Rhino Revision- wait or do it now? (photos)

I am scheduled to have another rhino revision with the PS that operated in 2012 next week. I like him and feel in good hands. However, from my photos you can tell my nose is bowed/bent at the bridge and the tip is droopy. Help! I am 44 and have never liked my nose! What do I do? Wait and see the specialist or go ahead next week and try again with the PS here?

Doctor Answers 5

My advice is to check out your surgeon again before having the operation.

All I have to go on is your photos and the history that you presented, but here's what comes to mind:

You've had two operations. That means that the third will be extremely complex. You've always had a long-ish nose, and nobody's been able to shorten it enough to make you happy. Shortening a nose is not a trivial matter, even in a primary rhinoplasty. Only a very small percentage of plastic surgeons can perform a primary rhinoplasty with expertise and some level of reasonably predictable results, and a third-time operation is a hundred times harder yet. "Liking" your doctor isn't good enough. You don't want to be in the position of looking for a fourth operation.

See the "Web reference" link, just below my response, for a discussion of how to tell whether your surgeon should perform your next operation.

Also in the link, I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands. You need a significant elevation of the tip. The fact that there's an ear cartilage graft there makes it harder. You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.

Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.

Omaha Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Revision rhinoplasty procedure

Revision rhinoplasty is one of the most difficult procedures to perform correctly in the entire field of cosmetic surgery so make sure you find a specialist does lots of For best results. It is possible to straighten the nose  lift the tip.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 reviews

Surgeon for Revision Rhinoplasty

A Rhinoplasty  is one of the most challenging cosmetic operations that we do and a revision is frequently more difficult. I feel this surgery should always be done by a specialist. I cannot tell you who should do your operation but make sure that you have your surgeon show you multiple examples of good results in patients who had noses like yours. If you're having second thoughts get a second opinion from another rhinoplasty surgeon.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 37 reviews

Revision rhinoplasty

Hello.  A revision rhinoplasty is a challenging procedure, that requires experience in analyzing the problem and skills to fix these problems.  In addition, often times, once the surgery starts, there can be unexpected scarring, defects, or deficiencies in cartilage.  An experienced rhinoplasty surgeon will be able to adjust and perform techniques to achieve your goals.  To illustrate why this is challenging, any one goal (i.e. rotating the tip up), can be achieved with multiple techniques-some which may or may not work in a specific patient's situation.  Plastic surgeons are trained in cosmetic procedures of the entire body, but you should really look for a plastic surgeon with extensive experience in rhinoplasties.  Alternatively, facial plastic surgeons' training are focused exclusively on the face and tend to be more experienced in rhinoplasties.  Ultimately, you have to trust the surgeon you select.  Take care.

Kenneth Yu, MD
San Antonio Facial Plastic Surgeon
5.0 out of 5 stars 5 reviews

Considering Revision Rhinoplasty?

Thanks for your post and sharing your concerns about a second rhinoplasty surgery. From your photos it appears that you may benefit from a revision rhinoplasty to correct the droopy tip, nasal length, improve tip rotation and nasolabial angle, place a strut graft, reduce the cartilaginous dorsum in the supratip and perhaps improve the middle portion of your bridge with spreader grafts. Seeking additional professional opinions from a rhinoplasty specialist with experience in revision cases seems reasonable and may help confirm your decision to go ahead. Why "rush" into a second surgery if you're unsure? I would postpone your scheduled revision for now and request recommendations from other surgeons. You may find that after getting other opinions, you feel the most comfortable with your original plastic surgeon and have confidence that he/she can improve your nose as you wish. It sounds like further information and reassurance is what you need in order to proceed with another nasal surgery. Hope this answer helps. 

Fred J. Bressler, MD, FACS
Houston Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

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.