How Many Revisions Can One Safely Get for a Nose Job?

I get asked this question a lot. There is no absolute number after which rhinoplasty becomes impossibly dangerous or doomed to fail.

However, it is a rule of thumb that the surgery is wrought with more difficulty, has a higher complication rate, and has the potential to lead to permanent problems the more surgeries one undergoes.

There are several reasons for this:

The first, scar tissue - each time the skin envelope is elevated from the underlying infrastructure of the nose it is traumatized it undergoes soft tissue contracture and it potentially weakens. The soft tissue contracture may thin the skin rendering it stiffer and thinner and less forgiving to hide any underlying imperfections.

Secondly, revision rhinoplasty if done in a reductive manner or done in a way that does not restore structural support to the nose has a possibility of weakening the infrastructure of the nose. Not all revision rhinoplasty is done is this way, in fact, in my practice, most of the time revision is performed to strengthen support that has been lost. However for other revisionists, further reduction is a rule leading to potential further weakening of the nose.

Also to take into consideration, the emotional condition of the individual changes when undergoing multiple revision procedures; it’s quite a different story when one is seeking primary rhinoplasty. The patient is full of hope, full of expectation and seeking to create improvement to the shape of the nose. The revision patient is one who has undergone disappointment, has potentially been injured or even impaired by a previous surgery. This causes this person, understandably, to be more skeptical, to be more anxious, and to be more risk adverse undergoing revision or multiple revised procedures. In some cases it causes the individual to pay undue or excess attention to the nose – in some cases becoming obsessive over very small details. In those situations it transforms a person who was once quite reasonable and had realistic expectations into a one who is unreasonably perfectionist about the outcome of the procedure.

Lastly, the anatomy has changed. The natural landmarks of the nose in primary rhinoplasty serve as guideposts for the surgeon, though which he or she can navigate through the anatomy of the nose – allowing them to create changes that are safe predictable and reliable. When the anatomy has been distorted by previous surgery, these familiar landmarks are no longer available causing a compromised baseline. In some cases this increases the complexity and difficulty of the surgery.

I would advise to seek out a consultation from a rhinoplasty specialist who performs a high volume of revisions.  Despite these challenges, in the hands of an experienced surgeon, even a multiple revision rhinoplasty can lead to a great outcome!

There is no known maximum number of times that a revision rhinoplasty can be performed. It should also be noted that sometimes a minor touch up is all that will be needed and that should not be considered a revision surgery considering the considerably less extent of dissection and healing that would be involved. However, one important factor to know is that every time you operate on a previously scarred and operated nose, you will induce more scarring and as such there will be more compromise of the vascularity of the tissue. That is why when you look at Michael Jackson’s nose the degree of deformity gets progressively worse with more scars replacing the native tissue. As such, the candidacy and risk versus benefit profile of a revision surgery is something that should be carefully discussed on a case-by-case scenario with an experienced surgeon.

With a rhinoplasty surgery, less is always more. You
do not want a nose that looks overdone, or it will start looking noticeably
fake. Though there is technically no acceptable number of times to get a
revision rhinoplasty, at some point it is best to draw the line and accept the
results of your surgery. Also, as a general rule of thumb, each proceeding
rhinoplasty surgery becomes more and more complicated, with higher risks of
complication and failure. My best advice would be to consult a board certified
surgeon in person, knowing that he or she may ask you to just accept and
embrace the imperfections of your nose. Computer imaging however is a good way
to communicate visually, especially showing the profile of the nose.

The number of revision rhinoplasty a patient can get is limited by the soft tissue envelope.  With subsequent procedures, some patients can get thinning of the skin and may have blanching and/or cyanosis (nose turning blue) either with exercise or cold weather.  In these cases, the nose is probably not a candidate for another procedure.  

The number or revision rhinoplasty surgeries a patient has had typically corresponds to the difficulty.  However, this is not a hard and fast rule.  There are patients with multiple rhinoplasty procedures who only need an endonasal tweak to the nose.  There are also primary rhinoplasty patients who may need costal cartilage or extensive reconstruction of the septum which may be much more complex than a revision rhinoplasty.  

Although revision surgeries gets progressively more difficult with multiple surgeries (scarring, loss of potential grafting material) , there is no absolute limit to how many rhinoplasties one can have

There is no fixed number of rhinoplasty procedures you can undergo.

The surgery becomes more complex as the tissue planes are disrupted with each surgery. This doesn't preclude additional surgery, but a risk benefit decision has to be made to assess whether further surgery is worth it. This can only be done with an in-person exam. I would recommend consulting with a few experienced rhinoplasty surgeons who you feel have good before and after results.

Depending on the type of revisions you've had done, it may be possible to have additional revisions without significant disruptions to your nasal architecture. Of course, the extent of surgery plays a factor as well as the type of proposed revision. I would definitely seek an expert on revision rhinoplasty so hopefully this will be your final procedure.

To answer, how many nose-jobs can someone safely have is difficult. The general dictum is that with each surgery the margin of improvement is less. Of course, the best way is to go to a specialist in rhinoplasty and get it done by the most skilled surgeon in the first place. Much of revision surgery is about restoring strength and structure. This is done by using your own cartilage, either from the nasal septum (as in deviated septum), ear cartilage or even rib cartilage. If little has been disturbed in the first or first few surgeries, revision rhinoplasty may may not be too daunting. If a lot of cartilage has been removed, then cartilage can be added. In more advanced cases, from a rib. I suggest you seek a specialist in revision rhinoplasty to see what can be done after so many operations.

The more times the nose is operated upon the less predictable the results are. It is extremely important to find a nasal surgeon who is very well versed in revision rhinoplasty procedures. Look for a surgeon who has performed thousands of rhinoplasty and revision rhinoplasty procedures. Make sure you have realistic goals and expectations prior to undergoing rhinoplasty.  

That depends entirely on the problem being solved.  Please see a facial plastic surgeon who specializes in revision rhinoplasty and review your options. 

Ramtin Kassir, MD, Facial Plastic Surgeon NY, NJ