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In my practice, about 40% of the rhinoplasties I perform are revision rhinoplasty cases from patients
who had operations elsewhere by another surgeon. The most common thing these patients
say is they did not realize at the time of their first operation that not all plastic
surgeons specialize in rhinoplasty or facial surgery.
If your first surgeon specializes in whole body plastic surgery, chances are his/her
practice does not specialize in nose surgery. Rhinoplasty may not be the most common
procedure performed in their practice. Unfortunately, most people seeking revision surgery
realize this after a bad outcome.
If you are reading this page, you may already be in this group.
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Like any other cosmetic surgery, rhinoplasty is not an exact science and some irregularities
may appear after rhinoplasty surgery. Rhinoplasty surgery, as opposed to all other cosmetic surgeries, is
by far the most challenging surgery. No two noses are alike, each surgeon's sense of
aesthetics is different and the surgery is performed differently by each surgeon. Even
if the surgeon does everything within his power to do the operation as well as he can,
he cannot control how the body heals postoperatively.
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It may seem that nobody would want to have rhinoplasty surgery to start with. In reality, if
you have real expectations about plastic surgery, the majority of outcomes are positive and
most people will not require additional plastic surgery.
But let’s focus on the small percentage of patients who did not get the outcome
they wanted. How and why does this happen?
Patient expectations are very important. No one’s nose, or face for that matter,
is perfectly symmetric. Therefore, it is important to understand that minor asymmetries
are present prior rhinoplasty surgery, so asymmetries will be present afterward as well. Some
patients may not be able to accept minor imperfections after surgery because of the idea
that results after surgery should be “perfect.” Remember, there is no perfection
when it comes to surgery; it is merely an improvement. Your nose was not perfect before rhinoplasty surgery and will not be after either.
No plastic surgeon will get a perfect result. If your surgeon tells you that he never
performs revision rhinoplasty on his own patients because they all turn out great, say thank you
for the consultation and leave the office. All rhinoplasty surgeons at one time or another
must perform Revision Rhinoplasty surgery on their patients because rhinoplasty surgery and the postoperative
healing are not completely 100 % predictable processes.
The real question then becomes: What percentage of Revision Rhinoplasty surgery does each surgeon
perform in his own patients? And, what are the problems needing Revision Rhinoplasty surgery?
The acceptable rate, in my opinion, for patients requiring Revision Rhinoplasty should be
about 5%.
The type of problems requiring Revision Rhinoplasty surgery performed by each plastic surgeon is
also important. Not all revisions are the same. Revision Rhinoplasty surgeries in one doctor's practice
may imply coping with minor problems after healing. While in someone else's practice,
it may mean returning to correct plainly unacceptable results after the first surgery.
It is true that we cannot control all aspects of the surgery, but the way the surgery
is performed, the level of expertise of your plastic surgeon in the field of Revision Rhinoplasty,
the type of training and the number of nose surgeries he does will have a significant
influence in the outcome of the procedure. Stated simply: You cannot control all aspects
of the surgery and the healing accompanied with it, but you can control who you choose
to do your surgery. From all controllable aspects in rhinoplasty, choosing the right
plastic surgeon is probably the most important factor in achieving a desirable outcome.
So, should you have another surgery? Who should do your surgery? And when is it appropriate
to have it?
As discussed earlier, no plastic surgeon gets perfect results all the time. The first
issue you must address is whether the problem needing repair is minor or an unpredictable
result after the surgery was performed properly by your surgeon. If this is the case,
the first surgeon likely will be able to take care of it.
On the other hand, if the result of the first surgery is plainly unacceptable and you
just realized that your plastic surgeon's practice doesn’t really specialize in
rhinoplasty surgery, it is not in your best interest to have the
same surgeon correct the first surgery. Chances are your doctor is not equipped to perform
the revision surgery required. Just as he did not get it correct the first time, he/she
will not get it right the second time. In fact a bigger problem may be waiting for you.
Emotionally this is very difficult. You just invested energy, time and money on a procedure
that had an unacceptable outcome (assuming your expectations were realistic before and
after surgery).
The last thing you feel like doing is paying for another surgery. Having a second surgery
by the same surgeon to repair the problem at no charge now sounds very appealing. What
you do not realize is that you have a very high probability of having a second bad outcome.
A second bad outcome will result in even more emotional distress to you and more damage
to your nose, which will be even more difficult and expensive to repair.
It is hard to make the decision to pay someone else for a second surgery. But, before
you commit to revision surgery by the first surgeon, get a second opinion by someone
who specializes in rhinoplasty to weigh all options.
Timing of surgery is also very important. No further surgery should be performed
at least a year after the initial surgery. It really takes a year for your
nose to recover from surgery (longer if you had more than one operation).
Several months after surgery swelling may still bother you, and no treatment may be
needed. Conversely, problems that are not evident several months after surgery may only
be visible a year later when swelling fully subsides. I know it is very difficult emotionally
to wait for resolution of your concerns, but be patient.
During revision surgery, the surgeon usually encounters scar tissue inside the nose.
It is very difficult and time consuming to operate with scar tissue. Also during this
surgery, the surgeon typically must “undo” what the previous surgeon did
and then “redo” an entire operation. This is a reason revision rhinoplasty
will take up to four times as long as a primary nose surgery.
Here’s another thing to consider. In most revision surgery cases the nose’s
skeletal support has been overly weakened from excessive removal of cartilage and bone.
Thus, the support and breathing function must be rebuilt at the same time as the cosmetic
aspect is addressed.
If your first surgery was less than satisfactory, chances are that in the right hands
you will achieve a very good result with revision rhinoplasty. Just like with primary
rhinoplasty, you must have realistic expectations about what the surgeon can and cannot
do. Expect improvements, not perfection. Remember, during the second surgery your nose
may have large amounts of scar tissue that makes it more difficult to manage during surgery
and creates even less predictable results than the first time. Consequently, it is important
to have the surgery done by someone who specializes in revision surgery; someone who
is accustomed to dealing with scar tissue and who can maximize your chances of a good
outcome.
If you had a less-than-ideal outcome from your first procedure and you will require
further surgery, do not rush into it. You must be ready emotionally to deal with another
operation and another recovery period. As mentioned before, revision rhinoplasty involves
operating on scar tissue. Scar tissue will take even longer to heal as compared to normal
tissue. It may take your nose twice as long to recover from swelling as compared to your
first surgery. Because of the complexity of this surgery, revision rhinoplasty tends
to be expensive.
Committing yourself to a second surgery requires you be in the proper emotional state.
Make sure that you feel good and confident about the doctor you have chosen to perform
the surgery. Understand that the healing after surgery will be prolonged due to scar
tissue from the previous surgery. It usually requires more time to heal after a second
or third surgery.
The resolution of swelling associated with surgery is a continuous and slow process.
Your nose should look better after surgery, but it will not have its definition or desired
shape for many months. You must prepare yourself to accept small incremental improvements
on the appearance of your nose as the months go by, rather than expect to be fully healed
after several weeks.
Revision rhinoplasty is a highly skilled surgery and is very time consuming. It may
take two or three times the length of time required for a first-time surgery. These two
factors make rhinoplasty an expensive procedure.
Revision rhinoplasty can be done successfully if done properly. Make sure you choose
the right doctor, have realistic expectations and are emotionally ready to have another
surgery.
Make an appointment with Dr. Siegel to discuss your revision rhinoplasty needs by calling toll-free 1-866-920-3223 or using our Contact Form.
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