a lot of questions about the surgery, facility, office staff, etc.. and you can ask them for before and after pictures of themselves (via private message or public). But keep in mind anyone can pull before and after pictures off the internet and claim its them or even photo shop pictures. You could ask them if they have family photo's as well and mention that they can block out their eye section if they like. Even better, is to use Skype, where you can see each other live via video camera. However don't get or use a real cheap camera, you may have troubles with motion. You don't need a very expensive one either, just very average. One site that allows you to interact with other posters is makemeheal.com  within their message boards section.

Some surgeons may even have great b/a pictures, and that's great assuming it's their own clients, but if you have a breathing issue, you need more reassurance. My last surgeon who was in his fifth year, had marketed himself very well on his website, youtube, and in cosmetic magazines. He convinced me that he performed more nose surgery's then the average surgeon. So I assumed his 5 years may be equal to 10 years of another surgeon. Big mistake. I ended up much worse off as I have already mentioned on other posts. This doesn't mean a young surgeon can't be a good choice. If you can't afford or for whatever reason don't feel as comfortable with an experienced surgeon, then seeking out a younger surgeon who specializes in nose surgery makes sense in some cases. Just ask a lot of questions and see if your comfortable with the answers. Don't feel pressured or desperate to give in to what ever they say. That's a red flag. Find out who the surgeon trained with? Did he train with any well known revision nose surgeon? Did he go beyond his regular specialty board license, for extra training in facial cosmetics? Did he graduate at top of his class? Did he go to reputable medical college? Has he conducted any research on the subject? Does he perform all different types of nose grafts for improving and strengthening the structure of the nose or does he just offer risky reductive surgery? Does he harvest rib, septal, and ear cartilage in any of his surgery's? Does his website dedicate a lot of information to nose revision surgery? Does the website indicate that he is knowledgeable in regards to the complexity and major issue's with correcting failed operated noses? Does he work in an office with other more experienced surgeons or does he work alone? 

http://www.dr-frank-ryan.blogspot.com/2009/12/truth-about-message-boards-and-plastic.html

Here's a site that specializes in Marketing to cosmetic surgeons.  I'm only including it here to show that such a company exists. I am not suggesting in any way that they engage in any of the above questionable practices.
http://www.surgeonsadvisor.com/