In the majority of revision rhinoplasty that we perform, the operative reports are unavailable or inaccurate. Look for an experienced rhinoplasty surgeon who has dedicated a significant portion of their practice to the discipline of rhinoplasty and revision rhinoplasty.
After being in practice for 12 years and performing over 1000 rhinoplasty surgeries with 1/3rd of those revision cases I have found that operative notes are not really helpful. Even when we get the notes I find that the description of the previous surgery is often inaccurate and of little help. What matters most in revision surgery is analyzing the nose now to determine what it needs to be improved and then doing a careful exposure to show what is going on under the skin. Tissue can change over time, bones heal, cartilage can weaken and resorb or shift making the nose very different from what was described in an operative note 5, 10, or even 20 years ago.
Your description of a failed surgery with several minor attempts to correct with tip revisions points to a problem with tip support and projection which is hard to fix without doing a full rhinoplasty surgery. I would advise to seek several opinions from experienced rhinoplasty surgeons. Good luck with your quest.
It is certainly feasible to do a revision rhinoplasty without having access to the prior operative notes. I find that in the majority of cases the old operative notes are either not available or not very accurate.
Regardless, you would want to be seen by an experienced revision rhinoplasty surgeon. This type of surgery is normally more complex so you want someone well versed in dealing with anything that may come up during surgery.
You can learn more about revision rhinoplasty at my web reference link below.
I would agree with others, that previous operative notes not always available and do not preclude revision surgery. Preoperative photos, even personal photos to judge the changes can be very helpful, as well as some idea of how much septal cartilage is still present ( was a septoplasty done). The most important factor is that the surgeon have options for cartilage grafts, as they are usually a part of a revision rhinoplasty. Your photograph, although limited in its information suggests that your nose is still large and bulky, and there is a very good chance that revision rhinoplasty could help. The previous experience of the revision surgeon is critical, and so you should be careful in choosing your surgeon..
- We frequently perform revision rhinoplasty without previous notes
- Usually, the previous operative reports are only somewhat helpful (sometimes inaccurate)
- I would visit a revision rhinoplasty specialist when you are ready
It can helpful to have previous records; however, over the past 35 years I've found that frequently they are not available. I have a large sampling because almost 2/3rds of my rhinoplasty surgery involves revision work.
In my mind, the chance of achieving an ideal outcome decreases with each revision surgery. So choose your rhinoplasty surgeon wisely! In saying that, from what is visible on your photo, you should be able to achieve tip rotation and refinement and, more importantly, tip support without to much difficulty. Your previous operation notes would be useful but are not essential to achieve this. Good luck!
After 3 procedures on the nose, it is important to know exactly what was done before any other procedures are considered. Perhaps your new surgeon will be able to directly communicate with the previous surgeon to gain further insight. As always, it is important to consult a board-certified Plastic Surgeon who has experience in revision rhinoplasty.
It is usually extremely helpful to have surgeons note for any kind of revisional work. More importantly, try to get the surgeons preoperative photographs, which will enable some assessment of what change has really been achieved.
One single close range photograph without any preoperative comparison makes it hard to judge.