Am I Pushing It With A Fifth Time Rhinoplasty?

Question

I had rhinoplasty 17 yrs ago to remove a bump which went well. 10 yrs ago, I had surgery to reduce the ball, but it just made it bigger. A second attempt was even worse. The tip hung lower, hiding my nostrils. Another surgeon improved it later, but after a year, it dropped back again. Recently, a specialist advised that I need my turbinates reduced. I was considering getting this done but am I pushing it if I try to correct the look of my nose again? I am older, but dislike my nose even more.

Rian A. Maercks, MD · Answer

Your next surgery is classified as a 'tertiary rhinoplasty'  that is a rhinoplasty after two or more unsuccessful surgeries.  Very different techniques are necessary for success and you should choose a surgeon well versed in these cases.  My bias is to select a plastic and reconstructive surgeon with extensive reconstructive experience as that is what has given me the skills to deliver excellent tertiary rhinoplasty results.  In general, harvest of a small portion of rib is necessary and replacing the basic structural integrity of the nose with some variation of an 'L-strut' followed by customized tip and alar grafting is necessary.  In this way a truly aesthetically and functionally sound new nose is produced.  I hope this helps!

	All the best,

	Rian A. Maercks M.D.

William D. Losquadro, MD · Answer

As long as the skin envelope has not been damaged, revision rhinoplasty is often safe even with multiple previous surgeries. Difficulty breathing with a drooping tip may be due to nasal valve collapse, and turbinate reduction surgery alone may not be adequate. Revising a nose with multiple prior surgeries requires extensive grafting to ensure that the changes are permanent, and rib grafting is often necessary.

Thomas A. Lamperti, MD · Answer

If you don't like how your nose looks one could consider another revision. Some surgeons are more adept and comfortable doing these cases than other, so you should chose your surgeon wisely. It's hard to be specific without seeing your nose, though.

	As a separate issue, surgery on your turbinates won't affect your nasal appearance (and is no easier or more difficult having had prior rhinoplasty surgery) but can help with nasal breathing problems. With so many prior rhinoplasties your surgeon should make sure there haven't been structural changes to your nose that are leading to breathing problems.

Steven Wallach, MD · Answer

I think more than one or two revisions is pushing it. The more you do the more likely you will have problems. One of my former professors once told me that a patient that undergoes a a 2nd or 3rd rhinoplasty often needs a 4th or 5th and wishes that they were back to the 1st one.

Michael A. Jazayeri, MD · Answer

I have never been wrong with the motto THE ENEMY OF GOOD IS BETTER.

	Having the turbinates reduced will not affect the cosmetic appearance of your nose. Regarding the cosmetic rhinoplasty, the five surgeries you have had will make it very difficult to achieve a good result, mainly due to scarring and inability of the tissues to be manipulated.

Am I Pushing It With A Fifth Time Rhinoplasty?

Answers (5)