Rhinoplasty Revision Rate?

The number quoted in our literature is more like 10%, meaning one in 10 patients ends up getting a revision rhinoplasty. This number is obviously very surgeon dependent. I am wondering why you brought up the American Board of Plastic Surgery? I do a fair number of revision rhinoplasties in my state and they all come from doctors who are board certified Plastic Surgeons. That is because most of the rhinoplasties around here are done by Plastic Surgeons.

I happen to be board certified by the American Board of Facial Plastic Surgery and the American Board of Otolaryngology. I bring this up not to start a battle but to illustrate that board certification is no guarantee of quality. Training exposure during residency and fellowship varies with each institution and program. I know great rhinoplasty surgeons who are board certified by the Board of Plastic Surgery, and great surgeons certified by the Board of Facial Plastic Surgery. I also know surgeons who should not be doing rhinoplasties. Even the best surgeon can have less than ideal results at times.

The healing process after a rhinoplasty can be unpredictable even when everything was done correctly during the surgery. This is a tricky area for the patient seeking a rhinoplasty, ask questions, check reputations, look at before and after photos.... good luck and I hope this helps.

First of all, going to a surgeon certified by the American Board of Plastic Surgery has absolutely nothing to do with revision rates and is no guarantee at all for success.

The three types of Rhinoplasty surgeons are:

1) Plastic Surgeons

2) Facial Plastic Surgeons

3) ENT surgeons

All of the above surgeons, theoretically and by training and certification, should be able to do a good Rhinoplasty. However, there are always good and bad surgeons. And there are always surgeons who specialize more in one surgery or another. For example, just because a surgeon is known for doing amazing tummy tucks, it does not automatically mean he is even decent at Rhinoplasty, and so on.

Then are are other issues:

1) No one can control how your nose heals. You heal the way you heal and so a minor revision may be necessary

2) patient expectations are important. Some patients are just never happy no matter what and they get stuck in a "revolving door" of revision rhinoplasties

3) incomplete pre op communication may be an issue where your surgeon gave you a great nose but you just wanted something different and either you did not get that desire across to him pre-op or he just did not listen to you.

4) And again I have to mention healing variations because this is a major factor in needs for revision but lets be clear that a nose job that is not done properly (like the late Michael Jackson's) is not an issue of healing but that was an issue of poor surgical technique and judgement, etc.

With all this said, minor revision rates, in good Rhinoplasty Specialists practices can be around 5-15%. Some other surgeons may have revision rates as high as 30% or more.

Hope this helped.

Traditionally, the rhinoplasty revision rate is between 5 -15%. I think a well qualified facial plastic surgeon ( ENT trained) or a plastic surgeon should be fine to perform the procedure.

Interesting topic and question. The rate of revision rhinoplasty nationwide is a difficult number to accurately quantify. This is due to the fact that patients historically tend to see physicians of different training backgrounds and abilities making it difficult to obtain accurate statistics. For instance, I'm boarded by the American Board of Otolaryngology (ENT) as well as the American Board of Facial Plastic and Reconstructive Surgery and have practiced nothing but facial plastic surgery since 1988. My revision rate hovers somewhere between 3-5% but that includes all patients that I take back to the operating room. The vast majority have a minor revision done under local anesthesia that typically takes less than 45 minutes with the most common "revision" being shaving down the rhinion. The rhinion is the area of the nose where the cartilage and bone merge and is the growth center of the nose; I tell my patients that at times they will grow cartilage and/or bone in this area 3-6 months post op and we'll need to address it. The other less common revision is in patients that retain supratip edema (the area immediately above the tip) and in these patients if steroids and taping do not resolve the problem aggressive scar tissue removal will usually address the problem. This is typically done after a year to allow as much healing to take place as possible. This problem is rare and tends to be more common in patients with thick sebaceous skin who have had an external approach.

To lessen your chances of needing a major revision seek a surgeon board certified by the American Board of Facial Plastic Surgery or the American Board of Plastic Surgery who has years of experience performing rhinoplasty and can show you many of their photos (which you find attractive). See 2-3 surgeons and pick the one you feel most comfortable with. Even surgeons with these boards may not do much rhinoplasty so ask how often they perform the procedure, what is their particular specialty and how long have they specialized. Experience is a great teacher. Finally be wary of physicians that advertize excessively as the best surgeons are usually busy due to word of mouth and reputation and find they need to market themselves modestly.

First Rhinoplasty is a very difficult surgery, experience is very important, realistic patient expectations is important. All these are factors in the rate of revision. Choose an experienced board certified surgeon, Have realistic expectations, consult more than one surgeon and communicate all your desires and concerns to your surgeon. Hopefully you will not need revision.

The results depend on the characteristics of yur nose, the thickness of the skin and your expectations.

The physicians who publish these rates are actually the doctors who are doing the most surgery, which is why they are publishing on rhinoplasty. Most are usually minor changes and not patients who need entire re-dos.

For a quality result you should trust a physician boarded by the American Board of Facial Plastic Surgery or the American Board of Plastic Surgery. However many physicians who are board certified don't do many rhinoplasties. So, board certification isn't the only issue, you should ask what percentage of your doctor's practice is devoted to rhinoplasty and how many they do per year.

Experienced surgeons do not have a revision rate even close to 20%. In this group of surgeons, a more accurate estimate is 5% and most of those are minor post- operative changes. Good revision rhinoplasty surgeons may actually have a higher rate because of the added challenge of these operations. The moral of all this discussion is pick your primary surgeon carefully; a surgeon certified by the American Board of Facial Plastic and Reconstructive Surgery or the American Board of Plastic Surgery who does a lot of rhinoplasties with results you like.

This has often been quoted as a revision rate procedure and is indicative of patient expectations, surgeon's surgical expertise, inability to change certain anatomic features, healing tendencies,etc. With a board certified surgeon, you are certain to recieve surgery with an individual who's training is supervised and credentialed.