Have I Had Too Many Nose Jobs?

I had 2 previous nose jobs when I was 18 and again at 20 I am now 37 and would like to shorten the tip of my nose but it seems the previous doctors left a hole between the nostrils inside. In other words, from what drs. have told me, there is no cartilage to hold up the tip to get it shorter.
Can you help me? Is there a way of correcting this and so there is no longer a hold from one nostril to the other.
Many thanks for anything you can suggest.

Doctor Answers 19

Rhinoplasty revision can be very safe

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There are a number of reasons why patients seek a secondary (revision) rhinoplasty procedure. In certain situations, the initial procedure may have not fully corrected the undesirable features of the nose. In other situations, the initial rhinoplasty may have actually resulted in certain undesirable features. As long as the skin of the nose is healthy, and enough time (typically one year) has passed since the previous surgery, there is no problem with having one or multiple revisions. The most important point is to do your homework and go to the best surgeon that you can so that you minimize the chance of needing a revision in the first place.

Presence of a hole (perforation) between the nostrils (this is called a septal perforation) does not prevent anyone from having a revision rhinoplasty but it does make it more likely that you will need cartilage grafting from the ear.

Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Septal Perforation Repair and Rhinoplasty

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It sounds like you would certainly be a candidate for revision rhinoplasty and repair of a perforation in your nasal septum. The septal perforation can cause issues for patients such as chronic crusting, bleeding, or whistling with breathing. In other cases, there may not be any symptoms at all. The septum can be repaired at the time of your rhinoplasty with the use of temporalis fascia, a soft tissue graft which is harvested by making a small incision behind your hairline, over your temple. 

Changing the shape of your nose may require the use of cartilage, which can be harvested from your ear or even your rib, if a larger amount of cartilage is needed. The perforation should not preclude you from having a revision rhinoplasty. Rather, the best time to repair your septum is during your revision rhinoplasty procedure. Revision rhinoplasty is among the most challenging and specialized of plastic surgical procedures so be sure to visit with a specialist. 

Best of luck,

Dr. Mehta

Umang Mehta, MD
Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 52 reviews

Possible Septal Perforation

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It sounds like the "hole" you describe is a septal perforation.

Seek a well qualified surgeon for advice about repairing the "hole," restoring tip support and whether the change you seek are advisable.

Revision Rhinoplasty can be challenging!

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.7 out of 5 stars 45 reviews

Revision rhinoplasty concerns

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As you have probably learned, revision rhinoplasty  requires a surgeon with experience and expertise to undertake this rather difficult procedure.  It is not just the number of surgeries that you had, but the state of your nasal tissues that matters.  A nasal specialist would assess the degree of scarring, residual nasal cartilage, need for additional cartilage (ear, rib, homologous) and prepare an appropriate surgical plan.  Only in this fashion is there any hope to created an aesthetically pleasing and natural nose.  The lack of support in your nasal tip can be addressed by an experienced surgeon.  The "hole" that you describe is most likely is in your nasal septum.  It might be correctable, but on occasion if it is asymptomatic it can be left alone.

Boris M. Ackerman, MD
Newport Beach Plastic Surgeon
4.8 out of 5 stars 62 reviews

Maximum number of revision rhinoplasty surgeries

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The answer to the question 'how many is too many' is highly indivualized and will vary from person to person. Problems such as the ones you describe may be correctable. However, a personal examination would be necessary to determine if these are feasible or recommended in your situation.

For example, it sounds as if you may have a septal perforation, or hole in the septum. In some cases, these can be repaired. In large perforations, a unique but extensive procedure can be used to repair the area in question.

Revision rhinoplasty is a specialty in itself and your should seek someone with extensive experience in this area, and perhaps get more than one opinion, before you decide if this procedure is right for you.

Hope this helps,

Dr. Sam P Most

Sam Most, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 68 reviews

Revision rhinoplasty

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We do many revision rhinoplasties, and they are sometimes indeed extremely complex. Sounds like you have a septal perforation, perhaps, and a droopy tip. The first thing you need to do is to see an experienced facial plastic surgeon and discuss your problems and expectations. Usually we can get cartilage from the ear, sometimes from the rib, to rebuild the structure that has been lost. It might be helpful for you to see several surgeons for their opinions, and decide whether the revision procedure is right for you.

Stella Desyatnikova, MD
Seattle Facial Plastic Surgeon

Be Careful With Tertiary Revision Rhinoplasty Specialized Grafting Techniques Are Needed!

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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. It sounds like at a minimum you will need bilateral spreader grafts and a columellar strut but a complete L-strut should be considered and harvesting a small bit of rib cartilage may be necessary depending on your findings. Is sounds like your surgeon is on the right track. 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 following 2 previous rhinoplasty procedures.

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From your description it seems a good choice to undergo another well planned and executed reconstructive rhinoplasty to restore form and function.  A third nasal surgery is not contraindicated when there is much to be gained and little downside. 

Mario J. Imola, MD, DDS, FRCSC. 

Mario J. Imola, MD, DDS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 124 reviews

Shorten my nose after 2 previous surgeries

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As you gather it sounds like you have a septal perforation, and it can be treated  or not depending on the level of morbity you suffer with it.  Some people can be operated on many times. Their skin doen't seem to wear out, the infrastructure seems to continue to be modeled without difficulty or complications. Whether you ae one of those or if you are one who needs to run away from surgery as fast as you can is a decision you and a Board Certified Plastic Surgeon can make together in his office.

I hope this information has been useful to you.
Jon I Sattler, MD, Board Certified Plastic Surgeon, Glendora, California


Jon Sattler, MD
Glendora Plastic Surgeon

Diminishing returns with multiple rhinoplasties.

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You describe a septal perforation which would require reoperation to fix.  It's not very easy if it's large.  The aesthetic portion is impossible to predict but with each subsequent rhinoplasty a predictable result is harder and harder to achieve.

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.