Chapter 33. Patient Education and Consent
It should go without saying that patients undergoing rhinoplasty should be cognizant of the nature, benefits, and risks of the procedure. They should also be aware of the timeline for healing and the need to wait a minimum of 1 year before deciding that a reoperation is required. The surgeon should understand the patient’s specific anatomy and particular concerns. These should be valid and consistent. The risks of each component of the planned operation should be reviewed with the patient in detail. Drawings are frequently helpful for the patient to understand the finer technicalities and to serve as a record of the detailed interaction. Preoperative photographs in standard AP, oblique, lateral, and worm’s eye views should be obtained. These should also be reviewed with the patient. Software can also be used to manipulate digital images in order to provide the patient with an example of the post-surgical result. A standard consent might have similar elements to the example given below:
INFORMED CONSENT—RHINOPLASTY SURGERY
The following document is an informed-consent form that has been prepared to help your plastic surgeon inform you about the nature, benefits, risks, and alternatives to rhinoplasty surgery. It is important that you read this information carefully and completely. Each page should be initialed to indicate that you have read the page and sign the consent for surgery as proposed by your surgeon.
Rhinoplasty surgery is designed and performed to reshape or improve the function of the nose. The techniques utilized may produce changes in the appearance, structure, and function of the nose. They may reduce or increase the size of the nose or change the shape of the various components of the nose, including—but not limited to—the dorsum, tip, and nostrils. They may also change the relationship of the nose to surrounding structures, including—but not limited to—the cheeks, the eyes, and the upper lip. Rhinoplasty may be indicated to correct congenital birth defects, acquired deformities, traumatic injuries, and/or functional problems with breathing. The techniques of rhinoplasty are customized for each patient and are not identical in all patients. The techniques may be performed using either incisions outside the nose or inside the nose, or a combination of the two. Patients interested in undergoing a rhinoplasty procedure should have realistic expectations and not expect perfection. They should also be in good physical and emotional health. Rhinoplasty can be performed in conjunction with other surgeries.
RISK OF RHINOPLASTY SURGERY
With any type of surgery there is inherent risk. It is always an option not to undergo the rhinoplasty surgery. An individual’s choice to undergo any particular surgical procedure is based on the comparison of the risks and potential benefit. Although the majority of patients do not experience these complications, you should discuss each of them with your plastic surgeon to make sure you understand the risks, potential complications, and consequences of rhinoplasty. Infrequently, it is necessary to perform additional surgery to improve your result.
Bleeding—It is possible, though unusual, that you may have problem with bleeding during or after surgery. Should postoperative bleeding occur, it may require emergency treatment to stop the bleeding, or require a blood transfusion. Do not take any aspirin or anti-inflammatory medications for 2 weeks before surgery, as this contributes to a greater risk of bleeding. Hypertension (high blood pressure) that is not under good medical control may cause bleeding during or after surgery. Accumulations of blood under the skin may delay healing and cause scarring.
Infection—Infection following rhinoplasty is rare. Management usually involves a course of antibiotic therapy but may also necessitate a return to the operating room for irrigation and/or debridement of infected tissue.
Scarring—Although good wound healing after a surgical procedure is expected, abnormal scars may occur both within the skin and the deeper tissues. Scars may be unattractive and of different color than the surrounding skin. There is the possibility of visible marks from sutures. Additional treatments including surgery may be needed to treat scarring.