When Can I Have a Revision Rhinoplasty? Should I Go Back to the Same Surgeon, or Find a Better One? (photo)

Question

I had a rhinoplasty, but my results were disappointing. My plan was to remove the hump, narrow the bridge/base, and refine the tip. I feel like the surgeon did a sloppy job on my nose: my nostrils are weird, the hump is still there on one side and kind of crooked. I know my nose wasn't that symmetrical to begin with, but this upsetting. Do you think I should trust him to fix it? I spoke to another surgeon and he said I can have a revision in 3 months, but is that too soon? How would you fix it?

Kevin M. Robertson, MD, FACS · Answer

Usually patients are encouraged to wait a full 12 months before revision, in order to get a complete interpretation of the end result.  However I have reoperated on some of my own noses at 6 mos post op if I know I won't be happy at 12 months, or if things are clearly worth revision.  From the looks of your pictures, you probably would want to wait, because the tip has yet to show the full potential of the surgery.  The bridge does have one side higher than the other, but that is an easy fix for revision.  Stay patient on that matter, and your potential revision plan will be more precise.

	As for your surgeon of choice, you need to follow your level of confidence.  Those of us who do a lot of rhinoplasty recognize that things don't always heal as we expect, and that nationally the revision rate is at least 5-10% of cases (some say up to 25%).  So revisions occur, and we have to address them from other surgeons as well as our own practice.  The key is to go with a surgeon that you trust.  The way to do that is get a couple of opinions, including that of your own surgeon.  It may turn out that your doc may be one of the best, but had one of those 5% outcomes, but stands behind their work to the point that you still trust him/her.  Most physicians don't recharge you for their own work (you will probably have to cover an OR and anesthesia fee).  

	If you don't trust your own doc anymore, find a rhino specialist.  There are lots of good surgeons in Atlanta.

Jamil Ahmad, MD · Answer

In the ideal circumstance, it makes most sense for a patient to have the original surgeon perform the revision surgery. For both the patient and surgeon, continuity in care and knowledge of what was done during the original surgery and what has transpired to date are intangibles. However, there are several other considerations. Is the original surgeon capable of performing the revision surgery. This depends on the complexity of the revision and the skill set and experience of the surgeon. You need to have a frank discussion with your surgeon. Another consideration is has there been a breakdown in the doctor-patient relationship-in particular has the patient lost confidence in the surgeon's ability? This is something that you need to answer. If you have lost confidence in your original surgeon, then you will have to do significant research to identify a surgeon that is adept at performing revision rhinoplasty. However, in most cases, it is best to wait at least a year prior to having revision rhinoplasty so that the swelling resolves in the nose and you are seeing what the final result is so that all deformities can be adequately addressed during revision surgery. Additionally, it takes about a year for scar tissue to mature and soften and revision surgery prior to this point can be technically difficult due to immature scar tissue. Having a revision by a different surgeon just 3 months after your original surgery sounds premature.

Jonathan Kulbersh, MD · Answer

Sorry to hear you are not satisfied with your result following surgery. Your nose will change over time as you heal. How long ago did you have your surgery? It can take up to a full year before your final result is visible. There are a few things which can influence your swelling:

	1) Whether the procedure was primary or revision
	2) Thickness of your skin
	3) Whether or not there was tip work performed

	I would not recommend having a revision after 3 months. Normally, you should wait up to a year before considering any revision work, but a revision can be performed sooner if there is no tip work involved (but not as soon as 3 months). Good communication and trust should be established prior to having surgery. If you are not happy with the plan your surgeon outlines for a revision if it is necessary, I would recommend seeking another opinion. It is difficult to determine exactly how this would be fixed without more info on your exact goals for additional surgery and details on what was performed during your initial surgery. I hope this helps and good luck!

Raffy Karamanoukian, MD, FACS · Answer

The nose will change after rhinoplasty. Although some cases such as yours will need to be addressed within the coming one year, it is always more prudent to wait the full course of one year before proceeding.

Mark Beaty, MD · Answer

I advise my patients that there may be asymmetries due to swelling for as long as 12 months following rhinoplasty. It sounds like your surgery was quite recent so I would recommend patience as some of the issues you see may improve with time. I would express your concerns to your surgeon, if you do not feel confident with them I would then seek an opinion with a surgeon experienced in revision rhinoplasty.

Nima Shemirani, MD · Answer

Dear who.nose.asia,

	
		It sounds like it is still early and you have some healing to do
	
		I would wait at least 6 months if this is your first rhinoplasty before doing anything because the nose will continue to change until then
	
		Once the nose stops changing, you can address any residual problems with a surgery
	
		As far as who you should go with...your original surgeon is probably going to be a lot less expensive
	
		In the end you should go to someone who you are comfortable with and trust


	Best regards,

	Nima Shemirani

When Can I Have a Revision Rhinoplasty? Should I Go Back to the Same Surgeon, or Find a Better One? (photo)

Answers (9)