Considering Revision Rhinoplasty? Here’s What You Need To Know

In a perfect world, every plastic surgery patient would be thrilled with the outcome of their procedure. In reality, there are an array of both functional and aesthetic reasons why someone may not be completely satisfied with the results. This is especially true of rhinoplasty and surgical alterations for the nose.

Just like there are many reasons why a patient might decide to get a nose job, there are numerous ways to perform rhinoplasty. Due to the complex nature of the procedure, it might not always go as planned. “It is not surprising then that people seeking revisions of their initial rhinoplasty is quite common,” explains Andrew Frankel, MD, a Beverly Hills-based double board certified facial plastic and reconstructive surgeon. “Although the rate of patients who seek out revisions is not published, it is generally accepted that it is around 20 to 25 percent.”

To better understand why a patient might want or need a revision rhinoplasty, we’ve talked to two specialists about the ins and outs of the procedure.

What Is Revision Rhinoplasty?

As its name suggests, revision rhinoplasty (a.k.a. secondary rhinoplasty) is a corrective surgery that aims to address the function and/or appearance of a nose that has already been operated on. “Revision rhinoplasty is the most difficult of all plastic surgical operations,” Dr. Frankel says.

One such reason is because of how rhinoplasty techniques have evolved over time. “Older rhinoplasties were reductive where a lot of cartilage was removed, which decreases support,” explains Jason Roostaeian, MD, a board certified plastic and reconstructive surgeon at UCLA. “This created less support and can create asymmetry in the shape of the nose.” Another issue? “The procedure used to be very cookie-cutter and may not look natural on all face shapes and sizes,” he says.

Since revision rhinoplasty requires revisiting a wound created by a previous procedure, there are several factors a plastic surgeon must consider before operating:

• Scar Tissue: “There is often a great deal of scar tissue present that has distorted the underlying delicate anatomy to the point of being unrecognizable — if it is not missing entirely,” Dr. Frankel says.
• What Lies Beneath: “Once the anatomy has been uncovered, it needs to be reshaped and there might not be any cartilage left to do this,” he explains. In such cases, grafting is required, but grafted tissues “are not necessarily ideal for the needs each case warrants.”
• Skin Condition: Past scarring can impact the skin, too. “The internal lining and skin might be too scarred and may not be able to stretch and re-drape over the structure that cannot be replaced,” Dr. Frankel says.
• Functionality: Needless to say, the nose still needs to function, too. “The airway must always be considered and maintained, which can be challenging in patients who still want a smaller nose but who need additional structure,” he notes.

To restructure the external shape and internal workings in alignment with the patient’s desires, a precise and individualized procedure plan is needed.

Why Patients May Seek Revision Rhinoplasty

When consulting with new patients, plastic surgeons emphasize that results can take six months to a year (or more) to be fully realized. Rhinoplasty falls into the ‘year or more’ category. But what if you still don’t like the outcome? Or what if there is an underlying complication? These are just a few of the reasons patients may seek a revision rhinoplasty:

• Complications: “Rhinoplasty is a delicate and complicated operation and is fraught with potential for asymmetries, irregularities, prolonged swelling and functional problems such as difficulty breathing and runny nose,” Dr. Frankel explains. The anatomy may not heal the way it intended to, which can be an issue moving forward.
• Aesthetic Goals: For some, a change in taste may lead to revision — especially if a patient underwent the procedure as an adolescent. “The outcome is highly subjective, and, in our current society, the expectations of patients are increasing due to social media and the idealized versions that they are comparing themselves to,” Dr. Frankel says.
• Past Experience: “The patients who are in search of a revision specialist are often fragile due to having prior bad experiences,” he shares. “This makes them wearier with greater scrutiny on every detail.” A previous negative outcome should not deter a patient from seeking out a highly skilled, board certified provider.
• Innovations: In the rhinoplasty world, there have been updates to technique and strategy, which may lead some to feel that a secondary experience could yield a more favorable outcome.

All of these are valid reasons for a patient to consider a revision surgery, though consulting with a board certified plastic surgeon is the best way to determine if you could be a candidate.

The Right Candidate For Revision Rhinoplasty

Revision rhinoplasty isn’t just about a second procedure. In some cases, patients have already undergone multiple surgeries. “Revisions make up about 30 percent of my practice,” Dr. Roostaeian shares, adding that he has consulted with patients who have had seven or eight previous corrective procedures. Neither of our experts has a specific number of past surgeries that will count a patient out of future work. Instead, they examine the physical state of the nose and the patient's health. Smoking, lifestyle, expectations, and, of course, the internal damage from past surgeries will all factor into a candidate's prospects.

What To Do If You’re Interested in Revision Rhinoplasty

You know you’re not happy with the results of your rhinoplasty, but what comes next? Arriving at the decision to undergo a revision may require even more thorough research and vetting than any of your previous procedures. Here are seven things to think about before going under the knife again:

1. Consider The Timing

“There is no specific amount of time any patient must or should wait before having a corrective surgery,” Dr. Frankel says. “This depends on the type of problem.” In fact, you might not even want to wait until the previous procedure is fully healed. “For example, patients who have a bump or irregularity on their dorsum two months following their operation or those who feel their nose is too short are better off having their revision sooner than later because the wound contraction will only make matters worse over time,” he explains. In other cases, patience is necessary. “If the issue is that the nose still looks too wide or big, time will often work in that patient's favor,” he notes. “Things might improve to the point where further surgery is not necessary.” Depending on where you are in the healing process, a conversation with your surgeon can shed some light on what to expect.

2. Do Your Research

A revision rhinoplasty requires a highly skilled aesthetic surgeon to address the issue at hand and will likely cost more than the first rhinoplasty. “Meet with at least two surgeons and try to determine if you are a good fit,” Dr. Frankel encourages. Consider whether or not the provider communicates well, has presented a clear plan, and is upfront about any potential limitations. Another suggestion? Ask to see lots of before and after images from each prospective surgeon, Dr. Roostaeian recommends. At that point, you should be able to assess the risk and determine what is best for your needs and goals.

3. Check Your Medical History

If you find a new provider for your revision rhinoplasty, make sure they have all the necessary details about your previous surgery. There are several types of rhinoplasty that a surgeon can perform and, because rhinoplasties of the past were often reductive, Dr. Roostaeian says having this information is advantageous to the new provider. Those who underwent rhinoplasty after an accident or traumatic event should also disclose this information.

4. Know Your Concern

Be as specific as possible when consulting with providers for revision rhinoplasty. “Mentally, know what shape, size, and changes you want and verbalize it,” Dr. Roostaeian says. “The more specific you are, the more it helps us.” As he explains, being able to clearly articulate what’s bothering you will allow your surgeon to better understand what they need to do. “We want to be goal-oriented when we operate, so you shouldn’t be ambiguous,” he notes.

5. Understand the Risks

There is risk involved with any surgery, and that’s even more so the case with revision procedures. It’s important to recognize that creating further trauma in the nasal area will leave behind additional scar tissue, and the cumulative scarring may make it difficult to achieve the results a patient desires. There is the added risk of complication as well.

6. Know When to Walk Away

Depending on the patient’s history, an experienced surgeon will not sugar coat the truth if a patient’s health will not allow for further revision. “I once consulted with a woman who’d undergone 34 prior rhinoplasties. Her skin was in jeopardy of necrosing altogether, so that was the deal breaker,” Dr. Frankel recalls. And it’s not just about physical health. Mental wellbeing must also be taken into account. “The operation becomes more technically challenging with each successive attempt and patients become more and more frustrated or depressed, so there is much to consider,” he says.

7. Plan For Recovery

Since revision patients have already undergone at least one rhinoplasty, they know what to expect from the recovery process. Generally speaking, healing from the revision will be a familiar experience. With that said, it’s important to follow any pre- or post-op care instructions laid out by your surgeon for best results.

The Takeaway

Those who are unhappy with the results of a previous rhinoplasty may be good candidates for revision rhinoplasty, but it should be approached with careful consideration and realistic expectations. “There are an infinite number of ways that a nose can become disfigured after a poorly performed rhinoplasty, and there is an unlimited number of nuanced techniques for handling them,” Dr. Frankel concludes. “It comes down to the artistry and creativity of the revision specialist and their commitment to rendering the best possible outcome.”