Of course you are not expected to ask all of these questions but you are entitled to if you want to. For ease of reference highlight the numbers of the questions you do wish to ask at your consultation.

Surgeon: ______________________________  Date: _____________  Time: ________ am/pm
phone: ____________________   address: _________________________________________
website: ______________________________ referrer: _______________________________
Certified by American Board of Plastic Surgery:  yes   no
Certified by American Board of Facial Plastic & Reconstructive Surgery:  yes   no
Other: ______________________________________________________________________

Rating (circle one)

• patient referral list available:  yes   no
• bedside manner:  poor   fair   average   above average   excellent
• communication skills:  poor   fair   average   above average   excellent
• attitude of staff:  poor   fair   average   above average   excellent
• appearance of surgeon:  poor   fair   average   above average   excellent
• office appearance:  poor   fair   average   above average   excellent
• all questions answered:  yes   no
• viewed before & after photos:  yes   no

1. What made you decide to become a Cosmetic Plastic Surgeon?
   ______________________________________________________________________
   ______________________________________________________________________
2. How long have you been practicing as a Cosmetic Plastic Surgeon?
   ______________________________________________________________________
3. Are you certified by the American Board of Plastic Surgery? If so, How long? 
   ______________________________________________________________________
4. If not, are you board eligible? If not? Why not?
   ______________________________________________________________________
   ______________________________________________________________________
5. If not certified by the ABPS, are you certified by the American Board of Facial Plastic & Reconstructive Surgery? If so, How long? 
   ______________________________________________________________________
6. What, if anything, was your medical specialty before you chose to practice Cosmetic Plastic surgery?
   ______________________________________________________________________
7. Have you ever been disciplined by a board or by the state?
   ______________________________________________________________________
8. Have you been involved in any medical malpractice suits? If so how many?
   ______________________________________________________________________
9. What is your favorite procedure to perform and why?
   ______________________________________________________________________
10. How many revision rhinoplasties have you performed?
    ______________________________________________________________________
11. How many revisions of your own work, on average, do you perform?
    ______________________________________________________________________
12. Have you or would you be willing to perform this procedure on a loved one or family member?
    ______________________________________________________________________
13. Would there be any reason that I would not be a good candidate for this surgery?
    ______________________________________________________________________
14. What are the complications for this particular procedure?
    ______________________________________________________________________
    ______________________________________________________________________
15. I have heard of patients developing a hematoma, this scares me; what is it, how often does it occur and how is it dealt with?
    ______________________________________________________________________
    ______________________________________________________________________
16. What type of implants have you worked with or do you offer any of the following:
    [  ] ear cartilage  [  ] bone grafts   [  ] fat grafting/soft tissue grafts  [  ] solid silicone implants
    [  ] Medpor/Porex (polyethylene)   [  ] hydroxyapatite   [  ] expanded polytetrafluoroethylene (ePTFE)  [  ] injectables
17. Are there other techniques, newer ones perhaps, that I am not aware of?
    ______________________________________________________________________
18. Do you have a video tape available of the revision rhinoplasty procedure that I may check out?
    ______________________________________________________________________
19. How long do you recommend I take off from work, school, etc. to heal properly?
20. Will there be much pain?
    ______________________________________________________________________
21. What types of medications will I be given and which pain medications do you normally prescribe?
    ______________________________________________________________________
    ______________________________________________________________________
22. I am sensitive to Vicodin and Codeine (it makes some people nauseated), what alternative medications do you offer? (if applicable)
    ______________________________________________________________________
23. Do you perform your surgeries with the patient under General, Light Sleep Sedation or any other? Which do you prefer and why?
    ______________________________________________________________________
    ______________________________________________________________________
24. I have heard that general anesthesia makes the patient sick to their stomach, is this true? What can you do to lessen its effect?
    ______________________________________________________________________
25. Can I view your Before & After photos? Do you have any consecutive collections?
    ______________________________________________________________________
26. May I speak with any of your patients who have had revision rhinoplasty? Do you have a patient/referral list so that I may call them?
    ______________________________________________________________________
27. Do you have many repeat patients and referrals?
    ______________________________________________________________________
28. How many of these procedures do you perform on average, annually?
    ______________________________________________________________________
29. Will there be much bruising or swelling?
    ______________________________________________________________________
30. When should I expect to look "normal" again?
    ______________________________________________________________________
31. I have heard SinEcch, a pharmaceutical grade derivative of Arnica montana, helps with the swelling and bruising if taken before and after my surgery. Is this true? Do you suggest it? What about the topical gel?
    ______________________________________________________________________
    ______________________________________________________________________
32. What about Bromelain or drinking pineapple juice? Anything else?
    ______________________________________________________________________
33. Will I have scarring? If so, how bad will it be?
    ______________________________________________________________________
34. Do you have an onsite accredited Surgery Center? May I see it?
    ______________________________________________________________________
35. Who is responsible for cleaning/sterilizing your operating room? Does a private company handle this matter or does your staff handle this area?
    _____________________________________________________________________________________________________________________________________________
36. Do you have hospital privileges, should I choose to undergo my procedure in a hospital? If not, did you lose those privileges? 
    ______________________________________________________________________
37. Will I have a certified anesthesiologist or a Doctor of anesthesiology if I have General anesthesia?
    ______________________________________________________________________
38. What side effects are possible with revision rhinoplasty?
    ______________________________________________________________________
39. What tips do you have for me to ease some discomfort and pain?
    ______________________________________________________________________
40. Must I abide by any special diet, both pre-operatively and post-operatively?
    ______________________________________________________________________
41. I take (birth control, diet pills, antidepressants, etc.) will I have any adverse reactions from the prescribed medications or anesthesia? Don't forget to view the Medication & Supplement List.
    ______________________________________________________________________
42. What would you do if I were to choose to undergo the surgery and I had a complication?
    ___________________________________________________________
    ___________________________________________________________
43. If my results are not what I wanted, what is your policy on revisions? Can I have this in writing?
    ______________________________________________________________________
44. Do you believe my expectations can be met?
    ______________________________________________________________________
45. What if I change my mind and back out, will my money be refunded?
    ______________________________________________________________________
46. If I have an emergency the night after surgery, what should I do?
    ______________________________________________________________________
47. If such an emergency arises, will you be the attending physician?
    ______________________________________________________________________
48. If I will need sutures (stitches), when will they be taken out?
    ______________________________________________________________________
49. Are there any hidden costs that I should know about? For lab work, post-operative check-ups, additional medications, compression garments or surgical attire?
    ______________________________________________________________________
    ______________________________________________________________________
50. If I need anything after-hours, how will I be able to get in touch with you or your staff?
    ______________________________________________________________________
51. What is your protocol on post-op care?
    ______________________________________________________________________
    ______________________________________________________________________
52. Do you offer financing (if applicable)? Do you expect full payment up front?
    Can I pay in increments? (or any other financial questions you may have)
    ______________________________________________________________________
53. When will I be able to walk, exercise, run or participate in contact sports?
    ______________________________________________________________________
    ______________________________________________________________________

Notes:____________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

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