How Many Revision Rhinoplastys is Too Many?

If you're still unhappy after three surgeries, is it possible to have another surgery or should you just live with it?

Doctor Answers 35

Revision Rhinoplasty

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There are many factors that determine whether or not patients are good candidates for secondary (revision) rhinoplasty. The number of prior surgeries is less important that the quality and characteristics of the nasal skin, framework, and the amount of scar tissue present. Other factors include the extent of the deformities, the risk:benefit ratio of correcting problems without causing addtional ones, and also the patient's psychological stability.

These are all factors that must be addressed on an individual basis in a one-on-one setting. Careful analysis of the patients photographs and the expectations for surgery need to addressed. Finally, revision rhinoplasty should usually be performed by a rhinoplasty surgeon who specializes in revision surgery.

Dallas Facial Plastic Surgeon
4.7 out of 5 stars 149 reviews

Revision Rhinoplasty advice

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I certainly appreciate your frustration, as you have been through the surgery and recovery period three times and are still unhappy with your aesthetics and ability to breathe.  In my opinion, form and function go hand in hand. That is, a nose which is well constructed and well balanced will also "work" well... Revision rhinoplasty is among the most technically challenging of plastic surgery procedures so be sure to see a rhinoplasty specialist with the training and expertise to address your concerns.  

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

Revision Rhinoplasty - Look for an experienced surgeon

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The ideal number of revision rhinoplasties should be zero. For this to happen you and the surgeon need to share a common goal that is realistic. The surgeon needs to make an accurate diagnosis and execute the operation well and the patient needs to co-operate with all postoperative instructions. Now that you're up to 3 surgeries with airway obstruction you need, more than ever, to see someone who can listen to your concerns and then offer a detailed diagnosis and treatment plan. You need a Rhinoplasty specialist. I find that copies of the prior operative notes are very helpful in anticipating what is left to reconstruct the nose with as well as identifying where things might have gone wrong before. It is also very important for you to have realistic expectations concerning the surgery and the results possible. This is a difficult situation but in most cases something positive can be done to improve the breathing and the appearance.

How many revision rhinoplasty is too many? "Depends"

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It is possible for you to have a nose that is natural-looking and functions well. The fact that you have difficulty breathing makes the decision to do a revision rhinoplasty a good option. You should obtain your pictures and operative report and bring it with you to the consultation. The number of the previous operations is not as important as the degree of scarring, cartilage and tissue loss as well as the degree of the deformity. You probably need to have cartilage graft to correct the deformity. The experience and experise of your surgeon has direct correlation to the success of your revision surgery.

Good Luck,

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 205 reviews

Revision rhinoplasty can improve the nose

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An experienced rhinoplasty surgeon must assess the nose to give an unbiased opinion as to the likelihood of significant improvement with the next surgery.  Each procedure is successively difficult with an increased chance for a complication.   The best chance for a good result is the first surgery, so choose your surgeon carefully.

Robert Mounsey, MD
Toronto Facial Plastic Surgeon

Revision rhinoplasty - breathing and aesthetic issues

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Revision rhinoplasty is one of the most complicated procedures in facial plastic surgery. As such, it would require a personal examination and counseling by an experienced surgeon to determine if it is right for you. Certainly, if you are having breathing issues, a combined functional and aesthetic revision may be necessary.

After having had two revisions (three surgeries), it is best that you seek someone with extensive experience in revision rhinoplasty specifically. You may require any of a number of techniques to rebuild/repair your nose--someone with experience can help guide you through this and determine if you are a candidate for this procedure.

Best of luck to you.

Sam Most, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 69 reviews

Redo Rhinoplasty

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Redo rhinoplasties are extremely challenging. In the cosmetic world they may be one of the most difficult things we do. It is impossible to say without a close examination and history if there are things that can be improved.

While a board certified plastic surgeon is always a good place to start, it is reasonable at your third surgery to go to someone with world renown experience. People like Jack Gunter in Texas or Nick Tabbal in NY - there are literally just a handful of kind of "super experts" that you may want to consider.

I have spent some time training with Nick Tabbal in Manhattan years ago and have nothing but positive things to say about his re-do rhinos.

This is not to say that any plastic surgeon cannot make things better but each subsequent surgery creates more scar tissue, weakens support and vascularity of your nasal structures and can create more problems if you don't get a home run. In my San Francisco practice we routinely see and operate on re-do's but are not above referring out very challenging ones (3rd, 4th, 5th redo).

I hope this helps.

Steven Williams, MD

Revision Rhinoplasty

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A revision rhinoplasty should be a thorough decision, but can have positive implications should you still be unhappy with your new nose. As a general rule of thumb, I advise my patients to limit the number of nose job surgeries to three. If all does not go according to plan after the first revision, it can be helpful to consider consulting a new surgeon and to get a new opinion and perspective on the alterations that would look best to your nose. It is also important to consider that your new nose is changing and adapting for at least a year after the nose job. Swelling continues to subside during this time, and a nose that is fully healed can look dramatically different than it did during the healing process.

Sam Rizk, MD
New York Facial Plastic Surgeon
4.7 out of 5 stars 79 reviews

Revision Rhinoplasty

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The ideologies of "secondary rhinoplasty," or nasal surgery on a nose that has already been operated on, are very much the same as those in the primary rhinoplasty situation. It is important to consider nasal balance, function, deformities of cartilage and bone, areas that need additional support or reshaping, and to devise a safe plan that satisfies, to the greatest degree possible, the patient's desired outcome. Typically, revision rhinoplasty, is much more difficult. The nasal septum, which is the prime building material for nasal surgery, has often been partially or completely removed. The cartilage and bone that create nasal shape have already been altered and are scarred or deformed; and the skin has become thicker and less pliable. The airway is often significantly impaired. Most importantly, the patient who has already gone through one or more prior disappointing experiences, has spent money for operations that didn't achieve what he or she wanted; and now needs to start over.  In this setting, it is critical that patient and surgeon understand each other. I must diagnose the problem, explain it to the patient, and then devise and explain a surgical plan that is most likely to achieve what the patient wants. Often there are several possible surgical solutions, each with a different outcome, some of which will be more complicated than others. Only by discussing each plan with the patient can he or she decide what will be most satisfactory or whether a revision rhinoplasty is optimum.

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 124 reviews

Revision Tertiary Rhinoplasties Require A UNique Skill Set

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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. 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.

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.