To determine the patient’s suitability for undergoing a rhinoplasty procedure, the surgeon clinically evaluates him or her with a complete medical history (anamnesis) to determine his or her physical and psychological health. The prospective patient must explain to the physician–surgeon the functional and aesthetic nasal problems that he or she suffers. The surgeon asks about the ailments’ symptoms and their duration, past surgical interventions, allergies, drugs use and drugs abuse (prescription and commercial medications), and a general medical history. Furthermore, additional to physical suitability is psychological suitability—the patient’s psychological motive for undergoing nose surgery is critical to the surgeon’s pre-operative evaluation of the patient. In the case of men, the surgeon must identify prospective patients presenting the mental traits denoted by the psychiatric acronym SIMON (single, immature, male, over-expectant, and narcissistic), which might indicate a man over-valuing the outcome of a rhinoplasty.
The complete physical examination of the rhinoplasty patient determines if he or she is physically fit to undergo and tolerate the physiologic stresses of nose surgery. The examination comprehends every existing physical problem, and a consultation with an anesthesiologist, if warranted by the patient’s medical data. Specific facial and nasal evaluations record the patient’s skin type, existing surgical scars, and the symmetry and asymmetry of the aesthetic nasal subunits. The external and internal nasal examination concentrates upon the anatomic thirds of the nose—upper section, middle section, lower section—specifically noting their structures; the measures of the nasal angles (at which the external nose projects from the face); and the physical characteristics of the nasofacial bony and soft tissues. The internal examination evaluates the condition of the nasal septum, the internal and external nasal valves, the turbinates, and the nasal lining, paying special attention to the structure and the form of the nasal dorsum and the tip of the nose.
Furthermore, when warranted, specific tests—the mirror test, vasoconstriction examinations, and the Cottle maneuver—are included in the pre-operative evaluation of the prospective rhinoplasty patient.