Revision Rhinoplasty Q&A
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Reason for High Demand for Revision Rhinoplasty?
asked 1 year ago by Vancouver39 in Vancouver, BC
Latest answer by Sam Naficy, MD
Question viewed 220 times
Tags: causes, mistake
Where does the problem usually go wrong in the first surgery? With computer imaging, I'd assume the doctor would be able to match the end result with the preoperative expectation before closing the patient up. Is it during the healing process where the aesthetic irregularities occur, or is it because the doctor made a mistake and decided to finish up before fixing it? Or do they not realize their mistake until after the surgery? Are the results difficult to predict for an alar wedge excision?
14 answers to Reason for High Demand for Revision Rhinoplasty?
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Reason for rhinoplasty revision
The reason is combination of the technical challenges mentioned by others as well the prominent and central location of the nose in the middle of the face where even slight asymmetries and imperfections are noticed.
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Reasons for Revision Rhinoplasty
There is probably no more challenging plastic surgery procedure than rhinoplasty. Even top surgeons will have some cases they do revisions on, especially if the surgeon is a perfectionist. This is mainly because of the difficulty in controlling how the skin heals over the underlying cartilages and bone that have been sculpted. It is so important to choose a surgeon who “gets” what you are seeking, as well as one who has extensive experience.
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High Demand for Revision Rhinoplasty
Rhinoplasty is the most common and most challenging cosmetic operation that is done. Some patients have undesirable results when they have their surgery done by inexperienced surgeons. However, revisions may be necessary because of the complex anatomy and unexpected scarring even when the opertion is done by the best. If you need a revision select a surgeon who specializes in this work. Unfortunately, revisions are common - over 2/3rds of the noses we do are...
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Rhinoplasty, nasal surgery
Facial imaging for nose surgery especially cannot predict the results that a plastic surgeon can achieve. I can show incredible results with a computer which would never translate into what I could accomplish at surgery for it depends on the thickness of the skin covering the underlying structures-cartilage, bone as well as the structures themselves.
Predicting the results from alar wedge excision though is much easier and realistic. Watch my videos....
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Edward J. Domanskis, MD
Orange County Plastic Surgeon
Orange County Plastic Surgeon
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Reasons for high demand for revision rhinoplasty.
Although there always can be errors of commission (too much removed, not enough removed, malposition of structural parts, etc.) these actually are usually relatively uncommon. Careful pre-operative planning (with or without computer video imaging, which is a "tool," not a guarantee of a specific post-operative result) in conjunction with back-and-forth discussion with the prospective patient allows the surgeon to have a detailed plan as to "what and how much" in each...
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There should not be a high demand for revision rhinoplasty
Rhinoplasties are each unique. Each nose has different characteristics such as skin quality, cartilage quality and septal support. These can be manipulated in the operating room to give the desired result. Computer imaging is only a representation and should be used conservatively to help demonstrate the desired outcome. Each person will heal their wounds according to their own behavior and ability to heal.
Robert Whitfield, MD
Milwaukee Plastic Surgeon
Milwaukee Plastic Surgeon
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Why is revision needed so often after rhinoplasty?
There is a great deal of anatomy and interaction between structural elements and soft tissue, all in a very small area. No surgeon would finish a procedure without thinking that there would be a good result, but sometimes trying to get a great result can lead to problems. Sometimes a nose can look perfect on the table and then there can be problems with healing.
The good news is that alar wedge resection can be done quite acurately.
Kenneth L. Stein, MD
Chicago Plastic Surgeon
Chicago Plastic Surgeon
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Revision rhinoplasty
Rhinoplasty is by far the most difficult cosmetic surgical procedure. Assuming that there are no miscommunications between patient and surgeon there are still numerous possible missteps in a pricedure that takes over 100 steps to do plus the factor of healing that is sometimes unpredictable. A famous rhinoplasty surgeon in New York City once said in jest, after having done over 12,000 (!) rhinoplasties that he would like to redo all !!! Of course, this is just to exemplify how intircate...
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Andrew Pichler, MD
Sacramento Facial Plastic Surgeon
Sacramento Facial Plastic Surgeon
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Why is there high demand for revision rhinoplasty?
There are a few reasons that patient end up pursuing revision rhinoplasty:
Lack of communication between the surgeon and patient. This relates to the use of computer imaging. I always tell patients that the morphed images are not like an architectural blueprint where I can guarantee the end result will be identical. It does form a great baseline from which the surgeon and patient can formulate what areas they want to change and by roughly how much. It's important to make sure...
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Why revision rhinoplasty is so common.
This is my personal opinion with which many may disagree. To some degree computer imaging is a way to estimate a desired goal but it cannot be used to predict a specific outcome. Rhinoplasty involves a biologic process in which there is a certain element of chance called the healing process. No one can predict the exact result of the healing forces in each individual. People are not made of clay and the nose cannot be molded and set in stone once a desired shape is requested.
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Otto Joseph Placik, MD
Chicago Plastic Surgeon
Chicago Plastic Surgeon
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Revision rhinoplasty - why?
The computer is NO GUARANTEE of how your tissues will respond to the surgery and the healing process so you are not correct in your first statement. Most of the nose is cartilage and even in the best of starting points at the end of surgery it can warp and distort during the healing not to mention scar tissues forming. This is all out of the surgeon's control.
Secondly the rhinoplasty is the toughest small operation done in plastic surgery and the patients are...
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Why a High Demand for Revision Rhinoplasty?
A great question. Biology is not like physics. We cannot put numbers into a formula and get an exact answer. Everyone has different genes, different environmental exposures, and different healing idiosyncrasies. Also, expectations may differ between surgeon and patient. Sometimes doing less is more, and subtle changes can go a long way. Sometimes subtle changes are not enough. I think the answer to your question is that rhinoplasty is very complicated and should be treated with the...
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Why is there such a demand for revision rhinoplasty?
This is an excellent question. Rhinoplasty is often considered the most difficult operation in cosmetic surgery. Even when everything is done right, things can change from scarring, cartilage warping and unusual healing. The physicians publishing the stats on revision rhinoplasty quote a 5% to 15% revision rate for their own noses. The doctors publishing articles are usually the most experienced as well. So, if the top docs are getting these numbers, it is likely higher for the rest. You...
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Rhinoplasty is a difficult operation.
Hi.
This is an excellent question. There are a lot of revision rhinoplasties, and many of the questions on RealSelf have to do with this.
It's all about the surgeon. Not every plastic surgeon is great with noses. Find someone who does a lot of rhinoplasties, and look at a lot of the surgeon's before and after pictures.
But even a great surgeon will have a 5 or 10% revision rate.
see video
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