Risks of revision rhinoplasty?

Question

I'm 22 now and got a rhinoplasty 7 years ago. I got it done by the "best plastic surgeon in Miami". I trusted him and he completely botched my nose. It's over projected and my tip is over rotated(pics attached). I'm so scared to get a revision rhinoplasty because I don’t want it to look worse. After 7 years of avoiding it, I'm finally starting to look into getting a revision. What are the potential risks if I get one? Would mine be considered extremely difficult?

Steven M. Denenberg, MD · Answer

The tip does indeed look high. However, the main thing that jumps out at me is that the tip is strong in its forward projection away from the face. If the tip is de-projected, brought back closer to the face, that movement tends to make the nose *look* longer, and it might not seem nearly as turned up. It's important to figure out whether that projection is part, or much, of what's bothering you, and how adjusting the projection and the tip elevation balance to get the right goal.

Any revision is difficult -- the question is how *predictable* the results would be, in expert hands.

How *much* to de-project the tip, or lower the tip, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

William Portuese, MD · Answer

Revision rhinoplasty is one of the most difficult procedures to perform correctly in the entire field of cosmetic surgery, so choose your rhinoplasty specialist wisely based on extensive experience. A closed rhinoplasty approach can accomplish decreasing your hanging columella and drop the rotation and decreased the projection. That's probably all you would need regarding a revision rhinoplasty. Consider placement of a chin implant for your recessive chin profile which are help with  facial balance and proportions, especially with respect to the projection of your nose from the side profile

Mats Hagstrom, MD (license on probation) · Answer

Can make an accurate assessment regarding the outcome of any plastic surgery procedure we need to see proper before and after pictures. If you don’t have before and after pictures, then try to contact your previous provider and ask them to forward the pictures they took. You should also ask them to forward the operative report.Signing the best provider is not easy or straightforward. Being famous does not have any relationship to being talented. Some of the most talented plastic surgeons fly under the radar and do not engage in social media, self promotion, or our in anyway famous by most people standards. in fact, there’s probably an inverse correlation relationship between being famous and being talented.To find the right provider, I suggest patient start the process by looking for plastic surgeon specialize in the procedure. You’re interested in in your local area.Look for providers who are senior, and have at least one to two decades of experience.During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients, who had similar characteristics to your own period.In your case that means secondary or revision rhinoplasty surgery.And experience provider should have no difficulty showing you the before and after pictures of at least 50 Previous patients.Being shown a handful of pre-selected, just representing only the best results of a providers career is insufficient to get a clear understanding of what average results look like in a hands of each provider or how many of these procedures they’ve actually done. There’s no correct number of consultations needed to find the right provider. The more consultations you scheduled the more likely or to find the best provider for your needs. The biggest mistake patients make is scheduling only one consultations and then scheduling surgery. This eliminates the ability to select the best provider.Recognize that most patients do not have a lot of experience consulting with plastic surgeons and that plastic surgeons have done thousands of consultations in their career.It is your responsibility to vet the provider, so take ownership of the consultation and recognize that it is your responsibility to differentiate, who is the best provider.Take careful notes during each consultation, especially regarding the quality and quantity of before and after pictures. For second opinion, consultations always come prepared bringing with you a complete set up before and after pictures and a copy of your previous operative report.Without knowing what you look like before your operation, we can’t really make an assessment regarding the outcome of your procedure.Your candidacy for a secondary rhinoplasty is not only based on what you look like now, but also on what you look like before your first operation.This is very important to understand.Good luck,Mats hagstrom, MD

Risks of revision rhinoplasty?

Answers (3)

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