How Many Times Can a Nose Take an Open Rhinoplasty with out Damaging the Skin?

        Provided that the nasal envelope has been properly dissected each time without thinning or devascularizing it, the surgery could be performed any number of times.  Kenneth Hughes, MD Los Angeles, CA                 

This is a great question -- and the answer is, "it depends." As others have implied, technique is very important. If the skin and soft tissue overlying the tip cartilages is dissected in the correct plane, healing is generally quicker and less scar tissue is created. This makes revision surgery easier, if needed. There is also a significant effect of the skin type of the patient -- patient's with thicker, oily or sebaceous skin may have more or more prolonged swelling, but also frequently have less visible incisions or scarring. Thinner skin can create problems with revision surgery, as any tiny imperfection in the cartilages below will show through.  In these cases, fascia grafts to help with camouflage in the tip can be a great option.

In general, the skin becomes a little thinner and more fibrosed after each surgery. If you start with a thicker, more sebaceous skin envelope, you can withstand more surgery.  Even if you have thin skin, very meticulous, careful surgery can be done successfully, but there is greated risk of skin damage or contour imperfections visible through the thinned skin.  If the skin is nearly translucent or turns purple or blue with cold exposure, it may be too compromised to safely undergo surgery.  All of these considerations are true whether it an open or closed approach.  If the skin is thin, there are measures during revision which can be taken to reduce risk, such as placement of fascia beneath the skin to provide greater bulk to the soft tissue covering.

The question is not how many times but what was done and how it was done. What is the present condition of the nose and the skin. This has to be evaluated individually for each person. See experienced surgeons and get more than one opinion.

 Every time a columellar incision(open rhinoplasty) is made, the tip and columellar skin  is lifted up through open rhinoplasty, there is a division of lymphatics and blood vessels. This can compromise the healing process. Closed rhinoplasty  is less invasive and  can be used in many instances to accomplish your goals

 The skin, of the nose, should be warm to the touch and not be pink or purplish in color which may indicate a lack of blood supply.  After a couple of Open Rhinoplasties, it's possible that the blood supply is compromised.

The answer to your question depends on what was previously done and what is necessary at this time. An experienced revision surgeon will examine you, establish goals,and present alternatives for additional surgery. 

Being a revision expert, multiple redo's of an open rhinoplasty can be challenging.  There is no hard and fast rule about how many times it can be done.  It depends on the patient, what was done with each procedure, how long it has been since the last procedure and what the nasal tip skin feels like on examination.  Make sure you go to someone who does open and closed rhinoplasties.  Many times, minor revisions can be done closed.  Each time the nose is "opened", scar tissue develops and some of the lymphatic drainage of the nasal tip skin is interrupted.  Some have chronically edematous skin after 2, some after 3.  All the best.