Need a 4th Revision Rhinoplasty. Will It Help?

Question

I'm very scared of doing another revision on my nose. Every time I try to get something corrected it ends up worse. The first Dr did two, first time I ended up with acrooked nose. The second time I ended up with a piggy nose. Last one was in December 2008 with a different Dr, my main concern was the columella hanging, now I have no assymetry and hanging columella. does my nose have hope or do I just live with it? Thanks for your opinions.

Sam Naficy, MD, FACS · Answer

As long as the tissues are healthy, you are motivated, and your expectations are realistic there is room for improvement. You may very well need a rib graft to correct the contour deformity of the bridge

Anand D. Patel, MD · Answer

If all you are looking to improve is the hanging columella, then, yes, I think a minor revision done with particular techniques would give you an improvement (see link).

Eric M. Joseph, MD · Answer

I read your concerns and reviewed your photos. In my view, you should reserve any further revision rhinoplasty surgery as a last resort. You have some tip asymmetry, and nostril retraction on both sides. You may want to consider a non-surgical rhinoplasty procedure to add some volume to your nose, lower your nostril margins, and restore tip symmetry. I prefer to use Silikon-1000, an off-label filler, for permanent results.

	I hope this is helpful for you.

	Regards from NJ:

Thomas A. Lamperti, MD · Answer

You never HAVE to have a revision rhinoplasty. The main issue is whether the problems that concern you can be improved with surgery and whether the risks, recovery time, and expense are worth it.

	In experienced hands your nose can be improved. If you are seriously considering revision surgery I would be sure to consult with a few surgeons who have extensive experience with revision cases like yours.

	A better sense of what could realistically be done would come from an examination of your nose.

William Portuese, MD · Answer

One should be very careful when undergoing a fourth revision rhinoplasty. An alar retraction is best treated with a combination of composite grafts from the ear along with any alar baton grafting. Columellar hanging and show are best treated by resection of both membranous and cartilaginous caudal septum. Look for a very experienced rhinoplasty surgeon who has lots of experience performing both primary and revision rhinoplasty before embarking on your next rhinoplasty endeavor.

Robert Kotler, MD, FACS · Answer

Hello, Mom from Gurnee.

	Know your city well; Six Flags Magic Mountain + consulted for the Gurnee School District just before entering US Army, following residency at U of Illinois.

	I advise no further surgery. You are an attractive lady. While your nose is not perfect, few -- natural or operated upon -- are. "Quit while you are ahead"  makes sense. What if the next operation leads to infection or tissue loss? You would kick yourself.

	Need I remind you,  or our visitors to RealSelf.com, that certain celebs, one of  whom shall be nameless but whose last name is the same as the President on a US $20 bill, was the poster boy for bad judgement regarding repeated operations on the nose?

	Gambling is what you do in Vegas; don't gamble with your nose.

	Best wishes.

	- Robert Kotler, MD, FACS

	Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON

Steven Wallach, MD · Answer

I would avoid repeated rhinoplasties on your nose.  Each time back is like a time bomb ticking. The skin may not handle the repeated trauma.

David C. Mabrie, MD · Answer

There are several reasons non-surgical treatment with fillers is a great choice in revision cases like yours.

	
		Using fillers is more of an additive process, building your nose, not weakening it further.
	
		Fillers may be placed without having to separate the skin from the bone and cartilage again.
	
		Fillers are actually better at small to medium changes than surgery as they can be more precise.


	If you use temporary fillers like perlane or juvederm, there is a chance that your body may produce some of it's own collagen, decreasing the need over time.  If the temporary fillers work very well for you, you may consider a permanent filler with a very experienced surgeon.

	Whether you opt for a fourth surgery or for non-surgical treatment, it is very important to see someone who specializes in revision rhinoplasty procedures and you would like to see a lot of before and after images.

	There is more information about non-surgical treatments on our website.  Good luck in your search for information!

Michel Siegel, MD · Answer

I think your nose has hope.

	You need to find an experienced revision rhinoplasty  surgeon. Did your other two surgeons specialized in rhinoplasty? Did they have years of experience with this type of surgery?

	Revision rhinoplasty is a difficult surgery, and the outcome will be highly variable on who performs the surgery. Ensure that you interview many surgeons and you look for an experienced FACIAL plastic surgeon, as usually they have more experience when it comes to rhinoplasty than surgeons who perform whole body plastic surgery.

	Your nose can be helped, but the key will be for you to find the experienced surgeon you need, in my opinion.

	 

	Best of luck,

	 

	Michel Siegel, MD

Jay M. Pensler, MD - Account Suspended · Answer

After multiple revisions often the scar dictates what is possible. I would suggest if anything very modest goals.

Need a 4th Revision Rhinoplasty. Will It Help?

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