Are rhinoplasty revisions really that common? Are they more because of botched results or finding small flaws?

Hello and thank you for your question. Rhinoplasty is the most challenging surgery in all of plastic surgery. Here is some general advice on selecting a surgeon in order to try to avoid the need for a revision. I highly recommend that my patients focus much more on real longterm before and after photographs rather than 3D imaging.   I encounter so many patients in my practice who see me for revision rhinoplasty who previously had surgery elsewhere who feel like they were mislead into surgery by surgeons who relied heavily on 3D imaging without adequate real before and after pictures to back it up. Photoshop is easy but real surgery is very different.

I always recommend that you carefully evaluate your surgeon’s online before and after gallery on their website for both quality and quantity of results. Make sure that there are hundreds of real before and after pictures which demonstrate long-term follow up results. If your surgeon is posting mostly on table results without real long-term follow up results, that is usually a major red flag. If a surgeon is posting mostly just splint removal day videos without longterm follow-up pictures, that can also be a red flag. Long-term results are much more meaningful than on table results or 1 week post-op results. 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

Hello,
This is a fantastic observation. While many patients are satisfied after their first, rhinoplasty is in fact one of the most commonly revised surgeries.
Rhinoplasty is a common procedure which combines function and aesthetic of your center-most facial feature. It’s arguably the most noticeable feature one could operate that must also be preserved or improved for breathing.
Why would anyone choose to undergo a second, third or more revision? Only they could say.
I’m happy to share my observations on the matter as primarily a revision surgeon. Let’s begin.
Basic dissatisfaction- some people are never satisfied. Even with the best of the best result, perfect function and no scar, there is no pleasing them.
Body dysmorphia- Even the most beautiful nose doesn’t look beautiful from every single angle in all lighting. Perfectionists and obsessive personalities can be disturbed by this and try to fix what they see as an imperfection.
Choosing the right surgeon -we believe there is a “right” surgeon for each patient.
During Surgery-excess bleeding, internal and unforeseen complications may contribute to irregular and unanticipated healing of the result. Recovery begins on the table. This is not the final result.
Anesthesia-Waking up with high blood pressure post-anesthesia can affect what patients see between table photos and actual result. Waking up startled can cause hemetoma and swelling to stay longer, altering the intended result.
Cartilage- cartilage has memory. A crooked tip you had your entire life may be improved initially but slowly start to twist back. Some patients opt to revisit their surgeon to correct this.
Scar tissue- scar tissue could form causing swelling or asymmetry the patient wishes to later correct.
Surgical Plan- your surgeon may recommend additional procedures for facial balancing.
Topography- The nose could be perfect but the other features may not support this. In theory you could create an ideal and perfectly symmetrical nose on uneven topography. In time the nose could pull more to the lower side.
And what about a successful operation with fantastic table photos, all supporting procedures needed for balance, performed by a world class surgeon; we have the patients side. The surgeons do the shorter job of the two, patients have the responsibility for life.
Obeying rules- alcohol, cigarette or drug use, rest and recovery, taping or not, when you return to sports, side-sleeping, heavy glasses, how you do or don’t follow after-care will all affect your outcome. Surgery is teamwork with the patients and surgeon.
Hopefully, you have chosen your surgeon on their real-life results and eye for harmony not only by their geographical location, price or morphs provided. As none of these guarantee your result, for better or for worse. What should you look out for?
Superior editing and imaging vs real life skill are a common factor we see for dissatisfaction. You want a surgeon not a photoshop master.
Eye for beauty-Talent and an eye for beauty exists or it doesn’t. Some know beauty but couldn’t perform the artistry. Some have skill but no eye for beauty. Aesthetic surgeons are not trained in any way during education to be experts on beauty. Not every patient realizes this.
Isolated POVs as examples- What is the harmony of the entire face? Proportion matters. Showing only the nose and not the forehead, cheek, philtrum or face is an entirely different story. Make sure you see real results. The table result can look amazing, but when you’re up and standing, proportion could be totally different. What’s on the table is not real life nor the final result.
So, how DO you get an optimum result?
Talent, skill, eye and patient-surgeon collaboration. Even in these ideal circumstances, remember error and life can occur from the table to the 1 year mark.
Best of luck and I hope you found this helpful

Rhinoplasty is a very complicated surgery with many different aspects having an impact on the final result. It is extremely important that when considering rhinoplasty surgery, you find a surgeon that has specific training in this operation. Need for revisionary surgery can be from a variety of factors including inappropriate technique at the time of initial surgery, substantial scar formation, or changes to cartilage that has been used for grafting purposes. It is very common that with time, people may note changes in the appearance of their nose after rhinoplasty- this is most common when sound techniques and principles are not used.
Sean M Fisher MD