Why Are There So Many Revisions Needed After Rhinoplasties?

Question

It seems like many people are seeking revisions (sometimes more than one) after a Rhinoplasty? Is this based on the skill of the doctor. I had my nose done over 20 years and was never satisfied. I am planning on getting a non-surgical procedure. Doctors have said that this would be a good alternative for my case. This is still happening 20 years later. Some people have gone to top notch docs and still have gotten poor results.

Donald B. Yoo, MD, FACS · Answer

A recently published study put the revision rate at 17%, but you are right, the actual rate may be even higher than that.  Why is the rate so high?  One of the most common reasons may be a disconnect between the patient's expectations and vision and that of the surgeon's.  Most board-certified rhinoplasty surgeons have the intellectual and technical know-how to perform a rhinoplasty surgery.  However, unlike other surgery with concrete goals - like removing an appendix - rhinoplasty surgery is a complex interplay of what the patient desires, what is surgically attainable, and managing the patient's expectations.

	Beyond this the reasons are multifactorial, but to address the issue of patients going to top docs and still requiring revision.  1.  Healing after rhinoplasty can be unpredictable.  The nose may look perfect on the operating table, but as the skin shrinks down around the nose, funny things can happen  2.  Patients seeking improvement, not perfection, are the best candidates for rhinoplasty.  Perfection can not be achieved with rhinoplasty.  Subtle asymmetries and contour irregularities will always remain, and for individuals who seek to constantly correct these things there is no limit to the number of revisions that may be performed.

Oakley Smith, MD, FRCSC · Answer

This is a great question. The true revision rate is unknown. It is thought to be between 5 and 20%. It will vary of course between surgeons. This is why the most important thing a patient does is the selection of their surgeon. The reason for revision fall into 2 groups. First, the result is poor by any objective standard and everyone agrees, patient and doctor, something has to be done. This is probably the minority of revisions. Second, the result didn't meet the expectations of the patient, although the result is acceptable if it were reviewed by an objective observer. This is the majority of revisions. Although technically the surgeon has succeeded, it's still a failure as he/she didn't manage the patient's expectations pre-operatively.

Steven J. Pearlman, MD, FACS · Answer

There are a number of reasons why the number of revisions for rhinoplasties are higher than other procedures. First, the nose has many parts that need to all work in harmony to make an attractive functional nose. Modifying one part can affect all the rest. Rhinoplasty is often called the most difficult operation in cosmetic surgery: easy to perform but difficult to get consistantly good resuts. So for surgery or revision surgery you should seek out an expert. Even then, a few percent of patients might not have ideal results but the vast majority are improved and happy with their results.

Douglas J. Kibblewhite, MD · Answer

Good question.  Redo rates for rhinoplasty are at least 10% for even the most experienced surgeons.  The rates are higher in less experienced surgeons, but basically any time you have your nose operated on you will have a 10% or more chance of needing a redo procedure, usually fairly minor, but sometimes not.

	If you do go ahead and have a redo (second) procedure, your chance of needing a third procedure is, again, 10% or higher.  This is why you hear of multiple rhinoplasties in the same patient.  Once you have had three or four or more procedures, those procedures get technically more difficult to do, and the chance of success drops.

	Sometimes patients have unrealistic expectations, for sure, but the surgeon should be able to identify this to start off with and get things on a more realistic footing.

	And you can go to top notch docs and get less than ideal results.  Those top notch docs should be the ones who can openly and candidly discuss their results (10% or more redo rates) with you.

Steven Wallach, MD · Answer

Revision rhinoplasty is usually required in 5-15% of patients. It is probaly a combination of things including patient expectations and minor irregularities.

Francis R. Palmer, III, MD (retired) · Answer

I have performed Rhinoplasty and Revision Rhinoplasty for 25 yaers and IMHO this is due to the following issues:

	
		A lack of understanding of the proper aesthetics of nasal and facial beauty for the creation of a naturally more attractive nose and face...both on part of the Rhinoplasty Surgeon and the prospective patients.
	
		Unrealistic expectatuions on the part of Rhinoplasty patients who mistakingly believe that a perfect nose will make them more attractive by itself.  This sets up repeated Rhinoplasties in search of that perfect nose when perhaps Cheek Implants, Chin Implant or Lip Augmentation is what is really needed aestghetically.  
	
		The nose is inherently different than other areas of the face and body and tends to heal less well following repeated Rhinoplasty Surgeries.  There is also an aesthetic limit to how much aesthetic improvement a Rhinoplasty can achieve.


	 I believe that the purpose of a Rhinoplasty should always be the creation of a naturally more attractive nose which does not need to be perfect...just refined.  Once this is achieved, the more important aesthetic facial features like the Cheeks, Eye Area and Lips become noticed to a greater exetent.  Hope this helps.

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