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?
Reason for High Demand for Revision Rhinoplasty?
Doctor Answers 14
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.
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 revisions of rhinoplasties done by other surgeons before we see them.
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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.
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.
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.
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 the procedure is. But having said all this a 5% revision rate is probably a reasonale one in any experienced hand.
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 that the patient's expectations are realistic.
- Uncontrollable healing variances. The forces of scar contracture on the nose can create unwanted asymmetries, cartilage buckling, etc. One approach to rhinoplasty (which I follow) involves focusing on making sure the structural support of the nose is able to withstand these forces. Otherwise, one will often find that years down the road unwanted pinching, collapse, or functional problems may ensue. Even in the best of hands, variability will occur. No surgeon has a 0% revision rate.
- Lack of rhinoplasty experience/misjudgment. Having extensive experience in performing rhinoplasty allows a surgeon to better guage how a particular nose will heal and how the changes made to the nasal structure will translate to the final result. I also feel that many less than desireable rhinoplasty outcomes are due to a incomplete treatment of the patient's nasal problems. I most commonly see this regarding the nasal tip - which is much more complex than the bridge to treat well.
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.
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 often the most perfectionistic. That is why the revision issues exist.