FPSAM - Roundtable 2022 - 7

EXPERT PANEL DISCUSSION
Dr. Spiegel: In other words, ''what we do, is we have
people go home.''
Dr. Rodman: I send them home whenever possible
because I do not think they get good care in the hospital,
honestly. I think a private one-on-one nurse is
better than the one to six or one to eight that they have
on the floor.
Dr. Spiegel: I agree with you, and something that
will evolve is that, at most of the larger medical
centers-and I am sure, Drs. Schechter and Knott,
and Garcia, and Dr. Alperovich, I'm sure you see-
that the nurse you get can matters a large amount.
Whether they are sensitive to the patient's needs
or not, I think with time and evolution, as people's
awareness increases, things will improve. I have
had, in 20 years, plenty of nurses who were almost
willfully not kind to the patients in the hospital,
which creates a tremendous amount of problems.
We have had a protected, controlled environment
now and like Dr. Schechter said, about a social
worker, I now have five people in our office who are
dedicated to perioperative care for patients, including
coordinating stays, nursing, follow-ups,
and everything else. Five full-time people.
Dr. Alperovich: It's with all the patient-reported
outcome measures, the breast q, the face q, the body q,
I think one of the things that I thought was most surprising
is that the office interaction, the perioperative
care, mattered almost as much as the final outcome.
I find that-especially working at a big academic
center, which sometimes has mixed awareness-you
are almost preemptively apologizing for potentially
unfavorable or unpleasant perioperative experience. If
everything goes well, great, but if there's any hiccup,
that almost predisposes you to having a challenging
postoperative course. I agree, if you can do anything to
obviate that, or whether that's one-to-one nursing care,
or outpatient care, I think that is ultimately beneficial
to the patient.
Dr. Spiegel: I agree completely with that, and surgeons,
by nature, like to control outcomes and
control experiences top to bottom. It's disconcerting
to release your patient into the wilds of the floor
there, to some extent.
Dr. Knott: I have a big rhinoplasty practice and all of
my patients go home after rib grafts, or whatever else,
and they have a great experience. I can really control
the entire experience preoperatively, postoperatively,
and PACU. My facelift patients, I oftentimes keep
them and as youjust said, it's rolling the dice. Youjust
don't know what experience they are going to have.
It's much more challenging to have an overall positive
ยช 2022 American Academy of Facial Plastic and Reconstructive Surgery, Inc.
experience. Even if one person who touches them in
the hospital, metaphorically touch them in a negative
way, it's amazing how they can perseverate on it and it
can ruin their experience.
Dr. Spiegel: One ofthe things that is going to appear
in this supplement is an article pointing out that
outcome measures in transgender surgery, or
gender-confirming surgery of any types, are in
their early stages at best. It is difficult to come up
with a great way to do a meta-analysis, or to look at
outcomes in these surgeries. My general opinion,
from the very high-altitude view, is that for most
aesthetic and appearance-related surgeries, the
only outcome measure that matters is individual
happiness.
It is not so scientific, necessarily, and it would be
great if we could come up with a way of more objectively
determining outcomes because then, even
if you had a patient who did not feel like their
outcome was affected adequately, you could show
them, well, on this scale, your femininity or your
outcome has improved considerably. That is
something for us all to work on.
A lot of rhinoplasty literature has always focused
on grafts and augmentation, but of course typically,
for feminization procedures and transgender patients,
you need to do a lot of reduction. Reduction
leads to prolonged swelling and lack of detail. Does
anyone want to offer some tips and techniques on
rhinoplasty?
Dr. Knott: Well sure, I would be happy to jump in
there, Jeff. I think it's interesting. Sometimes in general,
I agree that it's a reductive operation, and as much
reduction as is refinement. I do a lot of narrowing of
noses, narrowing of alar bases, probably more than I
am actually deprojecting noses, more rotating than
deprojecting. I find that the frontal-orbital work really
opens up the frontal-nasal angle, and really brings the
nose into, even if you do not do a rhinoplasty, it looks
much more feminine. Same thing with a lip lift. It's
that microenvironment around the nose that the angles
and the aesthetics are already improved. Then it's just
about creating, I do not necessarily make a ski-slope
nose, or overly feminized nose. It's just about creating
nice, smooth, even, feminine contours, and narrowing,
if I had to kind of give my overall approach.
Dr. Spiegel: Dr. Garcia, what are you doing about
managing swelling and helping to get noses looking
good faster?
Dr. Garcia: Typically, I do prescribe about 10mg of
steroid for about 10 days, without a taper since it's such
a low dose. Then I do have the opposite experience in
that I am doing a lot of augmentation rhinoplasty. I am
7

FPSAM - Roundtable 2022

Table of Contents for the Digital Edition of FPSAM - Roundtable 2022

FPSAM - Roundtable 2022 - Cover1
FPSAM - Roundtable 2022 - Cover2
FPSAM - Roundtable 2022 - i
FPSAM - Roundtable 2022 - ii
FPSAM - Roundtable 2022 - iii
FPSAM - Roundtable 2022 - iv
FPSAM - Roundtable 2022 - 1
FPSAM - Roundtable 2022 - 2
FPSAM - Roundtable 2022 - 3
FPSAM - Roundtable 2022 - 4
FPSAM - Roundtable 2022 - 5
FPSAM - Roundtable 2022 - 6
FPSAM - Roundtable 2022 - 7
FPSAM - Roundtable 2022 - 8
FPSAM - Roundtable 2022 - 9
FPSAM - Roundtable 2022 - 10
FPSAM - Roundtable 2022 - 11
FPSAM - Roundtable 2022 - 12
FPSAM - Roundtable 2022 - Cover3
FPSAM - Roundtable 2022 - Cover4
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