How common is tip necrosis after a 3rd rhinoplasty?

Question

It looks like I will need a revision rhinoplasty a for the 2nd time after exhausting all my options. I was warned by my surgeon that this is a risk. How common is it and should it hold me back from having another rhinoplasty?

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. When good technique is used, this is very unlikely to happen. With good surgical technique, you could likely have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Selcuk Yazan, MD · Answer

Hello,
This is a great question! Typically the number of revisions alone does not affect the likelihood of necrosis occurring. 
The nose has 6 arteries contributing to blood flow in the area (Supratrochlear artery, Dorsal nasal artery, Angular artery, Lateral nasal artery, Columellar artery and Superior labial branch) 
It is nearly impossible, if you’re seeing an expert in rhinoplasty to destroy all of these arteries. The least likely contributing factor would be blood flow loss to the area, which is great news. 
There are however, several other factors that may contribute to the likelihood of skin necrosis occurring. 
Tip filler is a common one. If your goal is to destroy the tip, just add filler. Otherwise, we recommend to keep it far away from your nose especially in the case of revisions. 
The second more likely culprit for a revision rhinoplasty (or some primary cases) is rib cartilage in tandem with a contracted nose.
The problem with skin necrosis in revision cases is typically these surgeries are using rib cartilage as a dorsal graft to achieve a projected result. Please note: Each surgeon has their own way to approach a revision case, which we respect and they may opt to use rib grafts. 
In most cases, after 2 surgeries, the skin has contracted quite a bit. If you attempt to enlarge the nose or give projection with this technique, the tension could be too much for the tip of the nose, which could lead to necrosis. When the skin cannot expand enough, the tip of the nose, which is an extremity where blood supply is already less, couldn’t be supported and you may see tissue die off. 
This can happen without surgery (filler), or again, in a primary operation where the tension is too much and blood supply couldn’t be supported with the added rib cartilage. 
Another major factor is you, the patient. Your overall health, history of disease, medications and following all pre-operative and post-operative instructions from your particular surgeon. 
Everything is important when surgery is on the line. Discontinuing use of alcohol and smoking prior to surgery tops most of my colleagues lists. 
Alcohol alone causes swelling and tension, rib cartilage grabs on to the water and if you smoke, you have no chance as blood supply alone is cut by this. 
Just as important as a proper surgeon, ensuring you’re a candidate in good health and ideally without tip-filler counts just as much. If you have Raynauds or a peripheral artery disease, your risk may also increase. 
So long as you’re in good health and you’re seeing an expert in revisions you should otherwise be fine as it’s unlikely for blood supply to be cut.

Kailash Narasimhan, MD · Answer

Tip necrosis is exceedingly rare, I have done fifth and sixth revision rhinoplasties without this complication. However, an expert in revision rhinoplasty is needed to do complex surgeries. During consultation I examine the nose and the integrity of the skin. From a technical standpoint, the procedure also needs to be done in a safe manner. Check us out ! NarasimhanPlasticSurgery.com

Kailash Narasimhan, MD
Tampa Bay Plastic Surgeon

Kailash Narasimhan, MD
Tampa Bay Plastic Surgeon

William Portuese, MD · Answer

Much more information is needed, such as a full set of facial photographs from all angles, what specific maneuvers you've had done on your nose in the past, and what you're trying to accomplish now. Closed rhinoplasty has a less chance of skin necrosis than open rhinoplasty.

How common is tip necrosis after a 3rd rhinoplasty?

Answers (4)

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