First published in A2: Aesthetic Surgery and Anti-Aging magazine (2014)
Successful Rhinoplasty – the cosmetic reshaping of the nose – depends ultimately on three factors, training, skill, and experience. So how, in this complicated, specialised field of surgery, does a prospective patient ultimately identify a good cosmetic surgeon?
Rhinoplasty, no matter which way you define it, is an art and science. An art because it requires artistic and aesthetic skills not usually associated with other forms of cosmetic surgery. A science because the nose is a complex 3-dimensional organ constructed from 240 odd anatomical variants. Some patients require only superficial aesthetic improvements; others structural modifications. Good surgeons work on margins of error of a single millimetre.
To complicate it further, cosmetic surgeons term cosmetic Rhinoplasty an ‘elective’ or ‘luxury’ procedure: it is strictly not necessary; you don’t operate to save a life. This is surgery by choice. The patient expects, and feels entitled to a good result.
Given the not often appreciated realisation that the results of Rhinoplasty – including revision surgery – display permanently on the most prominent part of the face, it makes sense to identify a surgeon capable of delivering a good result.
Social developments over a last decade reveal why it is important to identify a competent surgeon. Rhinoplasty is a popular, and common operation. The procedure, as we know it today, has evolved from a basic operation to correct obvious deformities of the nose, to the introduction of subtle aesthetic enhancements of the face treasured not just by models and actresses, but also ordinary people simply wanting to look and feel better about themselves.
This could entail a routine ‘hump removal’ procedure, the lifting of a ‘saddle depression,’ or a refinement of the tip of the nose. Surgeons promote procedures like this on television, they’re downloaded, they’re the subjects of online forums, and if you search the Internet for a surgeon, the response suggests that all surgeons are equally qualified and all equally capable of delivery good results. Yet, few patients appreciate the complexity of the procedure, or the training and skills a surgeon needs to execute a successful result. They may not realise it, but cosmetic surgeons do not undergo identical training or share equal skills.
Experience confirms this. If you want a good result, you can depend only on the best trained and most experienced surgeons to perform this kind of complicated surgery. The challenge lies in identifying them before surgery commences.
The most objective indicator of competence, says a Rhinoplasty specialist, is a before and after image. “Is a surgeon – with the necessary patient consent and respect for privacy – prepared to show prospective patients an earlier record of ‘before and after’ images; or even to display these images on a website,” says nose surgeon, Dr Pieter Swanepoel.
“Patients also need to ask pertinent and relevant questions about the surgeon’s capabilities, post-graduate training and whether the surgeon has been following recent developments in the field. What are your credentials? Have you undergone formal and specific training in cosmetic and functional surgery,” explains Swanepoel.
This is pertinent, because few medical schools, even internationally, offer specialised post-graduate training in nasal cosmetic surgery. Most reputable medical schools concentrate on fields where there is a high demand for specialised life-saving skills. Cosmetic surgery, in this context, is not considered essential. Surgeons embarking on a Rhinoplasty specialisation submit themselves to a mentoring process under recognised ‘master’ surgeons (often in America), or sign up for advanced courses offered by associations linked to the specialisation of this surgery. Qualifications arrive hard earned usually after several costly years.
Yet, degrees and diplomas reflect historic qualifications. They’re not a measure of current competency. “Continuing Professional Development (CPD) is vital for any surgeon,” explains Swanepoel. “The half-life of most medical disciplines today is three-and-a-half years. In other words, half of your doctor’s knowledge today outdates itself within three to four years.”
This is a consideration for South Africans. Although the Health Professions Council of South Africa (HPCSA), the body that regulates and monitors medical standards, requires an annual updating of medical skills, Rhinoplasty is not one of them.
A further concern emerges when functional surgery to correct a breathing related problem overlaps into cosmetic surgery. Cosmetic surgeons do not specialise in functional surgery to correct breathing problems. Ear, Nose, and Throat specialists (ENT) do not undergo specific training in cosmetic Rhinoplasty.
When overlaps between the two disciplines occur, two surgeons usually attend the operation. One, the ENT surgeon for the breathing problem, the other, the cosmetic surgeon to refine the shape of the nose.
If something goes wrong – and they occasionally do – who does the patient approach for resolution? “It is a question of accountability,” explains Swanepoel.
Specialised experience is another important indicator. How long have you been performing Rhinoplasty operations, and how often do you perform them? “I would say that 100 cases per year is an absolute minimum to maintain expertise in this field,” says Swanepoel. “If you practice your profession for an hour a day, your skills will improve. If you practice once week or twice a month, your skills, by comparison, will lag. You may never attain the delicate skills needed in this profession.”
“What patients need to realise is that a good, well trained and experienced surgeon can generally be depended on to achieve a pleasing result, but that makes it imperative that you first identify a competent surgeon,” says Swanepoel, “they’re the ones with advanced training, experience and a dedication to the field.” — www.thenoseclinic.co.za
