The critical elements are a workable, adaptable plan, and good communication between patient and surgeon. Both patient and physician bring individual knowledge crucial to the reconstructive process. The surgeon brings a knowledge of anatomy and wound healing, but most importantly a history of successful techniques. The patient brings the knowledge of who he or she is, what he or she wishes, and what he or she needs. The surgeon may be the architect and the builder, but the patient is the owner and the landlord.
Some patients forget that they are the boss.
This means that the surgeon should choose correcting functional problems before beginning on aesthetic concerns. Surgeons sometimes use this dogma to justify releasing a scar contracture of the hand before rebuilding a scarred nose. Well, I have some news for you. Function follows form. Things that look better tend to work better.