Revision Rhinoplasty: When and Why?

Revision rhinoplasty is a procedure done to correct a cosmetic concern or breathing problem resulting from a previous rhinoplasty. It is a second, reconstructive surgery to improve on the work of the first. Revision rhinoplasty may be an option in cases where the patient feels strongly that the initial surgery did not live up to pre-op expectations.

It is important to remember that problems leading to revision surgery can arise in any patient and with any surgeon, even the most experienced hand. However, the risk of revision rises in cases where the procedure is performed by inexperienced or “occasional” rhinoplasty surgeons. Overall, revision rhinoplasty is reported to occur at a rate of about 5 to 18 percent, whether the patient returns to the same surgeon or seeks out a new one.

That said, do not rush into a revision. Remember to give your nose time to heal before seeking a second surgery. Revision rhinoplasty is a complex and painstaking procedure: The surgeon must work through and around scar tissue and nasal structure changes created by the first procedure. This is a more intricate and time-consuming process, and it demands additional skill, patience, and specialized training on the surgeon’s part.

There are reasons, both subjective and objective, that people consider revision rhinoplasty.

• *You may simply not like the way your nose looks. This is a legitimate concern, but it’s also important to recognize that some people with good results will press further, seeking an elusive idea of perfection. In the process they risk undoing good work and ultimately making surgical worse. These types of revisions should only be considered with experienced surgeons with whom your sense of aesthetic taste is a good match. Set realistic expectations for surgery.
• You may be having difficulty breathing, in which case a consultation with an ear, nose, and throat doctor can help you determine the cause and decide a course of treatment. Revision rhinoplasty may be a viable treatment. The most common airway problem resulting from an initial rhinoplasty is collapse or narrowing of the lower third of the bridge or nasal valve area. Generally, this complication can be avoided by steps taken to maintain an appropriate amount of width and strength in the cartilages responsible for holding the nose open during surgery.
• You may be experiencing a visible shift, dent or collapse of nasal cartilage. If you had an implant or cartilage graft, it is possible for it to shift, causing a lumpy and unattractive look. Unintended problems or deformities masked by post-op swelling may become apparent later on in the healing process.

These issues, as well as the breathing problems mentioned above, can be the result of poor surgical technique, or poor planning and judgment on the part of a rushed or inexperienced surgeon. Reconstructive surgery in these cases often calls for grafting: the movement of cartilage from other areas to strengthen or rebuild skeletal nasal structures weakened or removed by preceding operations.

But every nose is unique and requires a unique combination of reconstructive techniques, and unforeseen issues can sometimes arise even when every precaution has been taken. When choosing a surgeon for a revision rhinoplasty, the important considerations are your trust for the surgeon, the surgeon’s experience with revision surgery and, most importantly, establishment of realistic goals for both patient and surgeon.

Dr. Jeffrey Epstein is a double board certified facial plastic surgeon with an expertise in rhinoplasty and revision rhinoplasty. To learn what the best course of action is moving forward for your particular case, contact one of his offices for a consultation. In Miami, call (305) 666-5884, and in New York, call (212) 759-3484.