I’ve just come back from talking at the Rhinoplasty Society of Europe meeting in Istanbul.  Istanbul’s a wonderful city.  A change of scene from work helps thinking and creativity particularly when you have the chance to look across the Bosphorus at night.

I really enjoy contributing to Rhinoplasty meetings.  I spent time with amongst the best rhinoplasty surgeons in the world and one of my goals has always been to move Rhinoplasty forward in collaboration with the best.

Of course, one of the challenges of Rhinoplasty is to achieve and create with complex anatomy, the most attractive harmonious nose possible.  The patient as well as the surgeon has to think the nose is attractive and harmonious.  Another challenge therefore for all of us is to pick out patients who have, after explanation of what’s possible, realistic expectations.  These expectations must be realistic not just for the cosmetic result but for what Rhinoplasty can achieve in their lives in general.

Sadly there is no perfect set of questions that can help us work out who is a good psychological candidate for Rhinoplasty.  One of my hugely experienced and respected colleagues presented a case of complex revision.  He achieved a very good aesthetic result but unfortunately the patient still perceived problems with the nose that were out of proportion to their appearance.  This patient is now constantly using the internet to attack her surgeon.

We are working closely as we have blogged before with the Centre for Appearance Research in Bristol and hope that one day we’ll be able to detect patients for whom surgery isn’t going to provide everyday psychological benefit.  We also need to try and develop a set of questions that can detect patients, for whom an unwanted result from even the best surgeons that they think makes their nose worse would result in anger and resentment.  We can not eliminate unpredictability from surgery, unfortunately nor currently can we completely predict and understand before surgery for whom such an outcome would be acceptable or not.

JRJ