Preoperative Evaluation

TL;DR: Preoperative evaluation for rhinoplasty requires meticulous documentation of facial asymmetries to inform the patient and guide surgical planning.

Abstract: Asymmetries of the Nose and Face In discuss ing rhinoplastic surge ry with the pat ient during a preoperativ e evaluation, it is very imp ortant that fac ial asy mme tries be menti oned and noted in the chart. Thi s is a word to the wise. Well-meanin g patient s ma y not be consc ious of these imperfections prior to surge ry, but will be advised of these afte r surge ry by friends, "do gooders ," or other categories of trouble-makers. As we all know, placing a nose exactly in the middle of an asymme trica l face will exaggerate var ious disproportions of other fac ial features . Th e surgeon mu st recog nize this and the patient mu st be mad e aware of it (Figure I). I have fou nd it invaluable to take Polaro id photograph s (see n in one minut e) at the time of my first meetin g with the patient. A dark eyebrow pencil used on the photo readily shows what tissues are to be removed or straightened . A pink eyebrow pencil shows what tissues are to be added. I may use computerized imagery in a similar fashion if time permi ts.