Revision Rhinoplasty - How Many is Too Many?

I have already had two revision rhinoplasties and think I might need a third? Is that too many?

Doctor Answers 26

No one likes to think about going through surgery and...

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No one likes to think about going through surgery and recovery more than once. At Profiles Beverly Hills, patients who have not been entirely happy with prior cosmetic results often are referred to us seeking revision surgery. This is not to say that many patients are unhappy after surgery…quite the contrary is true.

A great majority of patients are happy with their outcomes and most are not looking for perfection. What is a minor imperfection to some, though, is not so to others. Still fewer patients are left with a more significant deformity.

Conditions that may increase chances for a suboptimal result are:

  • Poor technique or lack of surgical experience
  • An uncommon complication, such as an infection
  • The unpredictability of healing

An honest dialogue between you and your surgeon regarding desires and expectations can go a long way toward avoiding postoperative disappointment. If you have a suboptimal result, it can often be improved upon.

However, you should be aware that the chances for unbridled success must be downgraded slightly in this situation. This is because we are faced with having to revise surgical alterations against a background of scar tissue and distorted or lost anatomy. Scar tissue also tends to build upon itself with each subsequent surgery while normal structures or layers within and below the skin may thin out or atrophy.

Nevertheless, in well-considered cases, we have had numerous successes in third, fourth, or even fifth rhinoplasty revisions. There is no magic number for allowable procedures. We consider each patient on an individual basis. If we believe that a person’s concerns are clear, motivations are honest, and desired improvements are achievable in our hands with acceptable risk, we'll recommend proceeding.

Sometimes, though, things are better left alone, and we will be frank with you in that event. If you have questions about revision surgery, feel free to contact us for a more detailed discussion.

Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

How Many Revisions?

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Revisions are an unfortunate potential in surgery, whether discretionary or necessary.  The number really does depend on what it takes to get the job done and realistic expectations.

Discuss your expectations, goals, risk/benefit and cost/benefit with your surgeon.

Number of revision rhinoplasties

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There is no hard and fast rule regarding the number of revision rhinoplasties. It depends on what is done at each surgery. Obviously a small trim of the alar base is different from a rib catilage graft.

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Too many rhinoplasties? Don't ask Michael Jackson

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You need to visit a well established rhinoplasty specialist. There is no magic number for revision rhinoplasty, but as I have said so many times in this forum, please choose your rhinoplasty surgeon most carefully. Unfortunately, many patients spend more time picking out the color of their new car interior than they do on choosing their surgeon.

Your nasal deformity needs to be diagnosed by a specialist with experience who will then share with you the plan for revision. In the Midwest, Dean Toriumi, MD in Chicago; in the south, Jack Gunter, MD, or Russell Kridel, MD in Texas; in the west, Rollin Daniels, MD in California are among the giants in revision rhinoplasty.

Stay away from Michael Jackson's surgeon.

Be well and good luck.
Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Another revision rhinoplasty is possible

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It is possible to have another revision rhinoplasty. However, revision rhinoplasty is one of the most challenging of all cosmetic surgeries, and each time a rhinoplasty is done, it becomes increasingly complex. Keep in mind that there are many factors involved, so your nose may not turn out exactly the way you want the third time either. If you do decide to have another rhinoplasty done, look for an experienced revision rhinoplasty specialist who has a strong aesthetic sense and the talent and experience to refine the nose as needed. Ask for before and after photos of previous patients. And be sure to get a second opinion.

Revision Rhinoplasty Requires Advanced Grafting Techniques

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Unfortunately you are in good company. Most rhinoplasty patients out there are very unhappy with their results in 1-2 years. The explanation for this is very simple: Most surgeons performing rhinoplasty do not have advanced training or experience, they perform the rhinoplasty of 50 years ago. Decades ago thought process of rhinoplasty was to remove cartilage to refine the shape of the nose and perform it through an open approach. An open approach makes it easy for neophyte surgeons to access visualize and manipulate the structures but also unnecessarily destroys two arteries and veins that are important for nasal vascularity. The open approach thus ensures that patients have 1-2 years of risidual swelling which hides the final result. Most rhinoplasties out there I consider cartilage robbing thus when the swlling resolves there is inadequate structure to provide aesthetic appearance and fight the cicatriacial forces or the continued scarring that results from the lowered oxygen tension and fibrosis of tissues. One additional problem it that most rhinoplasty surgeons out there inadvertently break the connection between the bony nose and the cartilagenous nose. this can cause irregular narrowing and what we calll "the inverted V deformity" which means the outline of the nasal bone becomes visible through the skin particularly in flash photography under certain lighting conditions.

In my opinion, an expert level rhinoplasty is always performed in a closed technique and ALWAYS involves grafting to add to the structural integrity of the nose. The act of opening the nose even under the closed technique causes healing and some contraction, thus for a long term beautiful result the nose must be left more structurally sound than it was found. This is missed upon most rhinoplasty surgeons.

In secondary cases such as yours it is even more crucial that sound grafting techniques are used. I Definitely do not consider any rhinoplasty procedure that does not include grafting preferably by an experienced Plastic and reconstructive training with ddition fellowship level craniofacial and aesthetic training. Of course this is my bias because it is my training but I think this level of training is very necessary for success in secondary and tertiary rhinoplasty because there is delicate nuance involved and every patient requires different maneuvers. I hope this helps!

All the best,

Rian A. Maercks M.D.

revision rhinoplasty how many as too many?

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 It's important for you as the patient to have realistic expectations upon what can and cannot be accomplished with revision rhinoplasty. Remember there is no perfect nose, but as long as there are structural or breathing problems that require additional surgery,  it is acceptable to proceed. Also important to make sure that patient's are in excellent health prior to undergoing another elective cosmetic surgical procedure. It is critically important that you find an expert revision rhinoplasty surgeon who is dedicated a significant portion of their practice to the discipline of rhinoplasty and revision rhinoplasty

As the number of surgeries increases, so do your risks of complications.

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Thanks for your question.  The reality is that it may only take one more surgery to get it right.  The problem is that each surgery makes it harder to reach your goal because of changes in blood supply and increase scar deposition in the nose.   Healing and recovery take much longer in general.  Also because of the scar the nose tends to become more stiff and not feel like your original nose.  Some times it is better to settle but consult an expert in revision rhinoplasty to make sure you aren't being overpromised success.

Good luck,

Dr. Shah

How many is too many revisions

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One revision is too many for some. After a few the nose isn't pliable and fixable anymore. Every case is different. Perfection is the enemy of good.

Revision Rhinoplasty - Each case is different

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There is no definite rule, and each case is different.  The number of revisions will depend on the scope of each surgery, and the condition of the nose. During the consultation process, expectations, goals, risk/benefit and cost/benefit are all factors to be discussed.

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.