Why are there so many botched rhinoplasties?

Rhinoplasty is acknowledged by all who perform this surgery as the most difficult of all cosmetic procedures. Therefore the more difficult, the greater degree of failure. However are there so many botched jobs? The answer is probably not. Surveys have consistently show about 80% of rhinoplasty patients are happy. 20% aren't. But of these 20%, the greatest number are still improvements which unfortunately haven't met the patient's expectations. Botched means the outcome is worse than the nose was before surgery. This on the whole is about 1%. So assuming 500,000 Rhinoplasties a year, then there's going to be 5,000 bad results. Just about everyone of these unfortunate people are going to complain and many go public on social media. The 400,000 happy people usually prefer not to announce to the world they're have cosmetic surgery.

The nose has many moving parts. There are paired nasal bones and two sets of paired cartilages on the sides as well as cartilage and bone in the center. Each and every surgical maneuver can alter a number of things. Narrowing the tip cartilages can alter not only the size but the position, angle strength and how far the tip sticks out from the face. Multiply that times 10 or more major maneuvers in rhinoplasty and the chances for inexact results are there. However, the vast majority of patients who get rhinoplasty are VERY happy. It's only the small minority (around 7% according to the medical literature) who need revision. And of that number only a small % are complete makeovers, most are tweaks of noses patients like. Lastly, happy patients don't often take the time to post their happy results and feelings everywhere. Unhappy patients tend to me more vocal and prolific with their issues.

This is a very good topic, and one that is near and dear to my own heart.  As a rhinoplasty surgeon, I make sure that I share my expectations with my patients ahead of time.  80% of rhinoplasty operations heal well and are a success.  20% (that's 1 in 5) will have some imperfections by the time they have healed 6-12 months later.  It's then up to the patient and the surgeon to decide if the imperfection is small (i.e. leave it alone), or big (i.e. needs a touch-up).  This does not mean the doctor or the patient "messed up" or the surgery was "botched."  It simply means that the body did not heal the surgical area as well as planned.  This of course assumes that the surgeon was experienced, the plan was a good surgical plan, and the patient followed the instructions well.  Here's why 1 in 5 rhinoplasty operations may not heal as a success:The surgery is very exacting, and the results are visible for everyone.  The tolerance for imperfections is very low, unlike body surgery, etc.The surgery involves, skin, soft tissue, cartilage, AND bone in most cases.  The more types of tissues we operate on, the higher the variability of the results will be.The patient and the surgeon cannot control the body's healing response 100%, no matter what we do.  This has nothing to do with skill, it has everything to do with nature and biology.Good surgeons will not let their imperfect results stand, and will offer touch-ups to those patients.  Good patients will understand this and will not accuse honest and consciencious surgeons of "messing up" or "botching" their surgery.On this site, and every other site, you will not find all the happy patients.  They are out there living life, enjoying the results of the procedure, and not having to talk about it.  Naturally, if someone has a problem after surgery, they will want to seek advice from doctors and the patient community, so they will come to this and other similar sites.  That means the proportion of patients who are not satisfied is naturally higher in these forums.I hope this helps you understand the issues at hand.