i have had five surgeries now as the first 4 were a complete disaster and the last surgeon had to totally reconstruct my nose with cartilage and fascia grafts. my nose is looking pretty good, slight asymmetry is evident however. is having a 6th operation risky in terms of tissue death? my dr implied that this had to be my last operation as i have had too many. i am wondering if tissue death is common?
Are 6 Revision Rhinoplasty Surgeries Too Many?
Doctor Answers 6
Multiple rhinoplasty revisions
The limitations are related to skin quality. Too much scarring and skin that is too thin can be a set up for complications. After 6 revisions there are two things to consider:
1) are my expectations realistic?
2) have I become too invested in this and too wrapped up in repairing what was an unsatisfactory initial result?
Once you start down the road of revisions there is the potential to hyper-focus, causing you to be more critical now than you might have been initially: what you would have been happy with after one surgery is now just a reminder that the first surgery didn't go well.
Before going too far make sure you get a few different opinions.
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6 th revision
There is no absolute maximum number of rhinoplasties that you can get as long as the skin is healthy. If you are still unhappy after multiple rhinoplasties you must consider whether your goals are realistic
Revision rhinoplasty and how many are too many?
Most patients have absolutely no idea of how complex and technically difficult a major revision rhinoplasty can be; most surgeons avoid taking on the challenge of trying to fix another surgeon's work because they know that the results they can obtain will be less than perfect in most cases and because the skill set necessary to obtain a good result will be demanding. For a minor revision, which only requires a small correction for a little irregularity here or there, the job is much easier. But from what you describe, you had a major revision that required cartilage and other tissue grafts. Taking tissue from someplace else and putting it into the nose to try to recreate natural anatomy needs the experience and skill of a surgeon who does many revisions. If you have a significant improvement, can you be satisfied with that? Remember that there is no such thing as perfection in nose surgery; we all start out with some asymmetries prior to any surgery and surgeons cannot control the healing process. It's not the number of surgeries that you have had that matters as much as what the current problem is, what has been done before, the condition of your nasal tissue and the skill of the surgeon. I once did the revision surgery on a patient who had 13 prior rhinoplasties done elsewhere and fixed her concerns with a 14th operation.
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6 revision Rhinoplasty surgeries is quite a lot
IMHO, 6 Rhinoplasties are a lot. Skin slough from compromised blood supply to the nasal skin is very rare after Rhinoplasty but if it did occur, it would deform the nose. Listen to the last Rhinoplasty surgeon and find some other part of your face and body to make more attractive. Time to leave your nose alone.
You have had a lot of surgery. Besides the risk of tissue death each time you operate you induce a new round of scar tissue which may alter the result. The chances of "hitting it just right" so the last little asymmetry that bothers you will be gone versus the chance of new problems keep getting worse for you. It's also possible that there are things you aren't noticing but after you have something else adjusted it becomes apparent to you. Ask yourself if your goals are realistic. Are they just about appearance, or did you expect different things to happen in your life as a result of the surgery? Cliche's become that way for a reason and there's an old surgical one that goes "the enemy of good is better".
Too Many Nasal Revisions
Six surgeries is significant and as you continue to push toward perfection the chances of a disastrous complication continue to rise. Even you mentioned a "slight" asymmetry, and this unto itself (if accurate) shouldn't warrant another intervention. Your nose will NEVER be perfect and at some point you have to stop. If you continue to look, someone will operate on you, but make this decision carefully.
Best of luck.
Vincent Marin, MD, FACS
San Diego Plastic Surgeon
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