Why Do Most Surgeons Avoid Revision Surgeries?

Question

When you are not happy with the results then you have to seek a revision-expert surgeon, not a regular one.Many surgeons refuse to revise a surgery and they send you to an expert. Why? What is so important about revision surgeries? I'm not happy with my nose surgery. There is nothing wrong with it but I want to improve it more. So, I need a revision surgeon.

Donald B. Yoo, MD, FACS · Answer

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.

Paul S. Nassif, MD · Answer

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

David C. Pearson, MD · Answer

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

Steven J. Pearlman, MD, FACS · Answer

I know you asked this in question form, but your comment is correct. The reason why you should seek out an expert for revision surgery,especially revision Rhinoplasty is because rhinoplasty is a very complex surgery in the first place. Revision rhinoplasty is even more difficult and has subtleties that may not be recognized by a surgeon who only occasionally performs this operation. All too often patients have even worse results if revsions are attempted by less than very experienced surgeons in that specific procedure.
To be frank, wouldn't you want an expert doing any surgery on you? I know I would.

Eric M. Joseph, MD · Answer

Revision Rhinoplasty surgery presents several unique challenges. There is scar tissue that makes exposure of underlying cartilage difficult. And, there can also be a paucity of cartilage remaining in your nose. For example, if you had Septoplasty performed during your initial Rhinoplasty, then there might be inadequate septal cartilage for grafting purposes.
You should consult a qualified, experienced Rhinoplasty specialist with many favorable photos before you proceed.
I hope this is helpful for you.

Sigmund L. Sattenspiel, MD · Answer

Cosmetic surgical procedures, especially those performed on the nose, require expertise and experience. Surgeons without significant expertise and experience wisely avoid performing revision surgery. Revision surgery is much more difficult than the initial surgery since the anatomical tissues have been altered and a certain degree of subcutaneous scar tissue has developed. It is often difficult to get the same good results whether revision procedure as compared to a primary procedure. A wise surgeon knows his or her limitations and does not want to risk performing a revision that may not make an improvement or even make matters worse. There are some revision procedures that are relatively straight forward requiring minor changes. On the other hand, there may be substantial anatomical deformities that are extremely difficult to improve.

Peter A. Aldea, MD · Answer

Many reasons. Some of which are:
1. Rhinoplasty is a complex operation which is done differently by different surgeons. A suboptimal result does not always indicate what exactly was done to the nose. Some surgeons are not comfortable with unpleasant intraoperative findings which limit their options. (Similar to building contractors who prefer to build new homes rather than remodel homes and be subjected to surprise findings in the walls)
2. Some suboptimal results may be impossible to correct. Especially in multiple revision cases. Very few surgeons are willing to put themselves in a situation where they deliver another poor result to a patient who is already stressed over the appearance of his nose.
3. Some surgeons may look at your nose and regard your deformity as minimal in nature. As such they are fully aware that revising your nose may result in a worse result rather than in an improvement and as such would rather pass you to someone else.
4. An unhappy patient, despite your best efforts, may remain unhappy. As such, he may decide to sue BOTH you and his previous Plastic surgeon(s). Many Plastic surgeons are not willing to assume such risks.

Steven Wallach, MD · Answer

Without specifying what type of revision you need I can only use generalizations. I think it is important to have a qualified surgeon do any surgery. But, revision surery can be tough because you are dealing with problems from the first surgery. Depending on what surgery it was will determine the complexity of the problem and the future surgical options.

Shervin Naderi, MD, FACS · Answer

Hi,
The fact that a Plastic Surgeon will do a primary Rhinoplasty but not a Revision Rhinoplasty should be an alarm to patients.  The fact is that Rhinoplasty is the most complex of all cosmetic surgeries.  There is no disputing this fact.  But many surgeons insist of performing primary Rhinoplasties when they are clearly not comfortable enough with the nose to perform Revisions as well.
On one hand its good that these surgeons know their limitations and refer Revisions to more experienced specialists.  On the other hand, it would be best if they also left the primary surgeries to more experienced specialists because the best time to get the best results is during a primary Rhinoplasty.

Richard W. Fleming, MD (retired) · Answer

After 33 years of rhinoplasty surgery I truly enjoy the challenge of revision work. Because of the presence of scar tissue and the frequent need for grafts, it is the most difficult nasal surgery I do. Many excellent surgeons do not share my interest. In all medical specialties, specialization is usually beneficial.

Why Do Most Surgeons Avoid Revision Surgeries?

Answers (12)

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