The Most Important Step in a Rhinoplasty Consultation

Announcer (00:00):
You're listening to The La Jolla Cosmetic Podcast with Monique Ramsey.

Monique Ramsey (00:06):
Deciding to get any cosmetic procedure is a big deal, but especially when it comes to your face. A big part of helping patients feel comfortable, confident, and well prepared ahead of time is giving them a visualization of what their final results might look like. Dr. Kiersten Riedler is here with us today and she takes her time during each of her rhinoplasty consultations to create a photo simulation of a patient's before image, what their goals are to make sure that they're seeing eye to eye with what she's seeing and is their goal possible because maybe their goal. And so it's a good tool for communication. And so welcome back Dr. Riedler.

Dr. Riedler (00:49):
Thanks for having me.

Monique Ramsey (00:50):
So tell us about why showing rhinoplasty patients an idea of what they might look like with their final results. So important and how does it help with expectations?

Dr. Riedler (01:02):
So I think it's really important because rhinoplasty is very personal and three dimensional surgery and everybody's nose is so different. There are sort of ideal ranges in terms of angles, dimensions, proportions, however that's a range just I think it's not about what nos I want you to have, it's about what nos you want to have. So it's really a great communication tool.

Monique Ramsey (01:34):
Do you do this at every rhinoplasty consultation?

Dr. Riedler (01:37):
Yeah, I do because everybody's anatomy is so different and I can talk all day about all the different little anatomical details and parts of the nose, but I don't expect patients to know any of those terms. So sort of like a picture's worth a thousand words?

Monique Ramsey (01:54):
Yeah, because I think sometimes patients dunno how to verbalize what it is they want to see, but they can point to a screen and if they see a picture of themselves, they can go right here. This is what's bothering me. Exactly. And now what kind of reactions do you get from patients when they first see that simulation?

Dr. Riedler (02:12):
I mean, a lot of times patients are excited and they're like, oh, that's exactly what I wanted, or that's exactly what I had in mind. That's not always the case. Sometimes they're like, whoa, it's weird to see myself with a different nose that's going to take a little getting used to. Those are the two most common reactions, but everyone's different.

Monique Ramsey (02:32):
Now what questions do you ask and what specific features are you looking at during that consultation to make sure that you're creating an accurate image of what the patients are looking for?

Dr. Riedler (02:43):
The things that I really ask patients to give me an idea of what they're looking for is what bothers them when they look in the mirror, when they see themselves in photos. Is it a bump, is it a crookedness? Is it that the tip, especially when you smile, things like that. And then also just looking at the rest of the face, how the nose balances with the rest of the face and also the skin thickness, the septum, it's all interrelated. But as far as what the patients goals and what I'm asking them, it's more about what bothers you, why are you here essentially?

Monique Ramsey (03:23):
And how accurate would you say your photo simulations tend to be when compared to the final result?

Dr. Riedler (03:29):
I think they're pretty accurate, but the goal isn't for them to be a hundred percent accurate. It's not a guarantee. It's more like this is a roadmap. This is what I am going to look at in the OR and try to create as closely to the simulation as I can. I think in my hands, or usually probably around 90% accurate if I could put a number on it. But healing can be unpredictable and in the beginning you're swollen, so it takes a little while to get to that final result. But the reason I like to do take the photos myself and do the morphs myself is I know what I can do working with your anatomy. So it's kind of helpful for me too. It's sort of like the first or second time I'm going through her whole surgical process in my head for that patient.

Monique Ramsey (04:26):
Yeah. Well and way back when Dr. Oleson was practicing in our office, I would do all the imaging for him. So we'd take the pictures and he would say, okay, Monique, now rotate the tip. And he would kind of point and I would execute and he would go off and see a patient come back when we're ready. And patients would say, oh, well can you do, I'm like, look, I can do anything on this picture. Exactly. That doesn't mean he can do it in the or. Exactly. And so I think cutting out the middleman and having you do it from the get go is really good. I mean, you could have somebody else do it for you. It only matters what the doctor feels that they can do.

Dr. Riedler (05:08):
Yeah That's true. I'm sure you're great at it, but

Monique Ramsey (05:11):
Well, I was pretty good at it, but it helped me, it was really interesting because it helped me look at people's faces in a new way. And I think I also was able to see patients be able to make that communication better with the doctor. And I remember one man in particular and he thought he wanted a chin implant. He kept talking about a chin implant, chin implant, chin implant. So I'm doing the imaging and I'm like, I'm pulling out the chin. And I'm like, this is just, he doesn't need it. I'm so confused. And finally when Dr. Oleson came back in, we just knew something wasn't right. And so he said, show me where you want to look better. And really what the guy wanted, he had an older brother that had a strong jawline. The patient was saying chin, he meant jawline. And so what if we never had that imaging, would a chin implant go in? So it's a really good tool because we don't know what we call a chin is a chin or is it the parts around near the chin. Exactly. And so in his case, it really was a helpful tool to help understand and with the doctor to understand they had already had a whole consultation by the time they came to image. So it still was not talking the same language. Exactly. So I think that tool, and I think the tool in your hands that cutting out the middleman part is great. So how long does it typically take you? What would I be doing while you're doing this morphing of my profile? How long does that process take?

Dr. Riedler (06:55):
So it takes about 10 to 15 minutes. I will take the photos, upload them, and then modify the photos, print them out, bring them back to show the patient and kind of go over them. And in the meantime, during that 10 or 15 minutes or so, usually I have my nurse or medical assistant going through some of the before and after photos in the gallery, in the room so that the patient can see other patient's results and get an idea of what to possibly expect.

Monique Ramsey (07:28):
And I think knowing that what we have in our gallery online is different than what we have in our gallery when you come in to visit, some patients don't want to be out on the interwebs. They're like, yeah, I'll share my result. But with patients in the clinic now, let's say if somebody was disappointed in, let's see, they see the imaging that you've done the morphing and they want a more dramatic result, but that might not be possible. How do you approach managing their expectations?

Dr. Riedler (08:05):
So I kind of talk about what are the things that I can change and what are the things that are just things that I just can't change. I can't change where your nose attaches to your face, for example, I can't change your skin thickness. I also want you to be able to breathe and I

Monique Ramsey (08:24):
Kind of important

Dr. Riedler (08:25):
And I want you to have a good long-term result. So just kind of explaining what is achievable, what is possible, and also going to give them good function is important. And that's one reason why I think this process is so important because it isn't just to confirm that we're on the same page. It's also to show patients what is possible, what is realistic with their nose, and also talk about the function, the long-term aspect of it. I want to give you a nose that is going to look good and breathe well for your whole life.

Monique Ramsey (09:02):
I'm going to just throw this out there and guess that because we have all these different AI assisted filters and all these apps and you can do anything to your face. And then people start to have a new reality of faces, of beauty of how often would you say patients are referencing when they come in and they'll show you, oh, I did this to my face. It's one thing to use makeup to draw to make the nose thinner or to emphasize cheekbones or whatever. But when you're actually using face tune and it's become a whole different you and you get used to seeing that. Are people bringing that in and saying, oh, this is what I want to look like?

Dr. Riedler (09:55):
Yeah, definitely. Sometimes patients will show me a filter or face tune and it's helpful because it shows me what they do. It's also actually helpful because that gives me an opportunity to show them what in that photo is physically possible and what is not. For example, often I'll notice that the nose is a lot narrower, but that's because the point where the nose meets the face is narrower and I can't give you more cheek skin. There's certain things I physically can't do. Even if that photo isn't possible surgically, that can still be a good communication tool because that gives me the opportunity to say, that looks gorgeous and I wish I could do that, but I can't achieve all of those things that you're seeing in the face tune or in filters.

Monique Ramsey (11:05):
Now, do you think patients having an image of a potential after sort of helps play a role in calming presurgical jitters or I don't know, maybe even after surgery, having the long while they're going through all the swelling and having the long-term like, okay, here's my goal and I will get there eventually.

Dr. Riedler (11:28):
Yeah, definitely because you're putting your face in somebody else's hands, which is a big deal. And so making sure that you're on the same page and then your surgeon have the same goals and the same understanding I think is really important and comforting. And then it gives them confidence also that they will look like themselves just a better version of themselves, but they're not going to look like a completely different person who's unrecognizable or has features that are totally off from what they were hoping to achieve.

Monique Ramsey (12:07):
And I think also seeing the imaging or the morphine or whatever you want to call it, is helpful. Does it maybe help let their brain

Dr. Riedler (12:18):
Relax sort of?

Monique Ramsey (12:19):
Right. And even, I don't know, there is something that happens to your brain a little, I would think after surgery, your brain has to get used to seeing a new you. Right? And there's got to be some time for it to connect. And so it seems like if you were able to pre-think about this new look, maybe it helps afterwards.

Dr. Riedler (12:44):
I definitely agree. I mean, I think it still takes a little getting used to sometimes when I'll show people the simulated photo, they'll be like, oh wow, I really like it, but it's kind of weird to see myself looking different. And so it helps your brain kind of wrap your mind around that a little bit sooner and kind of mentally prepare a little bit too.

Monique Ramsey (13:09):
Well, thank you Dr. Riedler for coming on the podcast. It's been a little while since we saw you and I want to see you more. This is really fun, and thanks everybody who's listening out there or watching us on YouTube. We love it. And if you come into the office and you show that you're a podcast subscriber, we're going to give you $25 off of any purchase of $50 or more with our skincare, and we have Alastin Skincare. Dr. Riedler, if you were going to use your $25 off, what's your favorite Alastin skincare product?

Dr. Riedler (13:43):
Oh my gosh, that's so hard.

Monique Ramsey (13:46):
They're all good. Right?

Dr. Riedler (13:48):
I really like the restorative skin complex. If I had to choose one, it's a great serum. It helps moisture. It really just improves your skin quality in a lot of different ways. So if I had to choose one, then I would do that.

Monique Ramsey (14:07):
But that's all we're going to let you do.Well, thanks Dr. Riedler, and thanks everybody for listening, and we'll see you on the next one. Bye.

Announcer (14:18):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment or mention the promo code podcast to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I-5 San Diego Freeway in the Ximed Building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com or follow the team on Instagram @ljcsc. The La Jolla Cosmetic Podcast is a production of The Axis, theaxis.io.