I've Had Bad Rhinoplasty Twice, Should I Keep Revising?

Question

I've had my nose fixed twice and the tip is still bulbous and is turned slightly to the right. Should I get more surgery?

Rian A. Maercks, MD · Answer

Without seeing pictures it is very difficult to advise you.  I have had extensive experience and training in what we call 'tertiary rhinoplasty' which means patients who have had two or more rhinoplasties.  When I am correcting a nose that has had two or more surgeries the root of the problem is in the structural support.  Most surgeons with minimal experience and training aggressively remove cartilage and destabilize the nose.  The result can be aesthetically pleasing for up to one year but progressive contraction, twisting and settling occur as time goes on resulting in a distorted deformity commonly 'saddle-nose deformity' which is caused by complete mid vault collapse.

	  In cases such as yours, the key is adding carefully planned sound structure back to your nose.  Unfortunately the prime harvest site for structural cartilage has likely been depleted of usable cartilage, the nasal septum.  Usually a small piece of rib cartilage is needed to restore a beautiful and lasting result.  The good news is that is can be harvested through an inframammary incision such as is commonly used in breast augmentation, and hidden under the breast.  Rib cartilage allows recreation of exactly the best nose to fit your face. 

	If you are considering another round of surgery I would suggest finding a Plastic and reconstructive surgeon that has done a formal craniofacial training with lots of nasal reconstruction experience.  It is the extreme challenges in reconstruction that have given me the skills in aesthetic rhinoplasty, particularly revisions.  I hope this helps! 

	All the best,

	Rian A. Maercks M.D.

Thomas A. Lamperti, MD · Answer

It's really hard for us to say if it is worth having an additional revision rhinoplasty procedure. If the same surgeon did your last two procedures you may want to get an opinion from another surgeon to see what options you have.

	In the right hands many persistent nose issues can be treated, but this can become more difficult with sucessive surgeries. An examination would help your potential revision rhinoplasty surgery determine if significant change can be made making surgery worthwhile.

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