Why Are There So Many Revisions Needed After Rhinoplasties?

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.  

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.

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.