How Many Revisions Can One Safely Get for a Nose Job?

I have had 3 nose jobs and my nose is still very long. Is it unsafe to try and have a 4th revision? What makes it look really long is the hollowed out area between my eyes and the thick bone between my eyes. Also, it looks like the tip is starting to fall. Thx.

Doctor Answers 11

It gets harder with more, but not impossible

I get asked this question a lot. There is no absolute number after which rhinoplasty becomes impossibly dangerous or doomed to fail.

However, it is a rule of thumb that the surgery is wrought with more difficulty, has a higher complication rate, and has the potential to lead to permanent problems the more surgeries one undergoes.

There are several reasons for this:

The first, scar tissue - each time the skin envelope is elevated from the underlying infrastructure of the nose it is traumatized it undergoes soft tissue contracture and it potentially weakens. The soft tissue contracture may thin the skin rendering it stiffer and thinner and less forgiving to hide any underlying imperfections.

Secondly, revision rhinoplasty if done in a reductive manner or done in a way that does not restore structural support to the nose has a possibility of weakening the infrastructure of the nose. Not all revision rhinoplasty is done is this way, in fact, in my practice, most of the time revision is performed to strengthen support that has been lost. However for other revisionists, further reduction is a rule leading to potential further weakening of the nose.

Also to take into consideration, the emotional condition of the individual changes when undergoing multiple revision procedures; it’s quite a different story when one is seeking primary rhinoplasty. The patient is full of hope, full of expectation and seeking to create improvement to the shape of the nose. The revision patient is one who has undergone disappointment, has potentially been injured or even impaired by a previous surgery. This causes this person, understandably, to be more skeptical, to be more anxious, and to be more risk adverse undergoing revision or multiple revised procedures. In some cases it causes the individual to pay undue or excess attention to the nose – in some cases becoming obsessive over very small details. In those situations it transforms a person who was once quite reasonable and had realistic expectations into a one who is unreasonably perfectionist about the outcome of the procedure.

Lastly, the anatomy has changed. The natural landmarks of the nose in primary rhinoplasty serve as guideposts for the surgeon, though which he or she can navigate through the anatomy of the nose – allowing them to create changes that are safe predictable and reliable. When the anatomy has been distorted by previous surgery, these familiar landmarks are no longer available causing a compromised baseline. In some cases this increases the complexity and difficulty of the surgery.

I would advise to seek out a consultation from a rhinoplasty specialist who performs a high volume of revisions.  Despite these challenges, in the hands of an experienced surgeon, even a multiple revision rhinoplasty can lead to a great outcome!

Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 27 reviews

55 Francisco Street
San Francisco, CA 94133

Maximum number of revision rhinoplasty procedures

The number of revision rhinoplasty a patient can get is limited by the soft tissue envelope.  With subsequent procedures, some patients can get thinning of the skin and may have blanching and/or cyanosis (nose turning blue) either with exercise or cold weather.  In these cases, the nose is probably not a candidate for another procedure.  

The number or revision rhinoplasty surgeries a patient has had typically corresponds to the difficulty.  However, this is not a hard and fast rule.  There are patients with multiple rhinoplasty procedures who only need an endonasal tweak to the nose.  There are also primary rhinoplasty patients who may need costal cartilage or extensive reconstruction of the septum which may be much more complex than a revision rhinoplasty.  

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 96 reviews

845 N Michigan Avenue
Chicago, IL 60611

Too many revisions?

Although revision surgeries gets progressively more difficult with multiple surgeries (scarring, loss of potential grafting material) , there is no absolute limit to how many rhinoplasties one can have

Sam Naficy, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 171 reviews

1110 112th Ave NE
Bellevue, WA 98004

No absolute limit to number of rhinoplasty surgeries

There is no fixed number of rhinoplasty procedures you can undergo.

The surgery becomes more complex as the tissue planes are disrupted with each surgery. This doesn't preclude additional surgery, but a risk benefit decision has to be made to assess whether further surgery is worth it. This can only be done with an in-person exam. I would recommend consulting with a few experienced rhinoplasty surgeons who you feel have good before and after results.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

1101 Madison Street
Seattle, WA 98104

Number of revision rhinoplasties one can get

The more times the nose is operated upon the less predictable the results are. It is extremely important to find a nasal surgeon who is very well versed in the rhinoplasty procedure. Look for a surgeon who has performed thousands of rhinoplasty and revision rhinoplasty procedures. Make sure you have realistic goals and expectations prior to undergoing rhinoplasty.  

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 70 reviews

1101 Madison St
Seattle, WA 98104

How Many Revisions Can One Safely Get for a Nose Job?

That depends entirely on the problem being solved.  Please see a facial plastic surgeon who specializes in revision rhinoplasty and review your options. 

Ramtin Kassir, MD, Facial Plastic Surgeon NY, NJ

Ramtin Kassir, MD
Wayne Facial Plastic Surgeon
4.5 out of 5 stars 60 reviews

799 Park Avenue
New York, NY 10021

Number of Rhinoplasty Revisions

The actual number of revisions is less important than what was done during each operation. My best advice is to see a very experienced revision surgeon because risks increase and expectations decrease with each intervention.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 22 reviews

416 N Bedford Dr
Beverly Hills, CA 90210

Revision rhinoplasty

Depending on the type of revisions you've had done, it may be possible to have additional revisions without significant disruptions to your nasal architecture. Of course, the extent of surgery plays a factor as well as the type of proposed revision. I would definitely seek an expert on revision rhinoplasty so hopefully this will be your final procedure.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

1361 13th Ave South
Jacksonville Beach, FL 32250

Rhinoplasty revision

Revising a nose several times can be problematic.  The soft tissue and skin can not usually handle too many procedures. 

Steven Wallach, MD
New York Plastic Surgeon
4.5 out of 5 stars 20 reviews

1049 Fifth Ave
New York, NY 10028

Revision Rhinoplasty

Not all nasal revision are the same!! In some cases rib grafts are added and in some cases several millimeters of tissue are removed or a small rasping of the side of the bone is all that is required. While it is certainly true that additional scarring is created with each revision it may range from trivial to very significant.

Jay M. Pensler, MD
Chicago Plastic Surgeon
4.5 out of 5 stars 12 reviews

680 N Lakeshore Drive
Chicago, IL 60611

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.