How risky is a third rhinoplasty? (Photo)

Question

I had an initial rhinoplasty in 1998 and another one in 2019. He latest one resulted in the attached and was a tip-plasty but my resulting tip is quite bulbous (the surgeon himself seemed less than thrilled and said something about scar tissue/how it healed). Should I risk another surgery or just be "ok" with what I have been left with.

Nima Shemirani, MD · Answer

Hi @Elisheva123. I recommend seeing an expert revision rhinoplasty specialist for an in person examination. There are options for you that can be determined after examination.

Best of luck,

Dr. Nima

Jonathan Kulbersh, MD · Answer

Thank you for your question and for providing a photo. It is safe to undergo a revision rhinoplasty after one year has passed following your last procedure. Details on how each of the previous rhinoplasty surgeries was performed would also need to be addressed. Each rhinoplasty procedure becomes more complex, due to scar tissue and other factors.

If you’re concerned about a third surgery, you may consider non-surgical rhinoplasty. This injectable treatment uses hyaluronic acid dermal fillers to reshape the nose and may reshape a wide nose tip. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who can assess your medical history and concerns on a more individual basis.

Gregory S. Dibelius, MD · Answer

Hi,
I generally think that if you are healthy and the skin and soft tissues of your nose are healthy, then it is reasonable to undertake a revision rhinoplasty, even if there was more than one surgery before. You do have to allow for sufficient time for the nose to heal; if your last surgery was in 2019 then that should be plenty of time. 
However, I would say that these surgeries usually require a different approach, and frequently that means using some other source of cartilage like ear cartilage or rib cartilage in order to get the desired result. This would be the biggest difference between a primary surgery and a revision surgery. Ironically, typically we need to add these cartilages in the form of well-placed grafts to actually make the nose appear smaller and thinner. 
You would need to consult with a board-certified facial plastic surgeon to review more specifics of whether you are a good candidate for surgery, but just based on your description and photo, revision is definitely a potential option. I would also encourage you to look for surgeons who focus on and have expertise in revision rhinoplasty, as they would be able to provide much more detailed and specific information to your case. You will almost certainly find different answers if you speak to multiple surgeons and so it is definitely worthwhile to speak to as many as you can. There is no need to "settle" until you have gotten all of your questions answered!

Man Koon Suh, MD · Answer

Thank you for your question. Your nose still looks big, and maybe it's bigger than your original nose. This phenomenon is not uncommon in bulbous tip correction. That doesn't mean you have to give up. More satisfactory results can be expected through revisional surgery. Bad result may be because you had a postrhinoplasty fibrosis syndrome. However, even in such a case, good results can be induced through scar tissue removal and alar cartilage realigmenment, and medication or steroid injection for scar tissue prevention may be required after surgery. Of course, it is necessary to expect realistic result rather than perfect result.

Eric M. Joseph, MD · Answer

It largely depends what was done to your nose and septum during your first 2 rhinoplasties. You appear to have a wide bridge and tip appearance. The feasibility of tertiary revision rhinoplasty would require a consultation with a rhinoplasty specialist. Hope this helps! Dr Joseph

Corey S. Maas, MD · Answer

You are correct in understanding that the more basal revision surgeries you undergo, the lower the predictability of outcome in general. However, (and without reviewing your records), over grafted noses or noses that are too large are much safer and more predictable then the over respected and under supported noses we more commonly see. Two pieces of advice. #1 find a facial plastic surgeon that has performed thousands of rhinoplasties and at a least 1/3 revisions. And #2 get more than one consultation and demand to in diagrams or computer imaging what the surgeons believes the cause of this deformity and how he or she would address the problem. Travel may be necessary. You are NOT hopeless!

Marc Polacco, MD · Answer

Thank you for your question. Only you can really answer the question if surgery is worth it. A general rule of thumb would be that if your nose bothers you 80% of the time or more, surgery may be worth the risk. Hope that's helpful. 
-Dr. P

Thomas Trevisani, MD · Answer

Every surgery has its risks. Revisions are more challenging and require an experienced Surgeon to perform the surgery .  The first time is the best time to achieve the best result. In order to evaluate accurately in person exam is essential as well as photos- all views( and reading the op-report would be helpful). Based on a limited photo- it appears that your nose can be improved - in the right hands- with Revision Rhinoplasty -preferably performed through closed technique.

David M. Kowalczyk, MD, MBA, FACS · Answer

Good Afternoon! A revision procedure to address the narrowness and tip refinement shouldn't be out of the question. I would suggest an open approach to be able to see exactly what's going on underneath the skin. At that time, scar tissue could be removed and better structure placed to recreate the tip. If you haven't tried already, steroid injections, compressions, low salt diet, and taping would be worthwhile to see if improvements can be made - even this far out. Hope that helps!

How risky is a third rhinoplasty? (Photo)

Answers (9)

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