Tuesday, January 19, 2010

Well known nose revision surgeons in United States of America, & elsewhere. Plus information about choosing a surgeon and about nose grafts.

All these American surgeons are experienced in using rib autografts (from your own body) or rib allografts (from cadaver) cartilage.  Autografts (autologous grafts) are considered the most preferred option for grafting  by many top revision rhinoplasty surgeons. Most harvesting of such grafts are taken from your own septal, ear, rib cartilage & placed elsewhere within the nose to help shape, strengthen or rebuild the structural framework of your nose.  A smaller number of surgeons prefer using  allograft (homologous grafts from cadaver) cartilage which are pre-treated by exposing them to doses of radiation to reduce or eliminate chance of transferring pathogens onto the recipient patient. They are commonly referred to as Irradiated homologous rib grafts or IHRG's.  It is possible & even recommended in some cases to use a combination of autografts and allografts for certain individuals.
 
Feedback on any of these or other nose surgeons are welcomed. NOTE: This list does get updated! Last updated July 30, 2016.

Dr.Toriumi, E.N.T.-Facial Plastic Surgeon , board certified  1988

Dr.Constantian, Plastic Surgeon , board certified  1979


Dr. Paul Nassif, ENT -Facial Plastic Surgeon. board certified. 4/10/1998
 
Dr.Calvert, Plastic Surgeon , board certified  2002

Dr.Guyuron, Plastic Surgeon board certified  1981


Dr. Becker, E.N.T- Facial Plastic Surgeon. board certified 3/26/1996

Dr. C. Spencer Cochran  E.N.T.  board cert. 05/04/2007 


Dr. Richard Davis- Board Certified Facial Plastic Surgeon/ent  1993

Dr. Russell Kridel, ENT-Facial Plastic Surgeon  board certified. 2/13/1981
(use's irradiated homologous rib grafts)
Dr. Rohrich  Plastic Surgeon board certified  1987

Dr.Babak Azizzadeh- Facial cosmetic surgeon/ent cert.5/19/2003

Dr. Andrew Frankel, Board Certified Facial Cosmetic Surgeon/ent -1995

Dr.John Hilinski-Facial Cosmetic Surgeon/ent, board certified  May 2002

Dr. Thomas Le- Facial Cosmetic Surgeon/ent, board certified    May 2004
 
Dr. Anil Shah E.N.T.-Facial Cosmetic Surgeon, board certified  2006

Dr.Frederick Newman Plastic Surgeon board certified  1985

Dr. Andres Bustillo E.N.T. Facial Plastic Surgery board certified 6/01/2005


Dr.Stephen Perkins- E.N.T.-Facial Plastic Surgeon board certified 10/18/1982 

Dr. David W. Kim- E.N.T-Facial Plastic Surgeon board certified 2003 (FPS 2005)

Dr. Shervin Naderi E.N.T-Facial Plastic Surgeon board cert.06/01/2005

Dr. Thomas Lamperti E.N.T.-Facial Plastic Surgeon.  ABO cert. 2006

Dr. William Binder, E.N.T./Facial Plastic,  board certified  1978


Dr. George C. Peck Jr. Plastic Surgeon board cert. 1994

Dr. Steven J. Pearlman E.N.T/Facial Plastic ABO 1987

Dr. Saman Naficy   E.N.T/Facial Plastic  ABO 1999

Dr. Adam Bryce Weinfeld  ABPS  2008

Dr. Kobi Derek Boahene  ABO 2005

Dr. Samieh Rizk ABO 2000
(use's irradiated homologous rib grafts)

Dr. Rima Finkel   ABPS 2009

Dr. Jason Litner/Dr. Peyman Soleiman   ABO 2005/ABFPRS 2008
(use's irradiated homologous rib grafts)
Dr. Jaimie Derosa  ABO 2006

Dr. Anthony Bared ABO 2011/ ABFPRS 2011

 Dr. Rollin Daniel, Plastic Surgeon.... Limits his practice to Women only in cases of nose surgery. (board certified in 1977)

For those needing nose reconstruction due to illness or accident Dr. Menick (cert.1983) in Tuscon Arizona and Dr. Gary Burget (cert.1980)in Chicago are highly recommended.  

Canadian Revision Rhinoplasty specialists

Dr. Oakley Smith        Toronto, Canada

Dr. Peter Adamson     Toronto, Canada 

Dr. Douglas J. Kibblewhite  ABO 1989   Vancouver, Canada

European Revision Rhinoplasty specialists

Dr. Gilbert Nolst Trenite   Amsterdam Netherlands

Dr. Rodolphe Meyer         Lausanne, Switzerland

Dr. Dirk Jan Menger         Amsterdam, The Netherlands              

Septal cartilage in the nose is the best choice of all the autograft cartilage options. Rib (costal) cartilage is next best option for a nose that requires a lot of cartilage to restore the main framework of the nose. Ear (auricular conchal) cartilage is another option but not nearly as strong as rib or septal cartilage. However because of it's shape & ease of access it can be a good choice for specific area's like rims of the nose. 

AUTOLOGOUS (AUTOGRAFTS) cartilage (from the ribs, ear, septum) and bone (iliac crest, calvarial, ethmoid plate, septum) is preferred by a number of top revision surgeons over synthetic material commonly referred to as ALLOPLASTS! Most commonly used alloplasts are Medpore, Gore-Tex and Silastic.
ALLOGRAFTS (from cadavers) is another option although still considered by many studies inferior to autologous grafts due to resorption but arguably superior to alloplasts for most but not all area's of the noseXENOGRAFTS (i.e. Porcine tissue) are rarely used or used for very specific purposes. A combination of the above types of grafts may be used in specific cases where one's own donor cartilage is not the best option for specific area's of the nose due to the naturing quality of the cartilage.


For Those Who suffer with Empty Nose Syndrome, Dr.Stephen Houser (cert. 5/10/1999) is highly recommended.

He places alloderm (cadaver skin tissue) in nose to deflect air on inspiration as the turbinate does. This turbinate replacement surgery is a new procedure developed by Dr. Houser. So beware of doctors who want to remove any amount of turbinates from your nose, there can be very "serious" and "permanent" side effects. Make sure the surgeon doesn't remove the bone part of the turbinate unless absolutely necessary (outfracturing is a safer option) and keeps as much mucosa as possible. Even removing 1-2cm of anterior portion can be too much and can have serious side effects, i know from experience. If you have turbinate surgery the safest ways to reduce enlarged turbinates is by somnoplasty, or using a microdebrider.  Do not believe that removing the 'anterior portion' of the turbinates is totally safe (especially if you had previous lateral &/or posterior partial removal of the same turbinate). That's not true, it can lead to serious problems. Your surgeon may argue you have superior and middle turbinates that can still do the job, do not accept that form of rational. Your better off finding another surgeon. I say this from experience and to protect you from not becoming another victim of empty nose syndrome. Your turbinates exist for a reason, and the 3 sets have different role functions which can't be overstated 

Due to  nose surgery and due to other reasons your turbinates can swell up and remain too enlarged for proper breathing. If this is your situation then consider the two of the most safest procedures i mentioned; microdebrider surgery or somnoplasty. Get your surgeon to examine if you have nasal valve collapse or deviated septum which can also cause your turbinates to overreact. However, many e.n.t.'s don't understand how to properly assess nasal valve collapsing nor how to repair it. You may have to travel outside your city , state/province or even country to get an expert opinion. If you can't find an e.n.t who is a facial plastic surgeon in your city who can do that for you , you should seek out a Plastic & Reconstructive Surgeon who is board certified in your city, that specializes in nose revision surgery.
 

Differences Between an E.N.T, Facial Plastic Surgeon and General Plastic & Reconstructive Surgeon. 


 Note: Do not confuse cosmetic or facial plastic surgeon with  general plastic and reconstructive surgeon! Many e.n.t's (ear, nose & throat surgeons known also as Otolaryngologist) and even general family physicians or general surgeons call themselves cosmetic surgeons based on their experience doing certain surgeries. Some E.N.T's who specialize in facial plastic surgery, become certified by the American Board of facial plastic and reconstructive surgery.  The abfprs has certain eligible requirements see link http://www.abfprs.org/applying/index.cfm however as they state on there website......

"The Board is neither an educational institution nor a licensing body, and the certificates it issues are neither degrees nor legal licenses to practice medicine or the specialty of facial plastic and reconstructive surgery". See link http://www.abfprs.org/about/about.cfm. 
   
I mention this because it can be confusing and misleading when you're told by some offices that the surgeon is double board certified in Facial Plastic Surgery and as E.N.T.'s (Otolaryngologist). Otolarynogology is a sub-specialty which residency program is  5-6 years in total after graduating from Medical School.   In very rare cases are there surgeons who are double board certified in two educational and licensing specialties, such as General Plastics & Reconstructive surgery and as a Otolaryngologist.  

General  Plastic & Reconstructive Surgery is also a sub   specialized program for medical school graduates which takes 5 to 6 years of residency in total. This doesn't mean an e.n.t./facial plastic surgeon can't do as good a job or better with a facial cosmetic procedure, as a plastic surgeon. It all depends on his/her level of personal ability, expertise, training and experience. However a Facial Plastic Surgeon certified by the ABFPRS tells you that the surgeon is a E.N.T. who's focus and main specialty is directed at facial cosmetic and reconstructive procedures and has gained the qualifications necessary to be certified by the ABFPRS. Also general plastic and reconstructive surgeons usually end up sub-specializing in doing certain specific surgery's. Some (I would say small percentage) are interested in revision rhinoplasty but not a large number. If you suffer with enlarged turbinates, sinus problems, polyps an E.N.T. is well trained to assess those kind of pathology issue's rather than a general plastic surgeon.

Revision Surgery complications from my last revision rhinoplasty


I myself suffer with nerve damage in the lower portion of the nose (tip and base regions) which is very painful and has to be treated with medication specific for neuropathy, such as Lyrica. This result occurred after a revision nose surgeon in Toronto operated on me in 2005. He  cut a lot of  tip cartilage and scar tissue from my nose in order to lower the high tip angle, and negligently cut off what was remaining of  my inferior turbinates which wasn't causing me a problem in my left nostril. He had made the rhinoplasty conditional upon me having both sides of my turbinates reduced, even though he was well aware I had two prior turbinectomies plus a cauterization on them many years ago.  He  promised to use ear cartilage grafts in my nose (the main reason i went ahead and traveled to have surgery with him) and during surgery decided not to do so. (which was written in the agreement). 


Always check if your doctor is Board Certified and Check with the State/Province the surgeon works in if they have had any disciplinary action and malpractice judgments. 
I.E. Doctor in California,...... Medical Board of California Ph: 1-916-263-2382
......Doctor in Ontario.............College of Physicians and Surgeons of Ontario Ph: 1-416-967-2603 


Please Note: Even though there may not be any disciplinary action or suspensions against a doctor, that doesn't mean they haven't had serious complaints or personal law suits brought against them. You can check with law courts for more information. The Colleges  & Medical boards do  protect their member physicians from complaints & will very likely side with them unless there is gross negligence. So perform search's online by searching the doctors name and see what you can find out as well . The more info you find the better.

RULES FOR CHOOSING A SURGEON

THE DON'TS:

DO NOT CHOOSE A DOCTOR BASED ON AN AMAZING WEBSITE AND GREAT WEBSITE NAME. A DOCTOR WHO JUST GRADUATED FROM MEDICAL SCHOOL CAN DO THAT.


DO NOT CHOOSE A DOCTOR FOR THE SIMPLE REASON THAT THEY'RE KNOWN AS A CELEBRITY DOCTOR OR HAVE MADE APPEARANCES ON TV SHOW'S. KEEP IN MIND REVISION AND RECONSTRUCTIVE RHINOPLASTY IS MUCH MORE COMPLICATED THEN PRIMARY RHINOPLASTY. 

DO NOT CHOOSE A DOCTOR THAT YOU HAVE DOUBTS ABOUT (RED FLAGS)ESPECIALLY IF YOUR QUESTIONING HIS/HER KNOWLEDGE,ABILITIES, EXPERIENCE, FEEL YOUR NOT ON THE SAME PAGE, SIMPLY DON'T FEEL COMFORTABLE WITH OR TRUST. YOU HAVE TO LISTEN TO YOUR GUT FEELING.  


DON'T BELIEVE THAT ANY NOSE SURGEON CAN SIMPLY FOLLOW A SURGICAL PLAN THAT WAS DEVELOPED FOR YOU BY ANOTHER NOSE EXPERT SURGEON YOU HAD SEEN PREVIOUSLY, AND WILL BE ABLE TO DELIVER THE SAME POSITIVE SURGICAL RESULTS.

DO NOT FALL FOR THE BELIEF THAT A NEW SURGEON WILL BE MORE UP TO-DATE WITH THEIR METHODS AND PRACTICES THEN AN OLDER SURGEON. THIS MAY BE TRUE IN CASES WHERE THE OLDER EXPERIENCED SURGEON HAS NOT KEPT UP TO-DATE WITH NEW SURGICAL TECHNIQUES BUT NOT IN ALL CASES. ALSO NEW SURGEONS VARY GREATLY IN THEIR EDUCATION AND TRAINING. THEY ARE NOT ALL EQUAL EITHER. REMEMBER THESE SO CALLED NEW TECHNIQUES THAT THE NEW SURGEON HAS LEARNED ARE TECHNIQUES THAT PIONEERS IN THE FIELD DEVELOPED IN THE FIRST PLACE. SO IT'S MORE ADVANTAGEOUS FOR YOU TO KNOW IF THE YOUNGER/NEWER SURGEON COMPLETED A FELLOWSHIP PROGRAM & WHICH SURGEON DID THEY DO THEIR SURGICAL TRAINING WITH. ANOTHER OPTION YOU HAVE OF COURSE WOULD BE TO DIRECTLY SEEK OUT ONE OF THE PIONEERS IN THE SPECIALIZED FIELD.

DO NOT JUST GET ONE OR TWO OPINIONS


DO NOT GO WITH SOMEONE WHO WON'T ANSWER YOUR QUESTIONS ESPECIALLY IN REGARDS TO HOW MANY SURGERY'S THEY DO ROUGHLY IN A YEAR OR IN THEIR LIFETIME LIKE THE SURGERY YOU NEED

DO NOT GO WITH SOMEONE WHO WON'T SHOW YOU BEFORE AND AFTER PICTURES.


DO NOT CHOOSE A DOCTOR BASED ON PRICE ALONE. THE CHEAPEST OR THE MOST EXPENSIVE, MAY NOT BE THE BEST AND MAY CAUSE YOU TO HAVE MORE SURGERY. HERE AGAIN, ONE HAS TO CONSIDER EXPERIENCE IN THE TYPE OF SURGERY YOU NEED. IT'S HARD AT FIRST TO KNOW WHAT YOU MAY NEED THAT'S WHY YOU NEED TO DO A LOT OF RESEARCH AND SEE FEW OF THE TOP SURGEON'S IN THE FIELD.

DO NOT GO WITH THE QUICK FIX DOCTOR

DO NOT GO WITH A DOCTOR WHO EXAGGERATES NUMBER OF NOSE SURGERY'S DONE IN A YEAR. IT'S POSSIBLE TO DO OVER 200 NOSE SURGERY'S IN A YEAR WHICH IS ABOUT 4 PER WEEK BUT IF THEY SAY OVER 300 THAT IS A PRETTY HIGH NUMBER. AND EVEN IF THEY DID MORE THEN 200 IN A YEAR, IT DOESN'T MEAN THEIR BETTER THEN SOMEONE WHO DOES 125 IN A YEAR. WHAT'S IMPORTANT IS HOW MUCH OF HIS PRACTICE HE COMMITS TO NOSE SURGERY AND REVISION SURGERY AND YEARS IN PRACTICE. SOME NOSE SPECIALISTS DO LONGER PROCEDURES ON THE NOSE AND ARE NOT CONCERNED WITH THE QUANTITY THEY DO BUT THE QUALITY OF THEIR WORK.  MOST IMPORTANTLY IS HOW MANY SURGERY'S OF THE TYPE OF SURGERY YOU SPECIFICALLY NEED, HAS THE SURGEON PERFORMED.

THE DO'S:

SEARCH OUT THE BEST DOCTORS , GET AT LEAST THREE OPINIONS


YOU SHOULD FEEL COMFORTABLE WITH YOUR DOCTOR AFTER MEETING WITH HIM/HER AND FEEL CONFIDENT THEY KNOW WHAT THERE SAYING BY THE WAY THEY ANSWER YOUR QUESTIONS AND THE EXAMINATION AND SURGERY PLAN


LET THE SURGEON WHEN MEETING WITH HIM/HER FOR THE FIRST TIME, TELL YOU WHAT THEY THINK THE PROBLEM AND SURGICAL PLAN IS,  BEFORE TELLING THEM WHAT ANOTHER TOP SURGEON YOU HAD SEEN RECOMMENDED. DON'T INFLUENCE THERE DIAGNOSIS AND THOUGHTS. YOU WANT A UNBIASED OPINION.

ASK IF THERE'S A PAYMENT PLAN


TAKE A INFO SHEET WITH YOU FOR THE LIST OF QUESTIONS YOU WANT TO ASK THE DOCTOR DURING FIRST VISIT

HAVE YOUR OPERATION REPORTS FROM PREVIOUS SURGERY'S WITH YOU WHICH YOU CAN SHOW TO THE SURGEON

FOR OUT OF TOWN PEOPLE USE EMAIL OR PHONE OFFICE TO CONTACT SURGEON EXPLAIN YOUR SITUATION, BUT DON'T EXPECT A DIAGNOSES UNTIL YOU VISIT IN PERSON. ASK THE OFFICE IF YOU CAN HAVE A SKYPE INTERVIEW.

MAKE SURE, [IF YOU CAN] TO WAIT AT LEAST 2 YEARS FROM THE PREVIOUS SURGERY SO ALL SWELLING IN NOSE IS GONE BEFORE GOING AHEAD WITH ANOTHER SURGERY.  FIRST OF ALL THIS GIVES YOU TIME TO RESEARCH AND FIND THE RIGHT DOCTOR. SECONDLY, IT GIVES YOU A CHANCE TO GET USE TO YOUR 'NEW' NOSE. CHANGES OCCUR OVER TIME, NOT JUST AESTHETICALLY BUT WITH FUNCTION AS WELL. YOU MAY OVER A FEW YEARS REALIZE YOU CAN LIVE WITH YOUR 'NEW' NOSE BY USING NON INVASIVE TREATMENTS. SEE MY POST ON NON INVASIVE NOSE TREATMENTS.


BEWARE:



MAKE SURE BEFORE HAVING THE SURGERY, THAT YOU HAVE A COPY OF THE PRE-PLANNED SURGICAL AGREEMENT FORM AND IT IS SPECIFIC AND PROFESSIONALLY WRITTEN. THIS IS CRITICAL ESPECIALLY IF YOU GO AHEAD WITH THE SURGERY AND LATER FIND OUT THE DOCTOR DIDN'T PERFORM WHAT WAS PROMISED ON THE FORM OR DID PERFORM SOMETHING THAT WASN'T AGREED TO!!! YOU HAVE TO COVER YOURSELF. YOU SHOULD GET THIS PRE PLAN AGREEMENT FORM FROM THE SURGEONS OFFICE.

MY LAST SURGEON IN TORONTO HAD WRITTEN DIFFERENT OPTIONS ON THE FORM FOR WHAT TYPE OF CARTILAGE HE WOULD USE, AND HE USED THE CONSENT FORM PART WHERE IT SAY'S IT WAS THERAPEUTIC TO DO AN ALTERNATIVE SURGERY... DUE TO HIS FINDINGS DURING THE SURGERY....THIS WAS HIS EXCUSE (WHICH IS ALL IT WAS, WAS A COP-OUT) IN NOT PLACING EAR CARTILAGE GRAFTS IN MY NOSE AS WAS PROMISED AND STATED ON THE SURGICAL PLAN AGREEMENT FORM!!! IF YOU FOR EXAMPLE ARE WORRIED THAT YOUR SURGEON MAY REMOVE PART OF YOUR TURBINATES DURING SURGERY THAT YOU DON'T WANT TOUCHED THEN ASK THE SURGEON TO STATE HE WON'T TOUCH THEM ON THE AGREEMENT FORM.
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