Be watchful before you select your surgeon
A two team approach is the perfect recipe for disaster
In India it is a very common practice for one surgeon to perform the external correction and another to do the septum work. In many cases the 2nd surgeon is a ‘ghost surgeon’, he comes in to the operating theatre at the time of surgery and never sees the patient after that, patients are made to believe that since two doctors are involved they will get best of both worlds when in fact the reality is just the opposite.
When I met world famous Rhinoplasty surgeon Prof Gubisch from Germany in Iran he said
“Only a surgeon who can do complete septal correction should be allowed to do Rhinoplasty”
Correction of a crooked nose is one of the more difficult and challenging aspects of Rhinoplasty. In all crooked noses with an external deformity there is an underlying septal deformity. Surgery for crooked Nose correction aims towards not only achieving an aesthetically pleasant result but also to obtain a nose which functions properly. Some cases of crooked nose have minimal internal deformity, these can be corrected by the camouflage technique. Except for these rare cases the majority of crooked noses require a septal correction.Crooked noses are considered as bony and cartilaginous units, in which both units contribute to internal and external deformity. Shape of the nasal septum is determined by the deforming forces applied by the surrounding structures to the bones and skin and hence it is difficult to achieve a septal correction unless these deforming forces too are corrected. Even for functional improvement a complete septorhinoplasty is required, both form and function; both of these are interdependent and must be corrected simultaneously.
The older concept of staging, that is to correct septal deformity first and the external deviation at a later stage is no longer valid. A one stage procedure which covers both aspects is more desirable.
In modern practice there is no place for a purely Nasal cosmetic surgeon or the two team approach where one team corrects the septum and another corrects the aesthetic aspect. This practice widely prevalent in this country is to be condemned. The surgeon doing Rhinoplasty should be competent to deal with both the Septal surgery and should be able to tackle both aesthetic and functional aspects.