How were rhinoplasty procedures affected at the start of the pandemic?
There was a concern initially because the virus lives at the back of the nose, which meant that there was a high risk of transmission.COVID-19 is transmitted primarily through aerosols (droplets in the air, containing the virus) and any procedure that generates an aerosol potentially puts the patient and medical staff at risk.
To ensure adequate facilities, the UK government took over private medical institutions for the NHS and imposed a complete restriction on any non-essential surgery. They released a clinical guide on surgical prioritisation with low priority patients (categorised as level 3 or 4) not permitted to have surgery, effectively excluding them from any treatment. Overall, the coronavirus pandemic has had a huge impact on people’s access to plastic surgery.
For patients still in recovery, how have follow-up appointments been managed?
We made arrangements for the patients on who had surgery already. Through the use of telemedicine via online video calls (Top Doctors’ e-Consultation tool), patients’ plasters would be self-removed with the practice nurse online instructing them how to do it using a home kit with cotton buds and plaster removal solution. Thanks to this guidance, the patients were all able to do it themselves.
Telemedicine has been the biggest change in terms of how we engage and treat patients for rhinoplasty.
How were surgeons advised on managing their clinics during the coronavirus pandemic?
I was recently involved with a European-wide multidisciplinary webinar, where specialist surgeons in rhinoplasty looked at available evidence for the risks in the pandemic receiving advice from virologists. A consensus view was agreed on how to minimise the risk to both surgeons and patients and to give enough evidence about catching COVID-19 around having general anaesthesia.
Using the information from a UK driven study called COVIDSURG, which is based on over 33,000 patients from around the world who developed Covid-19 around the time of their operation, we are now in a position to advise people about the risks of non-essential surgery and coronavirus infection.
Thanks to the COVID-19 green pathways, we can now ensure that our patients are moving forward safely using official guidelines. This includes advising patients to self-isolate before and have a period of isolation after surgery. The pathways give us clear guidance that we must follow for all rhinoplasty surgery. It is based on evidence from around Europe, enhanced by local regulations.
What precautions have been taken at your clinic for consultations and surgeries?
We have changed the way we practice. Now, we are very clear on social distancing and having no waiting rooms. We know that we cannot behave the same way as before with consultations.
We piloted the e-Consultation tool last year -ahead of the pandemic, refined it this year and now have an efficient and popular way to engage with patients – both for the first time and for follow up.
What is the new process?
After contacting us, the patient begins with a pre-chat with our clinical nurse specialist and then completes a detailed questionnaire and assessment form. We advise on how to take and send us photos. We have been using e-Consultation very efficiently with guidelines for lighting and positions during an initial consultation. This enables us to get around 80-90% of the information that we need.
The response of patients has been overwhelmingly positive. We have had over 40 patients committed to rhinoplasty at our clinic based on e-Consultations in the last few months.
The first doctor contact is always via video call and those who want to move forward with us are given a dedicated one to one face to face consultation, have their professional photos taken and an examination, all very efficiently.
When will you be resuming rhinoplasty surgery? Will there be a backlog?
We have backlogs now because of the limited access to operating theatres. Other specialists, such as ophthalmologists and orthopaedics have had the same problem as us. The NHS is using the private facilities, which has denied a lot of private patients access to treatment until maybe the end of August or longer.
The only way we can do surgery at the moment is to pick up the capacity that the NHS are not using, which is a bit of scramble and very stressful to organize for everyone.
For staff and patients, there is currently no opportunity for planning, and it has taken a while for this to sink in with our patients. The situation is frustrating for us because there are even some private clinics not tied to the NHS also shut.
How will consultations differ in the future when everything is back to normal?
Moving forward, the future is telemedicine. We firmly believe it is in the patient’s best interest to make the first engagement with us via video call. There will no longer be waiting rooms and we will have to see one patient at a time alone. We will deliver the same superb quality of service but now with a different journey.
We have a very good system going now. Those patients who want to proceed are able to advance much faster than having to wait for a face-to-face consultation.
In our clinic and hospitals, the staff are tested for COVID-19 every two weeks and we are adhering to local guidelines for safety and standard of service.
We wish everyone a safe and stress-free time.
The information published in this article in relation to coronavirus is from July 2020 and is subject to change.
Do not hesitate to book an online appointment with Mr Charles East via his Top Doctor’s profile here.