For What Scenarios Does a Nose Revision Pose More Risks Than the First Procedure?

Why is revision rhinoplasty a longer surgery than the original?  What are the most common complications to the bone, cartilage and skin?

Doctor Answers 7

For What Scenarios Does a Nose Revision Pose More Risks Than the First Procedure?

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I have perfomed Rhinoplasty and Revision Rhinoplasty for over 20 years and it's the scar tissue within the nasal tissues that makes Revision Rhinoplasty more difficult.  The scar tissue increases each time another surgery is performed, on the nose.  Then there's the issue of cartilage removal, asymmetry and decreased blood supply to the nasal skin as well as internal mucosal scar formation from previous incisions.

Having said all that, this isn't anreason not to have a Revision Rhinoplasty but rather a reason to be sure that you select a well trained, experienced Rhinoplasty Surgeon with a reasonable plan to make your nose more attractive.

Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Comparison of Primary and Revision Rhinoplasties

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Except for minor revisions, a revision rhinoplasty is always more difficult and challenging because normal anatomy is altered, scarring is present, circulation is compromised, and frequently too much bone and cartilage has been remove necessitating grafting from the ears or ribs. Revision rhinoplasty is a specialty of its own and should be done by a surgeon who is experienced in this work. I feel very strongly about that - when I started doing facial plastic surgery 35 years ago, I did not do revision rhinoplasties.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Revision rhinoplasty takes longer due to scarring and missing parts.

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Over the past 35 years of doing revision rhinoplasty I still find it one of the most challenging procedures in plastic surgery. Each is different due to scarring and missing parts removed during prior rhinoplasty. Therefore, the surgeon must know how to diagnose what is missing and make it.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Why is revision rhinoplasty difficult

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Where should we start? First there is the skin. Rhinoplasty is done by separating the skin envelope from the underlying bone and cartilage and then reshaping that structure so the skin can redrape to it. In a primary rhinoplasty with no previous surgery there is a natural plane between the skin and cartilage that allows it to peel right off easily. The second time you go back this plane is gone and it is like trying to separate two pieces of paper that have been glued together without tearing anywhere. This step alone which normally takes 10-15 minutes can now easily go 40-60 minutes or more to avoid damage to the remaining skin. Secondly during the first procedure there is normally an abundant supply of cartilage to work with that is in it's native position. In the revision cartilage is missing and is in altered positions requiring you to search for it and then determine if it is adequate to achieve your goals. Often it is necessary to rebuild structures which can be time consuming. Lastly the skin is no longer pliable and thus requires extra work to try and make it drape well and resist the additional scar tissue that is going to come from the revision surgery.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

Revision vs. Primary Rhinoplasty

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Revision rhinoplasty is one of the most difficult cosmetic plastic surgery procedures. My professor of plastic surgery recommended that surgeons should not attempt revison of other surgeon's rhinoplasty for the first 10 years of their careers. 

The first problem is the anatomy of an operated nose is not normal. Rhinoplasty surgery alters and changes the nose's normal anatomy in order to create the new shape. Skin, cartilage, bone and mucosa ( the internal lining of the nose) are all altered. You never know what you will find and the revising surgeon must have the experience to correct whatever abnormalities he finds.

All wounds and incisions heal with scar tissue. As the nose heals, the original operation creates scar tissue through out the nose. This scar tissue is harder than normal tissue and acts like glue in holding the anatomical structures together. It is more difficult to dissect the the tissues in  a scarred nose in contrast to the easy separation  in an unoperated nose.

Scars contract and tighten as they heal and mature. The more scar tissue and the less strong normal structures in the nose, the less predictable  the healing . Over time , the contracted scar can twist and tun the nose in unexpected ways.

When choosing a surgeon for revision rhinoplasty, I would recommend a surgeon with many years experience in rhinoplasty and revision rhinoplasty surgery. You might look for a surgeon who is board certified in both Plastic Surgery and Otolaryngology (ENT) or has taken a fellowship in rhinoplasty surgery.

Richard L. Dolsky MD

Cosmetic Surgery of Philadelphia

Richard L. Dolsky, MD (retired)
Philadelphia Plastic Surgeon

One word--- scarring

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Revision rhinoplasties are almost always much harder than the original surgery! Scar tissue under the skin makes dissection more difficult and the surgeon never knows what will be found. If cartilage was removed at the original surgery, grafting of cartilage is more likely to be necessary. Make sure the surgeon has a lot of experience in revision rhinoplasty.  Scarring and swelling tends to be worse after a revision surgery as well.

J. Charles Finn, MD
Raleigh-Durham Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews


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The problem with revision rhinoplasty is that even if the original surgeon is doing it he often can't tell exactly what is going on in there as healing is unpredictable. Also no matter what, your surgeon has to deal with scar tissue

David A. Bray, Sr., MD
Los Angeles Facial Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.