Will a revision taking 4.5 hours & more result in more years of swelling & recovery?

The length of the procedure does not correlate to swelling / recovery time, especially in the case of a revision rhinoplasty. The reason a revision takes much long is because we have to dissect through scar tissue without injuring the cartilage that remains, uncover a new anatomy that was created by the prior surgery, and reconstruct deformed / damaged / missing cartilage with grafts. The length of this is going to differ in every case, and can even be more than 4.5 hours in some cases. Most of the revisions that I see require a significant amount of work, even when it may not look like from the outside. This is because many of the issues that we see in revisions are the result of faster, short-cut, generic techniques that destabilize the cartilaginous shape of the nose. I also see many 2nd, 3rd, 4th ... revisions after other "faster" bandaid revisions have failed. Think of rhinoplasty as fine jewelry making. Are you going to get a better product from a quick mass produced job, or a meticulous one that takes as much time as necessary to get it done right?It also doesn't mean that a longer procedure means you're going to get a good result. You cannot use any one factor when choosing a rhinoplasty surgeon, especially for a revision. Consider their level of expertise, what they tell you during the consultation, how much care you think they'll put into your surgery. Kenalog injections are determined on a case by case basis depending on the progression of healing. They may be done as early as 1 week in some case but most are between weeks 2 and 4 for the first injection. Pregnancy will lead to increased swelling, as it does even without surgery. The post-surgical nose is of course even more sensitive to these changes, but it should not have an effect on the actual cartilaginous structure of the nose. You can try red light therapy to promote healing after surgery. I ask patients to AVOID facials and other skin treatments of the nasal skin for at least 6 weeks after surgery. Again, everything has to be taken on a case by case basis. Go to several consults, not just one. Compare the responses and education you receive at each consult. This will help you make a well informed decision. Good luck!

Hello and thank you for your question. 4.5 hours is definitely on the long side for this type of surgery. However, more so than just the time that your surgeon takes in surgery, it is much more important that you find the right surgeon. Here is a general advice when seeking a surgeon for a revision: I highly recommend that my patients focus much more on real longterm before and after photographs rather than 3D imaging.   I encounter so many patients in my practice who see me for revision rhinoplasty who previously had surgery elsewhere who feel like they were mislead into surgery by surgeons who relied heavily on 3D imaging without adequate real before and after pictures to back it up. Photoshop is easy but real surgery is very different.

I always recommend that you carefully evaluate your surgeon’s online before and after gallery on their website for both quality and quantity of results. Make sure that there are hundreds of real before and after pictures which demonstrate long-term follow up results. If your surgeon is posting mostly on table results without real long-term follow up results, that is usually a major red flag. If a surgeon is posting mostly just splint removal day videos without longterm follow-up pictures, that can also be a red flag. Long-term results are much more meaningful than on table results or 1 week post-op results. . I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

The length of time it takes to perform the procedure is irrelevant with regards to the amount of swelling it takes to heal over the first year or two. The maneuvers performed during the rhinoplasty procedure, and the thickness of the skin will determine how much swelling occurs. In our practice, we use steroid shots to reduce the amount of swelling in the nasal tip in the first several months after the procedure