Page 46 - Read Online

Page 6 of 14 Zhang et al. Plast Aesthet Res 2024;11:23 https://dx.doi.org/10.20517/2347-9264.2023.111

together, a careful psychologic assessment might reveal various traits that should be considered relative
contraindications to surgery or, at the very least, signs to proceed very cautiously. Additionally, psychiatric
[13]
consultation should be offered when indicated .

PHYSICIAN-PATIENT RAPPORT
Several articles cite the provider-patient relationship as being a cause for patient complaints relating to
[32]
rhinoplasty surgery . Adamson emphasizes that mitigating such issues begins immediately during the
initial consultation encounter, when the surgeon should seek to provide a space that allows the patient to
[13]
freely express their fears, desires, hopes, and expectations . If the surgeon exhibits inattentiveness,
callousness, or appears cold, arrogant, insensitive, or critical of others during evaluation, patients are more
[32]
likely to feel dissatisfaction with their overall surgical care . Gorney et al. report that regardless of technical
ability, providers who exhibit these characteristics or who do not communicate effectively are far more
[32]
likely to be the target of a malpractice claim . According to the study by Khansa et al. analyzing
real-patient reviews after rhinoplasty, among dissatisfied patients, nearly a quarter of female patients
[10]
complained that their surgeon had poor communication skills . Overall, patients might perceive
[13]
satisfaction as not just from surgical result, but from the overall care that was delivered .
IMPORTANCE OF PRE-OP COUNSELING AND CONSENT
During the initial evaluation, the surgeon should ask the patient to describe what they do not like about
their nose and assess their motivation for undergoing surgery. A handheld or three-way mirror might be
helpful to allow the patient to outline their concerns. The surgeon can then determine whether the patient’s
physical and psychological expectations can be met, the limitations of the surgical procedure must be clearly
discussed, and the patient and surgeon should arrive at an agreement about the surgical goal [1,13] .

Computer imaging and simulation can be a valuable adjunctive tool to enhance patient comprehension of
expected outcomes from rhinoplasty, allowing the surgeon and patient to arrive at a visual agreement on the
goal of surgery . Regardless of which tools are used, fostering effective communication at this stage has a
[1,7]
paramount impact on postoperative patient satisfaction . A study by Abbas et al. utilizing the ROE
[1]
questionnaire to assess satisfaction in a cohort of 54 revision rhinoplasty patients found that the mean
improvement in ROE satisfaction scores for patients who were satisfied with the given information
[2]
provided preoperatively was significantly higher than in patients who were dissatisfied . They also had two
independent plastic surgeons rate the severity of each patient’s nasal deformity preoperatively and found no
correlation between the severity of preoperative nasal deformity and improvement in patient-reported ROE
satisfaction scores. Due to this, the authors highlight the intuitive finding that even objectively minor nasal
deformities should be taken seriously and addressed.

Additionally, a study analyzing malpractice claims related to facial plastic surgery revealed that many
complaints arose due to issues regarding informed consent and poor patient selection rather than technical
[33]
errors ; the most common complaints contributing to litigation were poor aesthetic outcome or
disfigurement, with lack of informed consent contributing to legal action in approximately 22% of cases .
[33]
Another study that included the investigation of claims related to blepharoplasty, rhinoplasty, and
rhytidectomy showed that 38.6% of cases alleged a lack of informed consent . In a literature review
[34]
evaluating 24 different consent forms used for rhinoplasty, the authors found that “unsatisfactory results”
and “need for revision” were only covered in 83.3% and 75.0% of consent forms, respectively . Despite this,
[35]
they reported that these complications were among the top 5 cited in literature. Every consent process
should include these complications in both discussions with the patient and written documentation.