Selecting a surgeon, selecting a patient – It’s a two-way street

Most everyone will agree that a prospective patient should do some research to vet the qualifications and background of a physician before entrusting that person to their medical care.  This is especially important with complicated surgery, such as rhinoplasty, in which the margins are small and the techniques nuanced and intricate.  Patient who do their due diligence to find a rhinoplasty expert are rewarded with fewer complications and better outcomes.

What people may not realize, however, is that the rhinoplasty surgeon’s selection of patients to operate on is just as critical.  Many are surprised by the fact that I turn down about 15 percent of patients who come in to see me for a rhinoplasty consultation.  This decision is not in any way based on a position of bias, elitism, or any arbitrary selection process.  Instead, my decision whether or not to operate on someone is very straightforward and based on a fundamental question: can I help this person?

The answer to the question, “can I help this person” may be “no” for a variety of reasons.  For the inexperienced surgeon, the complexity of the required operation may be more than that surgeon can handle.  Rather than taking on a procedure beyond the surgeon’s ability, it is better to refer the patient to someone more experienced.  At this point in my career, having performed thousands of surgeries, this situation fortunately does not come up very often any more.  But it is a trickier situation when the problem is not a physical one and instead is related to the individual’s personality, expectations, or emotional state.  My goal as a rhinoplasty surgeon is to give a person a result which makes them happy.  There are individuals, however, who may be unlikely to feel satisfaction with an outcome, even if it is objectively good.  If I have this belief, I feel it would be wrong and even unethical to treat that individual.  Just as it’s wrong for a physician to administer a medication that is unlikely to help someone, it’s wrong for me to perform a surgery on someone who is unlikely to feel benefit from it.

I make my living performing rhinoplasty.  But ultimately, I am a physician before I am a facial plastic surgeon, and I must put each patient’s well-being as my top priority—even if it means not operating on them.  The list below describes some of the reasons why I turn away patients.  Although these situations may be disappointing for an individual, if I am honest with them about my concern for their well-being and my good intentions, they usually leave with acceptance and often gratitude.

  1. Body dysmorphic disorder or Dysmorphic traits
  2. Minimal or no visible cosmetic problem
  3. Unrealistic expectation
  4. Abusive personality (especially to my staff)
  5. Serious medical or psychological disorders which would make surgery risky