Why Do Most Surgeons Avoid Revision Surgeries?

This may not be applicable to all surgeons, but I think a reasonable illustration is this:  Let's say you are picking cherries from a tree.  The cherries on the lowest part of the tree are easy for you to grab without any extra effort of getting a ladder or trying to climb the tree.  They taste the same as the other cherries on the tree.

Most surgeons don't want the additional stress of revision surgery - it's more challenging, the patients have higher expectations, and the chances for an A+ outcome are lower since you are beginning with a nose that has already operated on.  For that reason, surgeons often "cherry pick" noses that they are confident of achieving a fantastic outcome on.  

Revision surgery is more challenging because of scar tissue, distorted anatomy, and increased patient anxiety/expectations, amongst other reasons.   

Hello,
A revision surgery is a complicated procedure. There is scar tissue present from the first surgery, and it takes an expert surgeon to reconstruct a nose that has already been operated on and make it structurally and functionally perfect. Please let me know if you have any specific questions, and feel free to send me any photos. Thank you and best of luck.
Dr. Nassif

Many of us, myself included, enjoy both the challenge of revision rhinoplasty as well as the satisfaction of restoring a patient to a more normal appearance. That said, some surgeons shy away from revisions either because they don't like the extra difficulty or don't feel confident in their ability to get a good result.
It is, however, specious to say that those who don't do revisions shouldn't do primaries. A decent surgeon will slowly build his expertise in rhinoplasty by picking those patients with easier noses (there are no easy noses), gaining experience with those, and carefully improving his skills before moving on to more complex primaries and only then moving on to revisions.
My greater concern is not the surgeon who will refer out a revision, but the one who doesn't know when to. There's a saying in surgery that it takes about six months to learn how to operate; it takes six years to learn when to operate; and it takes a career to learn when not to. :-)
All the best,
--DCP