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?

Doctor Answers (33)

Revision Rhinoplasty

+3

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.


Dallas Facial Plastic Surgeon
5.0 out of 5 stars 91 reviews

Revision Rhinoplasty advice

+2

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.  

Umang Mehta, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 27 reviews

Revision Rhinoplasty - Look for an experienced surgeon

+2

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.

Jon F. Harrell, DO
Miami Plastic Surgeon
5.0 out of 5 stars 31 reviews

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How many revision rhinoplasty is too many? "Depends"

+2

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.

Good Luck,

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 118 reviews

Revision rhinoplasty can improve the nose

+2

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
5.0 out of 5 stars 7 reviews

Revision rhinoplasty - breathing and aesthetic issues

+2

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.

Sam Most, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 32 reviews

Redo Rhinoplasty

+2

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

Steven H. Williams, MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 23 reviews

Revision Tertiary Rhinoplasties Require A UNique Skill Set

+1
Unfortunately you are in good company. Most rhinoplasty patients out there are very unhappy with their results in 1-2 years. The explanation for this is very simple: Most surgeons performing rhinoplasty do not have advanced training or experience, they perform the rhinoplasty of 50 years ago. Decades ago thought process of rhinoplasty was to remove cartilage to refine the shape of the nose and perform it through an open approach. An open approach makes it easy for neophyte surgeons to access visualize and manipulate the structures but also unnecessarily destroys two arteries and veins that are important for nasal vascularity. The open approach thus ensures that patients have 1-2 years of risidual swelling which hides the final result. Most rhinoplasties out there I consider cartilage robbing thus when the swlling resolves there is inadequate structure to provide aesthetic appearance and fight the cicatriacial forces or the continued scarring that results from the lowered oxygen tension and fibrosis of tissues. One additional problem it that most rhinoplasty surgeons out there inadvertently break the connection between the bony nose and the cartilagenous nose. this can cause irregular narrowing and what we calll "the inverted V deformity" which means the outline of the nasal bone becomes visible through the skin particularly in flash photography under certain lighting conditions.

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.

Rian A. Maercks, MD
Miami Plastic Surgeon
5.0 out of 5 stars 32 reviews

How many revision rhinoplasties is too many?

+1
  It is a very difficult question to answer, but as long as the integrity of the tissues is intact and there are structural/breathing issues that need to be addressed, it is acceptable to undergo another revision rhinoplasty. It critically important to find it very experienced rhinoplasty surgeon to get it right for the last and fourth time.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 56 reviews

How Many Revision Rhinoplastys is Too Many?

+1

 Revision Rhinoplasty is and should always, IMHO, be evaluated using the idea of diminishing returns.  The more the nose is operated upon, the less quickly it heals, the more cartilage and bone that has been removed from previous Rhinoplasties, the more likely excess scar will build up inside blunting the internal nasal shape and the more narrow the benefit curve becomes.  

 The nose should always, IMO, be evaluated aesthetically to create something that is refined and naturally looking...not perfect as a perfect nose alone does not make an attractive face.  Chasing better nasal breathing, symmetry or other minor flaws in the nose through repeated Rhinoplasty is ill advised and not the best way to make the face more naturally, youthful and attractive.  Although difficult, it's good to know when enough is enough.  An experienced Rhinoplasty Surgeon can help you make that decision if it's an appropriate one in your particular case.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

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