The first evidence-based guideline for rhinoplasty has been developed by the American Academy of Otolaryngology-Head and Neck Surgery Foundation and published in the journal Otolaryngology-Head and Neck Surgery.
The recommendations, which focus on improving patient care, include communicating expectations, comorbid conditions, nasal airway obstruction, preoperative education, patient counseling for obstructive sleep apnea, managing pain and discomfort and outcomes assessment.
Lisa Ishii, M.D., MHS, chair of the guideline group, tells Cosmetic Surgery Times that “clinicians can refer to the guideline when making decisions about pre- and postoperative management, such as information to collect from the patient before the procedure, and medications to administer after the procedure. Hopefully the guideline will ultimately lead to optimal patient outcomes and decrease unintentional variation in care.”
Dr. Ishii, an associate professor and director of research in facial plastic and reconstructive surgery in the Department of Otolaryngology-Head and Neck Surgery at Johns Hopkins School of Medicine, says the two most notable recommendations relate to antibiotics and packing.
“The evidence does not support routinely providing postoperative antibiotics for patients undergoing rhinoplasty, a practice currently common to many surgeons,” she notes. “The guideline also does not support routine placement of nasal packing.”
Rhinoplasty Numbers Increasing
According to the American Academy of Otolaryngology-Head and Neck Surgery Foundation, the increasing number of rhinoplasty procedures highlights the need “to reduce surgical morbidity, promote appropriate therapy, engage patients in their case, and to coordinate care effectively.”
For instance, clinicians should ask patients about their motivations for surgery and the patient’s expectations of outcomes. Clinicians should also convey to the patient if those expectations are realistic and document the discussion in the medical record.
Similarly, clinicians should assess rhinoplasty candidates for comorbid conditions that might modify or contraindicate surgery, such as obstructive sleep apnea, body dysmorphic disorder or bleeding conditions.
During preparation of the guideline, “gaps in our knowledge were identified,” Dr. Ishii says. “We look forward to future studies that will help us close the current gaps in our knowledge. For example, hopefully future studies will inform us as to whether steroids are of value in the postoperative management of patients undergoing rhinoplasty.”