Image via Wikipedia
Monday, August 2, 2010
Removing Rib Grafts from the nose
Image via Wikipedia
Sunday, August 1, 2010
Is revision rhinoplasty the most expensive cosmetic/plastic surgical procedure?
Image via Wikipediaworld.
http://www.mostinterestingfacts.com/human/top-5-most-expensive-plastic-surgery-procedures-in-the-world.html
So there you have it, Revision rhinoplasty is in the top 5 (4th on above links list ) most expensive cosmetic/plastic surgical procedure out there.
What's unfortunate is that the majority of the people needing revision rhinoplasty suffer from structural damage as a result of their primary or secondary surgery. It is unique when compared to the other cosmetic procedures because it's a health issue for many in terms being able to breath normal.
For example, like what happened to me, as has happened with many others, the primary nose surgeon over-resected the bridge of the nose and by doing so removed too much of the supporting cartilage, leading to nasal valve collapse, which makes inspired (inward) breathing through the nostrils difficult to near impossible. Even more frustrating and disturbing, is that revision rhinoplasty is not normally covered by health care system in Canada, at least not in any significant or proportionate amounts. And the ent's and plastic surgeons don't even try to help their patients with a out of province or out of Country referral , because they either don't understand the problem of nasal valve collapse &/or they figure its not worth the effort, since the government health care covers a nominal amount under Septoplasty. In the United States, some portion is recoverable if you have company or private insurance. The highest amount I read online was 50% of the surgery was covered. For Canada, I haven't heard or read any information about Insurance Coverage, I would suspect it would be the same as in the U.S. However If you have had nose surgery and problems with your breathing as a condition prior to you purchasing your Insurance I would pretty much guess most if not all the Insurance Company's wouldn't cover you. And I like many others had primary surgery when I was 18.
Related articles by Zemanta
Revision rhinoplasty: How to find the perfect nose surgeon
If your looking to have your nose operated to improve a cosmetic or functional problem that wasn't properly corrected or occurred from your primary surgery, then you are considering a revision rhinoplasty, or secondary rhinoplasty.
Some nose surgeons will correct a minor cosmetic defect at no charge if they did the surgery. However if your problem is much more serious then being upset about a very minor cosmetic change then you will have to do a lot of research and see top specialists in determining what is the problem and how it can be corrected properly.
That is one of the reasons i put this blog together. As a resource and to pass on my experience as a nose patient.
In my first post, i mention revision nose surgeons who have experience with rib grafts. I also have listed different websites you can link to for more information. There is no perfect nose surgeon, just have to find the right one who has experience correcting the problem you want corrected. If you need to travel outside your city or Country for someone who is more of an expert, then you should do so. Never settle for someone who simply say's they can do the surgery, and they can do what the other top experts promised you. Never underestimate the complexity of rhinoplasty especially revision rhinoplasty, its very challenging and specialized. Never underestimate what could go wrong either. I would of never thought i could end up with neuropathic permanent pain from nose surgery, but i did. You could also end up with serious condition called Empty Nose Syndrome. I have this to mild degree on my left side nostril. This occurs from removal of too much turbinate tissue. Just because the nose is relatively a small part of your anatomy, doesn't mean a serious side effect can't occur from the surgery. Take the surgery very seriously, its your body and only trust someone you feel absolutely comfortable with and has the experience and /or knowledge to fix your specific problem. If your uncomfortable with the surgeon and you are not getting a clear outline about what the surgeon plans to do with your nose then you may want to look elsewhere. If you are having doubts about their experience or approach to the surgery , that is a serious red flag. Don't expect a surgeon to change their approach because its not in line with what you think is right for yourself. . It's not likely going to happen, and it will likely lead to great disappointment after the surgery.
Some nose surgeons will correct a minor cosmetic defect at no charge if they did the surgery. However if your problem is much more serious then being upset about a very minor cosmetic change then you will have to do a lot of research and see top specialists in determining what is the problem and how it can be corrected properly.
That is one of the reasons i put this blog together. As a resource and to pass on my experience as a nose patient.
In my first post, i mention revision nose surgeons who have experience with rib grafts. I also have listed different websites you can link to for more information. There is no perfect nose surgeon, just have to find the right one who has experience correcting the problem you want corrected. If you need to travel outside your city or Country for someone who is more of an expert, then you should do so. Never settle for someone who simply say's they can do the surgery, and they can do what the other top experts promised you. Never underestimate the complexity of rhinoplasty especially revision rhinoplasty, its very challenging and specialized. Never underestimate what could go wrong either. I would of never thought i could end up with neuropathic permanent pain from nose surgery, but i did. You could also end up with serious condition called Empty Nose Syndrome. I have this to mild degree on my left side nostril. This occurs from removal of too much turbinate tissue. Just because the nose is relatively a small part of your anatomy, doesn't mean a serious side effect can't occur from the surgery. Take the surgery very seriously, its your body and only trust someone you feel absolutely comfortable with and has the experience and /or knowledge to fix your specific problem. If your uncomfortable with the surgeon and you are not getting a clear outline about what the surgeon plans to do with your nose then you may want to look elsewhere. If you are having doubts about their experience or approach to the surgery , that is a serious red flag. Don't expect a surgeon to change their approach because its not in line with what you think is right for yourself. . It's not likely going to happen, and it will likely lead to great disappointment after the surgery.
Neuropathy caused by Nose Surgery. It does happen!
Can a permanent neuropathic condition occur as a result of nose surgery?
Answer: YES.
After my second major revision nose surgery by a young inexperienced surgeon in Toronto, Ontario, i developed within 6 months time severe neuropathic pain around the tip, columella, and nostril regions. The pain was so excruciating it felt like someone was taking a scalpel to my nose and slashing it. Another phenomena in conjunction with this pain, is hyperesthesia and allodynia. This means the pain could be triggered further, by light sensation to the nose by touch, blowing fan, cold temperature, rain, etc.. I finally realized normal pain medication doesn't take away the pain. The only thing that helped control the pain, was anti-convulsant pills such as neurontin (gabapentin) however even though that helped somewhat, my neurologist recommended Lyrica (Pregabalin). That worked far better then gabapentin and you don't have to take as many pills. It however does have side effects one being lack of concentration and making you lethargic.
So what caused this? My opinion is excessive cutting and removing of soft tissue and tip cartilage, all around tip and surrounding area's. I don't believe its a coincidence that where most of the scar tissue in my tip and columella area was removed with cartilage, is now where i have neuropathy. My reason for mentioning this is so you are aware of this as a future patient, and that surgeons should be aware of this as well, and will hopefully make future patients aware of this as a possible side effect from the surgery, even though its remote. In fact I am not aware of anyone else with this condition, however i have read forums where a couple people mentioned they experienced nerve pain after surgery, but they never mentioned they required to be medicated with special medications like i take, or that they have a permanent condition.
What have I done for my neuropathic pain, besides taking medication?
I first had to do a lot of research. I discovered a site which i have linked on this blog, endthepain.org which is a great site about facial neuropathic pain. The section about Trigeminal nerve pain explains how this pain works. It's atypical however in my case, i have pain on both sides of my nose. I've had CT Scan to rule out Trigeminal Condition caused by pressure on a nerve in the brain. I have had temporary nerve blocks, at a pain clinic, i almost had radio pulsed frequency-sphenopalatine block done, but after the pain specialist after many appointments told me that the freezing injection could cause permanent loss of sight, i backed down from going ahead with that procedure. In fact the pain clinic in my city never performed radio pulse frequency until i mentioned it to them that it has been used as a treatment elsewhere for facial neuropathic pain. I have had botox injection in my tip area's, cortisteroid Kenalog, and inside my nose a sphenopalatine and ethmoid freezing block. I've tried cold lidocaine ointment and gabapentin cream and hot cayenne ointment cream. None had worked. The injections may of worked temporarily, but even that was inconclusive.
Answer: YES.
After my second major revision nose surgery by a young inexperienced surgeon in Toronto, Ontario, i developed within 6 months time severe neuropathic pain around the tip, columella, and nostril regions. The pain was so excruciating it felt like someone was taking a scalpel to my nose and slashing it. Another phenomena in conjunction with this pain, is hyperesthesia and allodynia. This means the pain could be triggered further, by light sensation to the nose by touch, blowing fan, cold temperature, rain, etc.. I finally realized normal pain medication doesn't take away the pain. The only thing that helped control the pain, was anti-convulsant pills such as neurontin (gabapentin) however even though that helped somewhat, my neurologist recommended Lyrica (Pregabalin). That worked far better then gabapentin and you don't have to take as many pills. It however does have side effects one being lack of concentration and making you lethargic.
So what caused this? My opinion is excessive cutting and removing of soft tissue and tip cartilage, all around tip and surrounding area's. I don't believe its a coincidence that where most of the scar tissue in my tip and columella area was removed with cartilage, is now where i have neuropathy. My reason for mentioning this is so you are aware of this as a future patient, and that surgeons should be aware of this as well, and will hopefully make future patients aware of this as a possible side effect from the surgery, even though its remote. In fact I am not aware of anyone else with this condition, however i have read forums where a couple people mentioned they experienced nerve pain after surgery, but they never mentioned they required to be medicated with special medications like i take, or that they have a permanent condition.
What have I done for my neuropathic pain, besides taking medication?
I first had to do a lot of research. I discovered a site which i have linked on this blog, endthepain.org which is a great site about facial neuropathic pain. The section about Trigeminal nerve pain explains how this pain works. It's atypical however in my case, i have pain on both sides of my nose. I've had CT Scan to rule out Trigeminal Condition caused by pressure on a nerve in the brain. I have had temporary nerve blocks, at a pain clinic, i almost had radio pulsed frequency-sphenopalatine block done, but after the pain specialist after many appointments told me that the freezing injection could cause permanent loss of sight, i backed down from going ahead with that procedure. In fact the pain clinic in my city never performed radio pulse frequency until i mentioned it to them that it has been used as a treatment elsewhere for facial neuropathic pain. I have had botox injection in my tip area's, cortisteroid Kenalog, and inside my nose a sphenopalatine and ethmoid freezing block. I've tried cold lidocaine ointment and gabapentin cream and hot cayenne ointment cream. None had worked. The injections may of worked temporarily, but even that was inconclusive.
Saturday, July 31, 2010
The Financial Burden of being a nose revision patient
What are all the financial costs of finding a good nose revision surgeon and cost of nose revision surgery?
Answer: A fortune
Costs:
1. Travel:
Travel costs of course vary for each individual. When finding a surgeon out of Country or State/Province your first cost is the cost to travel for a consultation. So you have flight, hotel, food, and Surgeons consult fee to incur here. Lets say you stay couple of nights within the city your surgeon works in, this with other costs then could cost about $600 for hotel, cab $75 back and forth, esp from airport to hotel, $125 food for 3 days, and consult fee of $200. Total = $ 1000.00 plus cost of flight, lets say $600 for a Total = $1600.00
That's if you see one nose doctor, if you see more then one in the same city then you just have to add consult fee of the other surgeon and maybe additional cab fair.
Now say your not happy with that surgeon and you need or want to see more nose surgeons which require you to travel to another city. Well if your able to do that within the same trip lets say as your above trip, then cost of flight might be extra $250.00 and hotel for couple nights $475 with food, cab $60 and consult $200 for sub total of $985. Cost of whole trip: Total =$1600 + $985 = $2585.00
Now you decide to go with one of the surgeons you have seen, so now your costs will include the surgery cost, and hotel costs for 7 to 10 nights of stay, since you are not suppose to fly after nose surgery that amount of days. So cost of secondary revision surgery lets say conservative figure today $12,000. Now add hotel fee for lets say 8 nights at $200. for amount of $!600 plus food, $320 and flight $650.00. Total = $14,570
If your taking a companion with add cost of additional seat on flight, food, etc.
So total cost = $2585 + $14570 =$17,155.00
Remember you will need prescription medication which is however a nominal extra cost.
Now that's with one revision nose surgery. What if your outcome isn't successful and you require more surgery? Well again, you have to travel for the consult appointment, and then travel again for the surgery. Very rare will someone book surgery with the surgeon before the consult or be able to arrange it right after the consult all within one trip. So first off to heal properly it takes about good 2 years before having another surgery. Mentally it may take as long as 5 years until your ready to do this again. Well in 3-5 years time prices the surgeons charges goes up, and now that your coming to see surgeon with more history and problems the cost because of that goes up substantially. Lets leave the costs from above the same except for the surgery cost. Now your nose revision cost is $ 15,000 lets be again conservative. So adding that to all your other costs and you end up with $3000 more then above total, which then will be a total of $ 20,155.00
So cost of two revisions cost you total of $37,310. Having two revisions would not be unusual.
Unfortunately, its at this point where one realizes if it has failed again, that seeking out the best revision nose surgeon is crucial. So your still having problems with your breathing the results of the cosmetic nose revision is showing poor results after couple years now what? A tertiary surgery, Oh damn! Why wasn't I more selective about who i chose from the very beginning. Well don't kick yourself even the best of the best have bad days.
But you need a 3rd revision and its not because your picky its because you didn't have the right surgeon perform the right procedure. OK, here we go again, now the top revision specialists quotes you $20,000 to $30,000 with anesthesia costs. Lets agree on $25,000 to correct the mess, and add the extra costs using same figures as we used above, so the cost this time around totals=$30,155.00
Now assuming you didn't travel to other city's for consults which you decided not to go with that particular surgeon, your total costs for the 3 revisions now totals= $67,465 dollars. Hopefully 3rd time was a charm. Oh but wait the surgeon requires for you to do a follow up with him/her. Some ask for more then 3 follow ups. Lets say you do one follow up in a year, so cost is lets say as above example $1400. no charge for follow up appointment. So new grand total of $ 68,865. Wow nearly $70,000. And most likely its not at all covered, so it's all coming out of your pocket. With a companion it would be at least that much. And the prices these surgeons are charging isn't slowing down anytime soon. It pay's to be rich, or becoming a revision nose surgeon.
Answer: A fortune
Costs:
1. Travel:
Travel costs of course vary for each individual. When finding a surgeon out of Country or State/Province your first cost is the cost to travel for a consultation. So you have flight, hotel, food, and Surgeons consult fee to incur here. Lets say you stay couple of nights within the city your surgeon works in, this with other costs then could cost about $600 for hotel, cab $75 back and forth, esp from airport to hotel, $125 food for 3 days, and consult fee of $200. Total = $ 1000.00 plus cost of flight, lets say $600 for a Total = $1600.00
That's if you see one nose doctor, if you see more then one in the same city then you just have to add consult fee of the other surgeon and maybe additional cab fair.
Now say your not happy with that surgeon and you need or want to see more nose surgeons which require you to travel to another city. Well if your able to do that within the same trip lets say as your above trip, then cost of flight might be extra $250.00 and hotel for couple nights $475 with food, cab $60 and consult $200 for sub total of $985. Cost of whole trip: Total =$1600 + $985 = $2585.00
Now you decide to go with one of the surgeons you have seen, so now your costs will include the surgery cost, and hotel costs for 7 to 10 nights of stay, since you are not suppose to fly after nose surgery that amount of days. So cost of secondary revision surgery lets say conservative figure today $12,000. Now add hotel fee for lets say 8 nights at $200. for amount of $!600 plus food, $320 and flight $650.00. Total = $14,570
If your taking a companion with add cost of additional seat on flight, food, etc.
So total cost = $2585 + $14570 =$17,155.00
Remember you will need prescription medication which is however a nominal extra cost.
Now that's with one revision nose surgery. What if your outcome isn't successful and you require more surgery? Well again, you have to travel for the consult appointment, and then travel again for the surgery. Very rare will someone book surgery with the surgeon before the consult or be able to arrange it right after the consult all within one trip. So first off to heal properly it takes about good 2 years before having another surgery. Mentally it may take as long as 5 years until your ready to do this again. Well in 3-5 years time prices the surgeons charges goes up, and now that your coming to see surgeon with more history and problems the cost because of that goes up substantially. Lets leave the costs from above the same except for the surgery cost. Now your nose revision cost is $ 15,000 lets be again conservative. So adding that to all your other costs and you end up with $3000 more then above total, which then will be a total of $ 20,155.00
So cost of two revisions cost you total of $37,310. Having two revisions would not be unusual.
Unfortunately, its at this point where one realizes if it has failed again, that seeking out the best revision nose surgeon is crucial. So your still having problems with your breathing the results of the cosmetic nose revision is showing poor results after couple years now what? A tertiary surgery, Oh damn! Why wasn't I more selective about who i chose from the very beginning. Well don't kick yourself even the best of the best have bad days.
But you need a 3rd revision and its not because your picky its because you didn't have the right surgeon perform the right procedure. OK, here we go again, now the top revision specialists quotes you $20,000 to $30,000 with anesthesia costs. Lets agree on $25,000 to correct the mess, and add the extra costs using same figures as we used above, so the cost this time around totals=$30,155.00
Now assuming you didn't travel to other city's for consults which you decided not to go with that particular surgeon, your total costs for the 3 revisions now totals= $67,465 dollars. Hopefully 3rd time was a charm. Oh but wait the surgeon requires for you to do a follow up with him/her. Some ask for more then 3 follow ups. Lets say you do one follow up in a year, so cost is lets say as above example $1400. no charge for follow up appointment. So new grand total of $ 68,865. Wow nearly $70,000. And most likely its not at all covered, so it's all coming out of your pocket. With a companion it would be at least that much. And the prices these surgeons are charging isn't slowing down anytime soon. It pay's to be rich, or becoming a revision nose surgeon.
Friday, July 30, 2010
Nose surgery a unique but questionable business
What's unique but questionable in regards to nose surgery especially revision nose surgery for breathing issue's, is that it is the only surgery that i know of where you have to pay out of pocket (in full in some cases) in order to improve your health condition while being a citizen in a Country that offers Universal health care, like that in Canada. For the few that are lucky enough to qualify in getting insurance coverage in Canada, or the U.S.A, they will still be out of pocket for the "cosmetic" component of the surgery which will likely end up being 50% or higher of the total fee. In Canada, it would be very difficult to get any portion of nasal valve collapse surgery costs to be covered by the health care system and less likely to get coverage for empty nose syndrome corrective surgery, since most e.n.t. surgeons aren't aware or refuse to recognize empty nose syndrome as a real serious condition and many don't know how to treat, let alone diagnose nasal valve collapse. Now as for Provincial or Federal Government financial assistance coverage don't expect a Plastic Surgeon to even help you apply. I had asked one Plastic Surgeon who is considered the best rhinoplasty surgeons in my city to see if I could get provincial health coverage to help cover nominal amount towards the surgery I need, (since he and no one else in the province could correct the problem with my nose). He ended up giving me the run around. First he told me it wasn't going to be much money and then recommended that I should ask an e.n.t doctor. I think he was afraid his reputation would look bad, to admit to the government that he couldn't do the surgery which meant I would need to seek out a more qualified specialist. He agreed with me I should pursue finding a surgeon out of the country who specializes in revision nose surgery yet was still unwilling to be of any help. He couldn't even recommend a U.S. surgeon. In Canada, If you need to have surgery outside of the country you will not be eligible for any reimbursement, without a surgeon's referral stating that the level of care or procedure you need is not available in Canada. In my case, I already had 2 major revisions, which made my problems worse and one of the surgeons was considered a top nose revision surgeon in all of Canada. So I need a highly skilled nose revision surgeon, like those in the United States, to correct my breathing issue's. This is a terribly unfair situation considering revision nose surgery for nasal valve collapse can cost upwards of $25,000 U.S. by a reputable experienced surgeon. The cost for empty nose syndrome surgery exceeds $10,000. There's also the cost's of travel, hotel stay (you can't travel for 7-10 days after nose surgery) supervision by nurse for a day (if unaccompanied for the surgery), medication and food. If that isn't bad enough, some surgeons don't even offer financial payment plans. In these situations the person who needs the surgery may not be able to afford it.
Many nose patients are unaware of these serious side effect before the surgery, and when it occurs, more often then not, the nose surgeon can't or will not correct the problem. The patient is now, not only out of pocket from the first surgery but has to pay out of pocket for the revision. Worse, like in my case, when you don't have a successful secondary surgery you are further out of pocket and the more nose surgery's you have, the higher the price a Nose Revision Specialist will charge you for another corrective procedure.
If you had unsuccessful eye surgery or ear surgery, and needed revision surgery because it made your sight or hearing worse, you most likely would be covered fully by the health care system in Canada , even if it was necessary to leave the country to get it done by a more qualified specialist. Unfortunately nose surgery is in a infamous league of its own when it comes to repairing a bad outcome that affected your breathing. You are included in the "Cosmetic" category even though your major or full complaint is a "Functional" breathing issue. If you are insured then the the nose surgeon additionally bills you for the cosmetic portion which is above and beyond what the insurance company covers for the functional portion. Depending what the overall charges are some would venture to say it's a double billing system. If you have no insurance then you will end up paying the full amount out of your own pocket, since doctors in Canada seem uninterested in helping you attain even a nominal amount of coverage through the Government. Many ent's don't understand why you need to go out of the country for the surgery. Many don't realize the complexity of the surgery, with regards to proper nose grafting procedures and the expertise and experience that a surgeon needs to perform such complex revision nose surgery's with consistent successful results.
Nose revision surgeons in Canada, should also become active in recommending that the health care system cover a larger amount then the miniscule amount being offered now towards the revision surgical costs. An amount that is at least PROPORTIONAL to the SURGICAL TIME needed to correct the FUNCTION of the nose. We pay into the system through our taxes. We should expect equal and fair compensation like other surgery's would receive, especially when considering the fact that a nose surgeon within our own country was responsible for these breathings problems in the first place.
There are also no set rules in how facial plastic surgeons (in general) divide up the fee's between the cosmetic and functional components. The nose revision surgeon arbitrarily decides what that breakdown will be. It seems to be that the portion the Government or Insurance company's covers (if you had prior nose surgery it may be very difficult to get any Insurance coverage) is the functional portion claimed and the balance is the cosmetic component. If you don't have insurance or not able to qualify for it, and have the surgery in Canada as a citizen, the Gov't provincial health care portion claimed by the surgeon is considered the functional component.
So how small an amount is this Gov't portion that is claimed for the functional surgery of the operation? Well very very small. There are different codes that are used by the surgeons when they make these claims, so it can be confusing to exactly what amount goes to the operation and what amount goes towards each consultation. With that in mind from my surgery in 2001 performed by a Plastic Surgeon the amount claimed for the operation was $508.40. From my surgery performed in 2005 by an E.N.T/Facial Plastic surgeon the amount claimed was $307.75. How much was I charged for the two surgery's? The Plastic Surgeon in 2001 charged me around $5500 for a 3-4 hour revision surgery. The E.N.T./FPS in 2005 charged me $7700 for a One and half hour revision surgery. So in other words the Functional component claimed in 2001 worked out to less then 10% of the total charges, and the Functional component claimed in 2005 worked out to less then 5% of the total charges. Note: My two only major complaints with each of those surgery's was 1) My problem with breathing due to collapsing of the nasal valve (a result of primary surgery) and 2) The projection and angle of my nose tip (also a result of primary surgery).
Nose revision surgeons in Canada, should also become active in recommending that the health care system cover a larger amount then the miniscule amount being offered now towards the revision surgical costs. An amount that is at least PROPORTIONAL to the SURGICAL TIME needed to correct the FUNCTION of the nose. We pay into the system through our taxes. We should expect equal and fair compensation like other surgery's would receive, especially when considering the fact that a nose surgeon within our own country was responsible for these breathings problems in the first place.
There are also no set rules in how facial plastic surgeons (in general) divide up the fee's between the cosmetic and functional components. The nose revision surgeon arbitrarily decides what that breakdown will be. It seems to be that the portion the Government or Insurance company's covers (if you had prior nose surgery it may be very difficult to get any Insurance coverage) is the functional portion claimed and the balance is the cosmetic component. If you don't have insurance or not able to qualify for it, and have the surgery in Canada as a citizen, the Gov't provincial health care portion claimed by the surgeon is considered the functional component.
If the nose revision surgeons really care at all about these victims they would be addressing these issues with the health care system. Isn't being able to breath through your nose an important function??? The real irony is that nasal valve collapse is a condition that is primarily caused by poor primary nose surgery (iatrogenic). Empty nose syndrome which is more rare, is a result from over aggressive removal of the inferior turbinates and/or middle turbinates (also iatrogenic).
Many nose patients are unaware of these serious side effect before the surgery, and when it occurs, more often then not, the nose surgeon can't or will not correct the problem. The patient is now, not only out of pocket from the first surgery but has to pay out of pocket for the revision. Worse, like in my case, when you don't have a successful secondary surgery you are further out of pocket and the more nose surgery's you have, the higher the price a Nose Revision Specialist will charge you for another corrective procedure.
There's no question greed and/or apathy has set in with some of the nose revision surgeons. They need to prove they care not just about the money but also about their patients health, by becoming vocal and active with helping them get some proportionate amount of coverage (either private or public) and offer a monthly payment plan. Its really in their best interest as well as the interest for their potential patients. The ability for the nose revision surgeon to state that even if the surgery is for breathing issue's, it's still a cosmetic procedure, allows the surgeon free reign to charge whatever (s)he wants for the surgery. There's no limit, its a business based on the open market. But even the "cosmetic component" portion that some charge can be so exorbitant that many will have to shop around for a surgeon who charges a more reasonable and equitable amount.
It's a serious problem, that won't make front page news and therefore not likely much if anything will be done to address these unjust situations. The revision nose victim falls within the cracks of the health care system and therefore many may end up with serious financial consequences depending on their financial position. Some may end up having to take out a loan or second mortgage on their home or find someone that will borrow them the money. Some may even have to sell a valuable possession of theirs (i.e. Jewelry) to come up with the money. For the nose victims who just can't come up with the money for the surgery, they will have to suffer in silence and find alternatives to rely on such as; nose sprays, decongestant pills nose splints or possibly a cheaper costing minor surgical procedure that may give some relief temporarily, until they can afford the appropriate surgery. And in the mean time the surgeons fee's, as well as hospital and clinic fee's will all continue to escalate.
Closed vs Open nose surgery
Most Primary (first nose operations) Surgery's are done by closed procedure, so no visible scars can be detected. However with revisions that require more extensive work that correct problems with collapsing of nasal wall, these Secondary or Revision Surgery's are done by Open procedure. There are few surgeons who will prefer closed technique, but they are the exception. There are advantages and disadvantages to both these procedures. If you have too many open procedures you risk greater chance of developing necrosis. With closed the drawback is you don't see the whole area that your working on, and you can't as easily place as large a graft as you can with open procedure. With closed you disturb less of the tissues of the nose, and you can have a better and faster idea how the nose will take shape. Its less invasive and heal time is much faster.
Subscribe to:
Posts (Atom)