I'm not satisfied with my rhinoplasty, should my surgeon perform a revision for free as it's partially his fault?

It is difficult to give you a definitive answer without evaluating you in person or at least seeing photographs. If it is less than one year since your surgery, you still have healing to do. You cannot yet evaluate your final results or consider a revision yet.

After one year, if you are still unhappy, you can discuss a revision with your facial plastic surgeon. However, some of your dissatisfaction may be related to your own healing process and anatomy – rather than surgical error – and may not be fixable. One caveat: if your unsatisfactory results are actually due to the surgeon's error, as you suggest, a “free” revision might not be a bargain, as revision rhinoplasty demands even more expertise than the first rhinoplasty.



While I understand your frustration and your wish to avoid spending more money, if you are truly unhappy with your results after you have healed, then maybe you need to work with a different facial plastic surgeon who already has expertise in revision rhinoplasty.You need someone with superb skills. But first, give yourself that year to heal. I hope this helps.

I am sorry to hear that you are not happy with the results of your surgery. You individual situation is difficult to assess without photos or a physical examination. It is important to remember that it can take up to a year for final results to show. Generally, when the error is the surgeon’s fault, he or she will take responsibility and perform a revision to correct the mistakes. This will vary from surgeon to surgeon and will also depend on individual circumstances. In most cases, if it is the surgeon’s fault you can expect to pay only small administrative or medication costs that correspond with the procedure. However, please note that revision rhinoplasty is never simple and only an exceptionally experienced plastic surgeon should be trusted to perform a secondary nosejob.

Most surgeons will discount their own revisions - especially if they feel that they could have/should have done better.  Not all surgeons own their surgery centers which limits their ability to discount operating room and anesthesia fees.

I read your concern. I'm sorry you did not have a favorable experience after your rhinoplasty surgery.

Correction of nostril asymmetry may require an open approach and cartilage grafting. If your nostril is swollen, you shoud try not to undergo another surgery until all of your swelling has subsided.

In my practice, I prefer to offer a non-surgical rhinoplasty with Injectable Fillers whenever possible and keep additional surgery as a last resort.

I hope this helps.

Regards from NJ:

Dear Islandgirl17,

I am sorry to hear that you have a disappointing result from your rhinoplasty.  It is hard to deal with a result that doesn't leave you happy after going through the whole process involved with surgery.  I believe that your line of reasoning that the doctor should perform the revision procedure for no cost  is one that, on the surface, makes a lot of sense.  After all, it is the model that all of us have come to expect from other businesses and indeed, most of us believe that, "the customer is ALWAYS right." 

However, with rhinoplasty, and facial plastic surgery in general, the process is a little bit more complicated.  There are numerous factors that can result in a poor outcome.  We (both the surgeon and the patient) try to make things as predictable as possible, but we are never 100% successful in doing so.  As a result, there are times when the outcomes are not satisfactory.  I would be completely shocked if your surgeon isn't as disappointed as you are with the result.  The surgeon doesn't have to live with the changes on their own face, but they do have to live with the disappointment and second guessing that comes with a less than satisfactory result. 

The other important factor is that the achievement of a perfect result is almost impossible.  Even in cases where the patient may be totally and completely happy, I notice things that I feel I could have improved or done a better job.  I think that this is true for most facial plastic surgeons.  In fact, it is what makes us enjoy our jobs.  Constantly trying to improve outcomes is the motivating factor and what makes medicine a rewarding field for so many of us.  This is especially true in rhinoplasty, which is the most difficult facial plastic procedure to get consistenly good results.  There are just so many factors involved in the healing process.

Due to these reasons, if every surgeon was to fix a less than perfect result, we would be fixing and refixing our patients all the time.  Doing this for free doesn't make much business sense,  Unfortunately, the business side of things is a necessary evil, which enables medicine to keep treating patients and making the necessary advancements and innovations that we rely upon.

Having said all of that, I would have a frank, honest, and open discussion with your surgeon.  Explain your concerns and disappointments and discuss what specifically you would like corrected. 

I wish you luck during this difficult time!  Let us know how it turns out.

 In our practice, we feel that it's important for patients to obtain their goal of achieving the nose that they desire. Some patients do require a minor touchup revision rhinoplasty. In our practice, we charge only for the anesthesia fee,  which is approximately $200 for our own touch-ups  for a revision rhinoplasty.  The industry standard is to charge for the operating room and anesthesia fee.

Hi Islandgirl17;

Most plastic surgery practices have a policy regarding "touch up" or revision rhinoplasty.  It may have been that that discussion took place, or you were given some written information about that, so I would definitely go back and check with you plastic surgeon's business office.  Ask to speak to the business manager. 

Don't forget, any cosmetic plastic surgeon wants to be proud of your results and to have you be a happy patient. 

Sometimes, as I am sure you understand, things just do not go well.  Even in the hands of the most specialized and experienced surgeons, sometimes Nature throws us a curve ball.  We know that some percentage of patients will need a touch up and are attune to addressing that issue with the patient, ideally, before the original procedure.  It is not too late to have a frank discussion with the doctor to ask what will be done and whether or not there will be a cost.  Sometimes the surgeon will charge a minimal amount.  Remember, there is also the issue of charges for the outpatient surgery center, doctor's office, or hospital, plus fees for an anesthesiologist.  Those are charged separately generally, or "rolled into" the overall fee.  But, that facility, and additional anesthesiologist's fees have to be considered if there is going to be another trip back to the operating room. 

Incidentally, it is best to go in with a positive attitude without being too accusatory.  It will make the discussion go much smoother. 

Robert Kotler, MD, FACS
Facial Plastic Surgeon
Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON
Author, THE ESSENTIAL COSMETIC SURGERY COMPANION

Every office operates differently.  You should check with your doctor's office.  Rhinoplasty is a very difficult operation that has a high dissatisfaction rate as opposed to other procedures, possibly because it is viewed all day long.  Usually a facility fee is required for revisions. 

Rhinoplasty is a complicated operation and there are always subtle differences in the nose. I cannot give you much of an opinion without photos, but small problems might be related to preexisting asymmetries or can be a result of the surgery.  Also, small surgical adjustments made during the nasal surgery can adversely affect other areas of the nose, and sometimes the surgeon must stop to prevent the creation of other problems with the procedure.

If this is related to your surgery - AND you are one year from the date of the procedure it is possible to have a revision and you should discuss this with your surgeon.  Many surgeons do offer a revision to their patients, but not all. Also, you need to have a physician who is skilled in revision surgery as this is one of the most complicated cosmetic operations we offer.  Problem scars are sometimes related to the surgery and sometimes the individual patient.  How you will heal is unpredictable.

Best of luck and be patient with your recovery.

Dear IslandGirl, I am sorry to hear that you are dissatisfied with your Rhinoplasty surgery. It is difficult to really have a good grasp on your exact problems without a physical examination or photograph. Correction of nostril asymmetry may require more then a "quick revision" Make sure you do not have revision rhinoplasty until all of the swelling is gone from your tip. This can take up to a full year for completely resolve. The ultimate goal in surgery is to have a happy patient and I personally would not charge for the secondary procedure. Best regards!