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While doing a recent retrospective chart review of over 200 rhinoplasty patients (female:male ratio of 2:1) in a study for one particular technique utilized in a 10-year period, one author (RWHK) noted serendipitously that the male patients to a significant degree were the least likely to make their follow-up appointments in the short and long term. As a group they also were the least likely to follow their written postoperative instructions, which were always reiterated verbally several times preoperatively and postoperatively by both physicians and nursing staff. Often, these patients did not apply intranasal ointment several times a day and came in with dried and crusted nostrils. Worse yet, many did not heed postoperative requirements not to engage in vigorous athletic exercise for several weeks after surgery. A few actually injured their noses in the early postoperative period. These findings are not isolated and are echoed by Sheen and Sheen22:

But the problems they pose are not proportionate to their number . . . Men ignore their postoperative instructions; they blow out their packing and braise themselves in hot sun. Their dressings fall off. They are intolerant of discomfort, and syncope is far more common than with women.

As surgeons we know how important postoperative patient compliance is and therefore with our male patients we must provide written instructions and be quite emphatic preoperatively to be sure that they read, understand, and promise to follow these instructions as well as agree to return for scheduled appointments.

REFERENCES

  1. Anderson JR: The dynamics of rhinoplasty. In Proceedings of the Ninth International Congress in Otorhinolaryngology. Princeton, NJ, Excerpta Medical International Congress Series No. 206, 1969, pp 708-710
  2. Anderson JR: On the selection of patients for rhinoplasty. Otolaryngol Clin North Am 8:685-688, 1975
  3. Anderson JR, Johnson CM: A self-administered history questionnaire for cosmetic facial surgery candidates. Arch Otolaryngol 104:89-98, 1978
  4. Bittle RM: Psychiatric evaluation of patients seeking rhinoplasty. Otolaryngol Clin North Am 8:689-704,
  5. Daniel RK: Rhinoplasty and the male patient. Clin Plast Surg 18:751- 761, 1991
  6. Ely JF: Less is more: A conservative approach to male rhinoplasty. Aesthetic Plast Surg 20:23-28, 1996
  7. Everson J: Violence against physicians: Rising tide prompts concerns for safety, education. Plast Surg News (ASPRS) March 1, 1994
  8. Goin JM, Goin MK: Changing the Body: Psychological Effects of Plastic Surgery. Baltimore, Williams & Wilkins, 1981
  9. Goin MK: Psychological understanding and management of rhinoplasty patients. Clin Plast Surg 4:3-7, 1988
  10. Goldwyn RM: The Patient and the Plastic Surgeon, ed 2. Boston, Little Brown & Co, 1991
  11. Hazards of cosmetic surgery [editorial]. BMJ 1:381, 1967
  12. Hinderer UT: Dr Vazquez Anon's last lesson. Aesthetic Plast Surg 2:375- 382, 1978
  13. Jacobsen WE, Edgerton MT, Meyer E, et al: Psychiatric evaluation of male patients seeking cosmetic surgery. Plast Reconstr Surg 26:356- 372, 1960
  14. Knorr NJ, Hoopes JE, Edgerton MT: Psychiatric-surgical approach to adolescent disturbances in self-image. Plast Reconstr Surg 4:248, 1968
  15. Kridel RWH, Konior RJ, Shumrick KA, et al: Advances in nasal tip surgery: the lateral crural steal. Arch Otolaryngol Head Neck Surg 115:1206-1211, 1989
  16. Kridel RWH, Konior RJ: Controlled nasal tip rotation via the lateral crural overlay technique. Arch Otolaryngol Head Neck Surg 117:411-415, 1991
  17. Kridel RWH, Konior RJ: The underprojected tip. In Krause C, Mangat D, Pastorek N (eds): Aesthetic Facial Surgery. Philadelphia, JB Lippincott, l991, pp 191-228
  18. Kridel RWH, Scott BA, Foda HMT: The tongue-ingroove technique in septorhinoplasty: A ten year experience. Archives of Facial Plastic Surgery, in press
  19. Micheli-Pellegrini V, Manfrida GM: Rhinoplasty and its psychological implications. Aesthetic Plast Surg 3:299-319, 1979
  20. Powell N, Humphries B: Proportions of the Aesthetic Face. New York, Thieme-Stratton, 1984
  21. Schilder P: The Image and Appearance of the Human Body. New York, International Universities Press,1950
  22. Sheen JH, Sheen AP: Aesthetic Rhinoplasty, ed 2. St. Louis, Mosby, 1987, pp 652-653
  23. Tardy ME: Rhinoplasty in midlife. Otolaryngol Clin North Am 13:289- 303, 1980
  24. Wright MR: How to recognize and control the problem patient. J Dermatol Surg Oncol 10:389-395,1984
  25. Wright MR: The male aesthetic patient. Arch Otolaryngol Head Neck Surg 113:724-727, 1987
  26. Wright MR: Management of patient dissatisfaction with results of cosmetic procedures. Arch Otolaryngol Head Neck Surg 106:466-471, 1980
  27. Wright MR: The psychology of rhinoplasty. Facial Plastic Surgery 5:109-113, 1988

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