How Many Times Can a Nose Take an Open Rhinoplasty with out Damaging the Skin?

        Provided that the nasal envelope has been properly dissected each time without thinning or devascularizing it, the surgery could be performed any number of times.  Kenneth Hughes, MD Los Angeles, CA                 

This is a great question -- and the answer is, "it depends." As others have implied, technique is very important. If the skin and soft tissue overlying the tip cartilages is dissected in the correct plane, healing is generally quicker and less scar tissue is created. This makes revision surgery easier, if needed. There is also a significant effect of the skin type of the patient -- patient's with thicker, oily or sebaceous skin may have more or more prolonged swelling, but also frequently have less visible incisions or scarring. Thinner skin can create problems with revision surgery, as any tiny imperfection in the cartilages below will show through.  In these cases, fascia grafts to help with camouflage in the tip can be a great option.

In general, the skin becomes a little thinner and more fibrosed after each surgery. If you start with a thicker, more sebaceous skin envelope, you can withstand more surgery.  Even if you have thin skin, very meticulous, careful surgery can be done successfully, but there is greated risk of skin damage or contour imperfections visible through the thinned skin.  If the skin is nearly translucent or turns purple or blue with cold exposure, it may be too compromised to safely undergo surgery.  All of these considerations are true whether it an open or closed approach.  If the skin is thin, there are measures during revision which can be taken to reduce risk, such as placement of fascia beneath the skin to provide greater bulk to the soft tissue covering.