Being a facial plastic surgeon who specializes in nasal surgery, I have been somewhat dismayed by the relatively recent increase in cosmetic as well as reconstructive procedures that are much more extensive than they need to be. This is not to say that the results aren’t acceptable or that it is being performed by inexperienced surgeons. However, one must always consider the associated morbidity or “collateral damage” that these procedures produce. When we consider cosmetic nasal surgery, especially revisional following prior poorly executed rhinoplasty, I am seeing many patients who come for second opinions because they were told they need a “rib graft”. While a rib graft may get the job done, it results in another operative site on the chest with its associated scarring, pain and risk of lung collapse. It is my procedure of “last choice” when there are no other alternatives such as nasal septal cartilage, ear cartilage or occasionally synthetic implants. And, to this date, I have never been disappointed in a result from the use of these materials in patients who were told that they needed a rib graft.
Regarding reconstructive nasal surgery following trauma or cancer surgery, I have seen a huge increase in the use of forehead flaps. These require an unsightly flap of tissue from the forehead attached to the nose for a period of three weeks, a second or more additional surgeries and resultant forehead scarring (which is usually acceptable). Once again, there are usually many alternatives like local flaps, skin grafts or composite (skin plus cartilage) grafts. Obviously, the main object of cancer surgery is complete removal of disease. However, it is still important to “factor in” the post-operative morbidity and, at least, to consider these other alternatives.