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.  

Superior rhinoplasty is detailed and complex, always with a keen eye towards understated, natural beauty. You may be observing more unpleasant results compared to next individual. I would contend however, that most are so extraordinarily natural looking that the average person would not know if a particular nose was given by birth OR in fact sometime after birth. I would like to believe that my colleagues who are truly skilled contribute sizably to the latter. The scrutinizing onlooker should never know either way! Barry Weintraub MD

Rhinoplasty results are viewed under the microscope because it sits in the middle of the face. Most results are improved but the expect ions are always very high. There is always some bleeding into the tissue and that can lead to asymmetry after the blood is resolved because that results in difference in the scarring.

Hi there RemiThe reality is that Rhinoplasty is a very exacting procedure. It is an operation that has both a functional and aesthetic component.From an aesthetic point of view any minor imperfection is obvious for all to see. To put this in perspective for you, a 10% volume difference in breast size following a breast reduction would go almost unnoticed. Yet if the tip of your nose is 10% too high then it will stand out a mile.Having said all that, I think your assertion that only a small percentage get a good nose job is an exaggeration. Whilst it is commonly stated that there is no perfect rhinoplasty, the majority of patients I believe are happy with their result.Rhinoplasty has come a long way over the last decade or more. Most Rhinoplasty surgeons now perform an open procedure in the majority of cases, which makes visualisation of the structures possible. Also many surgeons with an interest in rhinoplasty  surgery have moved to what is called structural rhinoplasty. This technique involves using the patient's own cartilages to maintain the shape of the nose. Often small changes to the shape of ones nose can lead to dramatic changes in facial harmony and aesthetics, so a technique that maximises exposure, stability and durability greenly leads to more consistent results.Finally in the consultation process many of us use Vectra technology which enables simulation of the surgical changes so that expectations can be set in a realistic and easily communicated fashion.Regards,Richard

The "botched" work is probably what you notice as bad work, but I would like to think many get very excellent results on a regular basis. Good luck.

The rate of revision rhinoplasty has been reported at 5-15% nationally. That means that for 500,000 rhinoplasties performed in the US each year, approximately 25,000 to 75,000 people will need a revision...This number includes both small "touch-ups" and major revisions - botched rhinoplasties. Most revision surgeries are surely small touch-ups, but even though the number of botched rhinoplasties may be a small percentage, it is a lot of people!The great majority of patients who have rhinoplasty have a very happy outcome, and if you are considering a rhinoplasty, then you obviously want to be one of them.  How do you avoid being "Botched?"There is no shortcut to choosing a rhinoplasty surgeon - you have to do your own research. A referral from a doctor, an aesthetician, from a friend/patient, or by "word of mouth" can help, but I would not suggest relying on them completely.There are certain critical facts about a doctor and his practice, such as how often they perform rhinoplasty, that you should know. Knowing your doctor's credentials and his specific specialty within plastic surgery (ie what does he or she do most and best) may also help you make an educated decision.Once you find a doctor whose credentials you are satisfied with, you should meet them and see if you feel comfortable. The doctor should be able to explain the procedure to your satisfaction, and instill confidence in you. It is important that you see examples of the surgeon's rhinoplasty results. (Many surgeons show these on their websites).  This is not a guarantee of success but can give you an idea of the surgeon's personal aesthetic and an idea about his ability. It is important to establish that the doctor has a special expertise in rhinoplasty. During your office consultation (the "interview") you will get a gut reaction. Do you like the surgeon? Does he seem to have a passion for the operation? Does he take the time to explain the surgery, in detail? Does he listen to what you want, or does he tell you what he wants to do?In the end, there is no guarantee - you cannot negotiate away the risks of surgery. If you are looking for a new car and do good research, most tend to arrive at the same great car companies. But occasionally, even a great car company makes a lemon!To summarize, if you do the right research, you should b able to find a "great surgeon" and reduce the risk of being "Botched." Good luck!

Rhinoplasty is a process not a job!(up to a year for final results) It is the most challenging procedure and the outcome is mutifactorial!whilst the surgeons experience plays a vital role the patients tissue thickness and expectations are very important too!!because often it is down to millimetre accuracy the fine tuning /readjustment of rhinoplasty is not uncommon! as Doctor Loury alluded most happy patients do not bother to come online and write their experience !bwJawed TaheryConsultant ENT/Facial Plastic SurgeonChester,UK

Rhinoplasty is an extremely difficult and demanding surgery, anyone who performs a lot of them particularly revision surgery will tell you this. When you add on top of this everyone's different tendencies in terms of wound healing it adds another layer of complexity to the surgery. Expectation of constitutes a "good" result is probably the most important factor in determining if something is truly "botched". Realizing that minor asymmetries and imperfections are what make us human and cannot be completely corrected by rhinoplasty is important. Having a truly "bad" result hopefully isn't as common as many people think it is. A "less then ideal" result is probably fairly common since even in the best of hands it's a difficult surgery. Generally the more aggressive one gets about reshaping the nose, the more risk of being "botched". I generally tell people we are born with a certain type of nose and the more we try to change it, the more risk of impairment of breathing and potential for catastrophic problems for scarring and skin contracture. You can refine what you have but drastically altering your nose is risky.