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How Many Revision Rhinoplastys is Too Many?

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?

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+2

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... more
Ali Sajjadian, MD
Orange County Plastic Surgeon
+2

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 t more
Umang Mehta, MD
Bay Area Facial Plastic Surgeon
+2

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... more
Jon F. Harrell, DO
Miami Plastic Surgeon
+2

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.
Robert Mounsey, MD
Toronto Facial Plastic Surgeon
+2

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... more
Sam Most, MD
Bay Area Facial Plastic Surgeon
+2

Revision Rhinoplasty

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... more
C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon
+2

Redo Rhinoplasty

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... more
Steven H. Williams, MD
San Francisco Plastic Surgeon
+1

Revision Rhinoplasty

As rhinoplasty is the most difficult and complicated operative procedure that we do in aesthetic plastic surgery, revision rhinoplasty is even more difficult. In my opinion, revision rhinoplasty should only be done by rhinoplasty surgeons with significant amount of these operative procedures. Not only are they difficult procedures, but the patient can only do so many revisional rhinoplasties without significantly and permanently deforming the nose. It would behoove a patient to take... more
Rod J. Rohrich, MD
Dallas Plastic Surgeon
+1

How many rhinoplasties is too many?

The more rhinoplasties you have, the more difficult each is.  3 rhinoplasties may or may not be too many, depending what was done with each surgery.  Most rhinoplasties today increase the nose's strength by adding cartilage, so you don't have to worry about getting a Michael Jackson look.  If you are still having trouble breathing and don't like the way your nose looks, find a skilled surgeon who has done a lot of revision rhinoplasty, get several different... more
Minas Constantinides, MD
Manhattan Facial Plastic Surgeon
+1

Multiple Rhinoplasty Challenging for Surgeon and Patient

You have had several surgeries already without complete success. Have you had some benefit from the previous procedures? Even with an expert Revision Rhinoplasty surgeon it is exceedingly difficult to make improvements on a nose that has been operated on this many times. It is always difficult for a surgeon to tell a patient to ”just live with it” but in the end that may be the best advice.
Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
+1

Too many rhinoplasties???

The answer to your question is that it depends on the patient and the examination.  Part 1 of the problem is to determine if revision is possible.  Some of the factors that affect the answer to this question are: 1. How tight is the skin envelope?  2. How much cartilage is present.  3.  Are there any functional problems 4.  Is their any cicatrix of the nostrils, etc The next part of the question is the psychological aspect of rhinoplasty.  What are... more
Raghu Athre, MD
Houston Facial Plastic Surgeon
+1

Revision rhinoplasty still an option

There is no finite number of rhinoplasties that one can undergo. That being said the more procedures your nose undergoes the more difficult any revision becomes due to scarring and injury to the underlying nasal framework.  I would recommend consulting with an experienced revision rhinoplasty specialist who can examine your nose and determine what can be done to improve the function and appearance of your nose. I find that patients often end up having several revision... more
Thomas A Lamperti, MD
Seattle Facial Plastic Surgeon
+1

Revision Rhinoplasty

One key tenet in your situation is to not try to redo the whole thing a 4th time.  Pick some specific areas to fix, for example breathing, etc. and get it done.  After so many surgeries, the cartilage framework of the nose is at risk of being compromised and the soft tissue covering is at risk of having a lot of scar tissue.  Both of these issues introduce high degrees of variability in healing. 
Pradeep K. Sinha, MD
Atlanta Facial Plastic Surgeon
+1

You should have another surgery

It would be possible for you to have another surgery. You are not only having functional, breathing, but also cosmetic issues with your nose. Revision rhinoplasty is a technically challenging surgery and should be preformed by a highly skilled surgeon. 
Babak Azizzadeh, MD
Beverly Hills Facial Plastic Surgeon
+1

Revision Rhinoplasty Limitations

There are a variety of factors that go into deciding whether or not you can have additional revision rhinoplasty surgery. One of the most important considerations relates to your skin integrity. If you have natively thin skin and/or your skin was made thinner as a result of the prior rhinoplasty procedures, the risks of further surgery might outweigh the benefits. Other considerations include how much cartilage was removed and whether or not you need grafting performed. All of these... more
John M. Hilinski, MD
San Diego Facial Plastic Surgeon
+1

Revision difficult after each previous surgery

I’m sorry to hear you are unhappy with your nose after having gone through three surgeries. Thirty percent of Rhinoplasty surgeries are a revision with a previous Rhinoplasty with another surgeon. Nationwide, 20% of Rhinoplasty patients required a revision surgery to obtain their goals. In our practice, about 8% of our patients required a revision surgery. That said, there is no real limit to how many Revision Rhinoplasty surgeries you can have, however, with every Rhinoplasty... more
David Mabrie, MD
Bay Area Facial Plastic Surgeon
+1

Third revision rhinoplasty can help certain patients

I am sorry to hear that you are still having problems after three nasal surgeries. It does become harder to provide good, functional nasal breathing and a nice aesthetic outcome each time a revision rhinoplasty is performed. Your facial plastic surgeon is not only fighting against scar tissue and wound healing forces but trying to counter whatever maneuvers were previously performed and did not provide the outcome you were looking for. With that said, another revision rhinoplasty should... more
Stephen Weber, MD
Lone Tree Facial Plastic Surgeon
+1

How many revision rhinoplasties are too many?

The number of revision rhinoplasty procedures which a patient can have depend on a variety of factors: Vascularity and integrity of the soft tissue envelope.  Over multiple rhinoplasty procedures, the skin tends to thin, making subsequent procedures more difficult. Anatomic issue requiring revision- Some issues are more easily corrected than others.  A frank and open discussion in regards to what can be expected and what is possible should be entertained Goals-... more
Anil R. Shah, MD
Chicago Facial Plastic Surgeon
+1

Achieving satisfactory revision rhinoplasty

Revision rhinoplasty requires a surgeon with experience and expertise to undertake this rather difficult procedure. It is not just the three surgeries that you've had, but the state of your nasal tissues that matters. A nasal specialist would assess the degree of scarring, residual nasal cartilage, need for additional cartilage (ear, rib, homologous) and prepare an appropriate surgical plan. Make sure you see a rhinoplasty specialist who can properly asses your condition to see... more
Boris M. Ackerman, MD
Newport Beach Plastic Surgeon
+1

Each revision rhinoplasty is harder and less predictable than the one before.

I really find revision rhinoplasty a challenging operation particularly when the 1st operation was done by another surgeon.  Each subsequent procedure introduces more scar tissue and less opportunity to change appearance.  After one revision, most patients are going to have real problems.
Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
+1

Too many rhinoplasty revisions

It certainly is possible to have more revision rhinoplasty procedures - as long as you have a nose to operate on! But, you are losing tissue and creating more scar with each operation, which makes each attempt more difficult and the result less predictable. You need to see an experienced surgeon who, after examining you and discussing your concerns and desires, can give you proper advice regarding additional procedures.
Randy J. Buckspan, MD
Austin Plastic Surgeon
+1

The risks in multiple revision rhinoplasties

When a patient has had a previous rhinoplasty or several previous rhinoplasties the next rhinoplasty can be exceedingly difficult. This is because the surgeon not only needs to perform techniques to help you meet your aesthetic goals, but must also battle the scar tissue and the deformities from the previous surgeries. Many times your tissue has suffered extensive trauma after all of the surgeries and may not be pliable enough. It is often necessary for surgeon to bring in healthy tissue... more
B. Pat Pazmino, MD
Miami Plastic Surgeon
+1

When is enough, enough?

It the law of diminishing returns. Each revision surgery is more difficult and the success is increasingly remote. Patients wish more and more they had only left it alone and they begin to wish for their old nose again. A secondary rhinoplasty occurs in 5 to 15%. The exact percentage can be argued and is really unknown.   A third surgery is probably less than 5%, although data again isn't available. There are few surgeons who have operated on a nose for a fourth time and... more
Oakley Smith, MD
Toronto Facial Plastic Surgeon
+1

Revision rhinoplasty numbers

There is no way to know how many revisions are too many.  Every patient is different and every operation sequence is different.  Obviously, the more rhinoplasty that is done the more scar tissue that forms and the more damage that is done to the skin of the nose.  I find that the skin envelope is what really limits the results in rhinoplasty more so than the cartilage framework or bones.  The patient that I operated on that had had the highest number of operations on... more
Jay Calvert, MD
Beverly Hills Plastic Surgeon
+1

How many revisions too many?

There is no absolute number but what matters is the health of the tissue and whether there is unrealized potential.  Also very important to make sure that your expectations are realistic and you do a good job communicating them to your surgeon.
Sam Naficy, MD
Seattle Facial Plastic Surgeon
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