re: Skin necrosis in revision rhinoplasty. skin is 'paper thin' per MD. My tip bossae showing through.

Revision rhinoplasty requires a very careful dissection which is made more difficult by scar tissue from.the previous surgery, and in difficult.case is best done by a surgeon with a great deal of experience.  Skin necrosis is a devastating complication that fortunately is very rare.  I would not proceed with the operation if the risk is that high, and seek another opinion.

Hi canuckgirl810That seems pretty high, but of course none of us have examined you.  The use of temporalis fascia is recommended in patients with thin skin, and use of cartilage from non-nasal sites is common.If you have more questions about risk, it is probably a good idea to multiple opinions from doctors in person.

All procedures carry a certain amount of risk. Revision rhinoplasty is no exception. An open revision rhinoplasty does have a higher risk of skin necrosis than a closed revision rhinoplasty, but because of the complex nature of your revision, it does sound like an open procedure may ultimately give you a better result. While I don't think the actual risk of skin necrosis is nearly as high as your surgeon is saying, I do think he or she is doing this on purpose. Skin necrosis, no matter how low the risk, is still a real possibility, and you need to know this before deciding on any kind of a revision procedure. My suggestion would be to make another appointment to visit your surgeon and specifically address this particular issue. My guess is that you will get a pretty good idea of how concerned he or she really is about this possibility, which should help you make the right decision. Good Luck.

 A closed rhinoplasty  should significantly reduce the risk of necrosis and the tip of the skin, since all of the incisions are placed inside the nose and not across the columella where the blood vessels which nourished nasal tip skin. A revision rhinoplasty is extremely difficult to perform correctly, so choose your rhinoplasty surgeon widely based on experience

I think that is a pretty high estimate. In general, revision cases are much more difficult and there is more scar tissue. There are very few times that I would say the risk of actual necrosis is that high. However, that surgeon has seen you in consultation and I have not. Best of luck

Dear canuckgirl810,

The reported incidence in skin necrosis in revision
rhinoplasty when one reviews peer reviewed literature is far less than 2%. However, each case of revision rhinoplasty is
assessed on its own merits and tissue liabilities. It may be that your previous rhinoplasties
have left your skin extremely thin and perhaps more predisposed to vascular
compromise. The operative rhinoplasty
surgeon you saw is in the best position to make this judgement. However, with any aesthetic procedure of the
face where there carries with it a 10% risk of significant devastating
complication like necrosis, I would likely not proceed with that procedure. You may benefit from seeking the
consultations of other very experienced secondary rhinoplasty surgeons such as
Dr. Peter Adamson, Dr. Conrad, Dr. Philip Solomon, Dr. Andres Gantous and
myself.

I was fortunate enough to train in both plastic surgery and
ear, nose, throat, head and neck oncology and have been performing primary and
secondary rhinoplasties for many years.
External approach rhinoplasty does carry it with at a higher risk of
vascular compromise than endonasal techniques, but in many secondary techniques
involving tip restructuring it is necessary.

I hope this information has been of some assistance and best
of luck.

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R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto