My nose has been operated on three times and I am still unhappy. I have trouble breathing through my nose and I do not like the way it looks. Is it possible for me to have another surgery or should I just live with it?
How Many Revision Rhinoplastys is Too Many?
Doctor Answers 35
There are many factors that determine whether or not patients are good candidates for secondary (revision) rhinoplasty. The number of prior surgeries is less important that the quality and characteristics of the nasal skin, framework, and the amount of scar tissue present. Other factors include the extent of the deformities, the risk:benefit ratio of correcting problems without causing addtional ones, and also the patient's psychological stability.
These are all factors that must be addressed on an individual basis in a one-on-one setting. Careful analysis of the patients photographs and the expectations for surgery need to addressed. Finally, revision rhinoplasty should usually be performed by a rhinoplasty surgeon who specializes in revision surgery.
Revision Rhinoplasty advice
I certainly appreciate your frustration, as you have been through the surgery and recovery period three times and are still unhappy with your aesthetics and ability to breathe. In my opinion, form and function go hand in hand. That is, a nose which is well constructed and well balanced will also "work" well... Revision rhinoplasty is among the most technically challenging of plastic surgery procedures so be sure to see a rhinoplasty specialist with the training and expertise to address your concerns.
Revision Rhinoplasty - Look for an experienced surgeon
The ideal number of revision rhinoplasties should be zero. For this to happen you and the surgeon need to share a common goal that is realistic. The surgeon needs to make an accurate diagnosis and execute the operation well and the patient needs to co-operate with all postoperative instructions. Now that you're up to 3 surgeries with airway obstruction you need, more than ever, to see someone who can listen to your concerns and then offer a detailed diagnosis and treatment plan. You need a Rhinoplasty specialist. I find that copies of the prior operative notes are very helpful in anticipating what is left to reconstruct the nose with as well as identifying where things might have gone wrong before. It is also very important for you to have realistic expectations concerning the surgery and the results possible. This is a difficult situation but in most cases something positive can be done to improve the breathing and the appearance.
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How many revision rhinoplasty is too many? "Depends"
It is possible for you to have a nose that is natural-looking and functions well. The fact that you have difficulty breathing makes the decision to do a revision rhinoplasty a good option. You should obtain your pictures and operative report and bring it with you to the consultation. The number of the previous operations is not as important as the degree of scarring, cartilage and tissue loss as well as the degree of the deformity. You probably need to have cartilage graft to correct the deformity. The experience and experise of your surgeon has direct correlation to the success of your revision surgery.
Revision rhinoplasty can improve the nose
An experienced rhinoplasty surgeon must assess the nose to give an unbiased opinion as to the likelihood of significant improvement with the next surgery. Each procedure is successively difficult with an increased chance for a complication. The best chance for a good result is the first surgery, so choose your surgeon carefully.
Revision rhinoplasty - breathing and aesthetic issues
Revision rhinoplasty is one of the most complicated procedures in facial plastic surgery. As such, it would require a personal examination and counseling by an experienced surgeon to determine if it is right for you. Certainly, if you are having breathing issues, a combined functional and aesthetic revision may be necessary.
After having had two revisions (three surgeries), it is best that you seek someone with extensive experience in revision rhinoplasty specifically. You may require any of a number of techniques to rebuild/repair your nose--someone with experience can help guide you through this and determine if you are a candidate for this procedure.
Best of luck to you.
Redo rhinoplasties are extremely challenging. In the cosmetic world they may be one of the most difficult things we do. It is impossible to say without a close examination and history if there are things that can be improved.
While a board certified plastic surgeon is always a good place to start, it is reasonable at your third surgery to go to someone with world renown experience. People like Jack Gunter in Texas or Nick Tabbal in NY - there are literally just a handful of kind of "super experts" that you may want to consider.
I have spent some time training with Nick Tabbal in Manhattan years ago and have nothing but positive things to say about his re-do rhinos.
This is not to say that any plastic surgeon cannot make things better but each subsequent surgery creates more scar tissue, weakens support and vascularity of your nasal structures and can create more problems if you don't get a home run. In my San Francisco practice we routinely see and operate on re-do's but are not above referring out very challenging ones (3rd, 4th, 5th redo).
I hope this helps.
Steven Williams, MD
A revision rhinoplasty should be a thorough decision, but can have positive implications should you still be unhappy with your new nose. As a general rule of thumb, I advise my patients to limit the number of nose job surgeries to three. If all does not go according to plan after the first revision, it can be helpful to consider consulting a new surgeon and to get a new opinion and perspective on the alterations that would look best to your nose. It is also important to consider that your new nose is changing and adapting for at least a year after the nose job. Swelling continues to subside during this time, and a nose that is fully healed can look dramatically different than it did during the healing process.
Revision Tertiary Rhinoplasties Require A UNique Skill Set
In my opinion, an expert level rhinoplasty is always performed in a closed technique and ALWAYS involves grafting to add to the structural integrity of the nose. The act of opening the nose even under the closed technique causes healing and some contraction, thus for a long term beautiful result the nose must be left more structurally sound than it was found. This is missed upon most rhinoplasty surgeons.
In secondary cases such as yours it is even more crucial that sound grafting techniques are used. It sounds like at a minimum you will need bilateral spreader grafts and a columellar strut but a complete L-strut should be considered and harvesting a small bit of rib cartilage may be necessary depending on your findings. I Definitely do not consider any rhinoplasty procedure that does not include grafting preferably by an experienced Plastic and reconstructive training with ddition fellowship level craniofacial and aesthetic training. Of course this is my bias because it is my training but I think this level of training is very necessary for success in secondary and tertiary rhinoplasty because there is delicate nuance involved and every patient requires different maneuvers. I hope this helps!
All the best,
Rian A. Maercks M.D.