Aside from having a minor septal deviation (lots of people have them and don't even know it), this was elective surgery because there was no insurance-worthy breathing problem to fix. If I were going to have just a septoplasty, then I'd look for an ENT to perform the surgery. Although there are some ENT's (which have an ABFPRS board certification) that perform excellent rhinoplasties, I wanted an ABPS board-certified plastic surgeon to perform my operation. This is a cosmetic procedure, and I think that ABPS plastic surgeons are more attuned to the aesthetic aspects – which is what it's all about in my case.
My choice for anesthesia did play a role in selecting a surgeon. The plastic surgeons I selected for consultations either preferred general anesthesia, or could use it if requested. It turned out that this really didn't narrow down the selection much, because only a couple of plastic surgeons declined to use general anesthesia at all. Most of the plastic surgeons that didn't use general anesthesia by default, were happy let me pay extra and bring in an anesthesiologist.
In addition to being what I considered the safest situation, I wanted to be totally knocked out. Why knocked out? Well, when I was twelve years old, I have four teeth extracted. The extractions were done using Novacaine, and I was treated to a front-row seat watching my hulking and not-very-gentle dentist, twist and turn the pliers to yank out my teeth. If I were smart, I would have closed my eyes. Instead, I have been left with a memory that is a bottomless pit of nightmare fodder. This time around, I had a good idea of what would happen in advance. I knew that I'd be better off not hearing the dripping, sucking, tapping, rasping, cracking, and whatever else goes bump in the O.R..
Using the above resources, Yellow Pages listings, message boards, and numerous ad-hoc web searches, I was able to create a list of well known surgeons in my area. At least I got the ones who know how to advertise.
At this point my list still had about a dozen surgeons, and it didn't seem reasonable to go on that many consultations, so I did in-depth web searches on each surgeon. Having experience in this area made is easy for me, but it took perseverance.
Once again, I scanned the message boards to see who was popular or unpopular that month. The message boards are very subjective, but they are useful if they are viewed as providing corroborative input. There's always going to be supporters and detractors for each surgeon, but if there is an unusual number in either case, that warrants more investigation.
Most consultations would begin with a plastic surgeon describing the procedure, risks, etc... After the overview, the plastic surgeon would go thorugh the computer imaging exercise. During the computer imaging, I would casually sneak in some of my questions. After the imaging was complete, I'd go through the list of questions that hadn't already been answered. Although I didn't ask every question in every case, I did take enough notes that would allow me to form a reasonable judgement later. It's necessary to take notes, because after a few consultations, they begin to blur together.
On my consultations, I brought along a few pictures of noses that I liked. However, I rarely used the photos because I already had a concrete image in my mind of how I wanted my nose to look. After a couple of consultations, I ended up having a routine containing key phrases that I used to express what I wanted. My prioritized list of changes was:
Knowing what I wanted, and having a prioritized list, was well received on all of my consultations. With the exception of straightening my nose, all of the other changes were feasible.
During the course of three weeks, I went on six consultations, with the following surgeons:
| Surgeon | Comments |
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He was able to immediately show and explain various aspects of my nose. He had excellent communication skills, and could answer all of my questions precisely. I had immediate trust in his capabilities. He also has an excellent office staff. |
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He has good B&A photos, and a lot of rhinoplasty experience. |
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He performs many nasal surgeries per year (100-200), although I'm not sure how many are strictly rhinoplasties. He has excellent computer imaging software that appears to manipulate the image as a 3D object – very cool for software wonks such as myself. |
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Good surgeon. |
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Good surgeon. |
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Although he had a few good B&A pictures (some I really didn't like), I didn't think he performed enough rhinoplasties per year (6-12) to have enough experience. |
Most of the computer imaging results were good, but I didn't view the computer images as the most important part. The communication used to create the images was the most important part, and the images were merely a record of that communication. I never expected my post-op nose to be a perfect match for the computer image, but with a good plastic surgeon and a little luck, the match should be close. It's one thing to create a perfect computer image, it's another thing to achieve those results.
Because most of the changes I was interested in were specific to my profile, the computer imaging sessions were effective. For changes in the frontal view, I don't think that computer imaging was as effective because the the current technology is mostly two dimensional, and there is a limited sense of depth on a computer monitor. One plastic surgeon did have very good imaging software that was able to show 3D-like effects, and it did produce better imaging results from a graphical point of view, but it didn't change the nature of the interaction in my case.
On my first two consultations I asked if it were possible to get a copy of the images generated. Both plastic surgeons declined to give me copies due to possible malpractice issues. I stopped asking for copies on subsequent consultations. I should have kept on asking because it turns out that some plastic surgeons do allow patients to take home a copy.
