The Newcastle Upon Tyne Hospitals NHS Foundation Trust

4. Mr T complains about the care and treatment he received from Newcastle Upon Tyne Hospitals NHS Foundation Trust (the Trust) related to an open septorhinoplasty (operation to change the shape or size of the nose) on 8 January 2024. He complains; • the Trust failed to warn him the surgery could result in a hump on his nose • the surgeon left a hump on one side of his nose • the Trust refused to fix the hump

5. Mr T says the hump makes him extremely self-conscious about his appearance, and has caused him to be depressed, to lose confidence in himself, and have suicidal thoughts. He is now reluctant to leave his house because of his appearance, which has affected his partner and children.

6. Mr T would like for the Trust to reconsider its decision not to remove the hump on his nose and financial compensation for the impact his has had on him.

7. On 25 August 2023 Mr T was recommended to have an operation to change the shape of his nose to help him breath better.

8. On 8 January 2024 Mr T underwent the surgery and was discharged the same day. Once the swelling reduced, Mr T identified a hump on his nose which was not there before the surgery. Mr T asked the Trust to it, but the Trust refused.

Issue 1 – The Trust failed to warn Mr T the surgery could result in a hump in his nose

12. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong. We have seen evidence the Trust correctly informed Mr T of the risks of his surgery and obtained consent from him. We hope our explanation reassures him.

13. Mr T told prior to his surgery the surgeon said he would try to straighten his nose to help with his breathing, a procedure called an open septorhinoplasty. He does not remember a conversation about possible deformities as he does not have a clear memory of what they spoke about. Mr T told us he thought the surgery would help him breath better. He expected his nose shape to change but was not expecting this to make his nose ‘wonky’.

14. Mr T’s medical records show on 25 August 2023 his surgeon discussed his nose surgery with him. Mr T and the ENT surgeon signed a consent form that listed the risks of the surgery, including ‘altered nasal shape’.

15. On 8 January 2024, the day of his surgery, the Trust gained consent for the surgery again from Mr T. The consent listed ‘altered nasal shape’ as one of the risks.

16. NHS consent guidance states consent must be given by a patient prior to any treatment. For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision. Informed means the person must be given all the information about the treatment, its risks and benefits, alternatives, and what will happen if the treatment does not go ahead.

17. Our adviser confirmed an altered nasal shape is a known complication of the type of surgery Mr T had.

18. The NHS consent guidance goes on to say, consent should be given to the clinician responsible for the patient’s treatment. If the patient is going to have an operation, their consent should be secured well in advance, so they have plenty of time of understand the procedure and ask questions.

19. Our adviser told us, best practice would be for the surgeon to explain the risks of the procedure during an initial consultation in clinic, and to obtain consent at that time. On the day of the procedure, the clinician should review the risks with the patient and confirm their consent.

20. We have seen evidence the surgeon who performed the operation informed Mr T of the risks and benefits of his surgery prior to his surgery and again on the day of his surgery. We have not seen any evidence this consent was not voluntary or that Mr T didn’t have the capacity to make an informed decision. We have seen the Trust specifically raised the risk of an ‘altered nasal shape’. We consider the Trust acted in line with guidance and best practice when it consented Mr T for his operation. We hope our findings reassure him.

21. As we have seen no indications of failings, we will not be taking any further action on this part of Mr T’s complaint.

Issue 2 – The surgeon left a hump on one side of Mr T’s nose

22. On 31 December 2024, after the swelling had reduced, Mr T complained to the Trust about a hump on his nose which was not there before the surgery.

23. According to his medical records, the surgeon noted the hump was prominent with part of it being swelling and the other being the nasal bones. The Trust advised Mr T his nose had healed internally, and the swelling would settle in time.

24. Our adviser reviewed the photographs Mr T supplied of his nose. They stated they could see evidence of an ‘altered nasal shape’.

25. Our adviser told us is it not uncommon for an open septorhinoplasty to result in a residual hump in the nose, or the appearance of a hump at the supratip depression. This is the gap between the end of the bone running down the bridge of the nose and the cartilage at the end of the nose.

26. We have seen evidence Mr T has an altered nasal shape as a result of his surgery. We have not seen any indications something went wrong during the surgery to cause this. Developing a hump is a known complication which Mr T consented to. The primary purpose of the surgery was to improve Mr T’s breathing.

27. We appreciate how distressing his altered nasal shape has been and continues to be.

Issue 3 – The Trust refused to fix the ‘hump’ on Mr T’s nose

28. Mr T told us the hump made him feel extremely self-conscious causing him to be depressed, lose confidence and become reluctant to leave his house. He contacted his GP who made an urgent referral to the Trust.

29. In response to the referral, the surgeon advised Mr T the objective of the surgery was to straighten his nose to improve nasal airflow, and this had been achieved. They said Mr T consented to the risk the surgery may cause nasal deformity and they would not address cosmetic changes under the NHS. They advised against any intervention, including fillers or surgery, and recommended a referral to psychology to support Mr T’s mental health.

30. In its complaint response, the Trust said Mr T consented to the risk of a potential deformity and cosmetic changes could not be addressed on the NHS. It repeated the surgeon’s advice against further intervention.

31. GMP states, ‘if a patient under your care has suffered harm or distress, you should put matters right, if possible’.

32. NHS nose reshaping guidance states nose shaping surgery is not usually available on the NHS for cosmetic reasons but may be provided on the NHS if it is needed to help a patient breath.

33. We have seen the hump on Mr T’s nose was a predicted complication of the procedure he underwent. Mr T did consent to this complication, but his consent does not eliminate the fact the complication occurred as a result of the Trust’s actions, and it caused Mr T harm and distress.

34. We have seen GMP guidance, which considers the actions of individuals, states if a clinician cases harm or distress they should put matters right, if possible. In contrast, we have seen evidence the NHS does not commission cosmetic surgery unless it is to help a patient breathe. We have therefore found it was not possible for the surgeon to consider if cosmetic surgery would have been suitable for Mr T as they could not have provided this service funded by the NHS even if it was clinically appropriate for Mr T.

35. The NHS must use resources wisely, and the decision not to allow operations on the nose for cosmetic purposes is one it is entitled to take.

36. We have seen the Trust acted in line with guidance when it refused to fix the hump in Mr T’s nose. We appreciate this will be very disappointing for Mr T to hear as we will not be asking the Trust to reconsider its decision. We hope our explanations help you understand what happened and wish you well.

1. We have carefully considered Mr T’s complaint about Newcastle Upon Tyne Hospitals NHS Foundation Trust. Mr T had surgery on his nose to assist his breathing. This resulted in a hump forming on his nose which the Trust have refused to correct.

2. From the evidence we have considered, we have not seen that anything was wrong with the Trust’s consenting process prior to Mr T’s operation, the operation itself, or the Trust’s decision not to correct the hump formed on Mr T’s nose following his operation.

3. For this reason, we do not propose to investigate further. We know from the information Mr T send to us and from our discussions how important this complaint is to Mr T and how much the hump on his nose is affecting him. We are very sorry to hear Mr T’s distress, and we appreciate the details he kindly shared with us.