The New Rules for Rhinoplasty in the COVID-19 Era

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New York plastic surgeon Jeffrey S. Yager, MD recently started performing elective cosmetic procedures again after the three-month, state-mandated halt was lifted. 

One thing he’s found most surprising during the COVID-19 crisis: “The majority of my patients were eager to proceed, as they view the surgeries as safe,” he says. “And, they finally have time off from work to recover.” 

While his office in Upper Manhattan is now seeing a surge in demand, there are new precautions being taken. For starters, all patients are now tested by nasal swab for COVID three to five days prior to the procedure in his office, mainly because he does not want a healthy patient potentially being exposed to the virus in an urgent care center.

“I’m still encouraging all consults to be done virtually to minimize patient flow in the office,” Dr. Yager explains, adding that he’s seen a major uptick in contact and communication with patients via social media. “Even some post-op visits can be done virtually to avoid potential exposure. Of course, each patient comes for an in-person preoperative visit and exam, but we ensure strict social-distancing and mask policies, and have a clear cleaning protocol between patients.” 

Wayne, NJ facial plastic surgeon Jeffrey B. Wise, MD is doing something similar at his practice. “For all of our surgical and hair transplant patients, we are testing the patients for COVID with the PCR test—typically within five days of the procedure. Then, we ask patients to quarantine after their test to mitigate exposure. Likewise, the staff is tested every few weeks and monitored for symptoms and daily temperature checks.”

Luckily, according to Dr. Wise, in New Jersey, the census for hospitalized COVID patients is quite low at the moment. “For example, the hospital where I perform some of my procedures had a COVID census this week of three patients in the entire hospital,” he says. “Regardless, hospitals are limiting the numbers of friends or family members that accompany patients to surgery. For procedures performed at our office, I have been meeting patients’ companions or their rides in the parking lot after surgeries to limit traffic inside the office.”

“Through all this, our patients understand and appreciate our efforts to keep them and the staff safe and are very compliant with our policies and protocols!”

For Smithtown, NY facial plastic surgeon James C. Marotta, MD’s patients, similar modifications have been made.   

Besides having all surgery patients COVID-tested five days prior, all visitors to the center must attest they are symptom-free and have their temperature screened by a member of the staff (who is wearing an N-95 respirator and face shield) before being allowed into the building.

“Surgery patients enter unaccompanied—unless they are a minor—to limit our exposure to visitors. In the prep area, surgery patients are asked to keep their masks on and they are only removed when I do surgical markings,” he explains. “I am, of course, in full PPE with an N-95, glasses and face shield when their masks are off. During intubation, we limit the staff in the room to the anesthesiologist and nurse who are in full PPE. Operating rooms, as always, are thoroughly disinfected, but we have added UV-irradiation of the circulating air in the OR to further insure patient and staff safety.”

It’s the surgeon and staff safety that needs special consideration when it comes to rhinoplasties, specifically, according to La Jolla, CA plastic surgeon Robert Singer, MD.

“With a rhinoplasty, you’re dealing with the respiratory system—which we know carries the viral load—as well as the aerosol droplets,” he explains. “Early studies suggest that additional precautions are needed and, in addition to wearing the appropriate PPE, some recommend irrigating the nose with antiseptic or a diluted solution of hydrogen peroxide or mouthwash before surgery. But these steps are more for the safety of the surgeon performing the surgery and the staff to keep them protected.”

As for the whole wearing-a-mask debate, Dr. Singer says it’s not something you have to worry about—at least not in regards to the post-op days after nose surgery. “You can still have a splint on and you can wear a mask over that,” he assures.

Dr. Yager agrees, adding that there are also modified masks that some offices offer. “Facial procedures such as rhinoplasty and as facelift need some special caution, as the wrong mask can damage the results of a surgery in the immediate postoperative period. We have modified the masks so they do not put any pressure on the cheeks or nasal bridge, yet still provide a safety barrier for airborne pathogens.”

While Dr. Yager describes the pandemic as “a bizarre experience,” and having to halt working for three months as an “eye opener,” he also points to many positive learnings in the industry—especially when it comes to safety.

“I think a lot of surgeons found new ways to reach out and stay available to patients during this time,” he says. “This can only deepen our connection and commitment to our community.”

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