Rhinoplasty (nose surgery) is one of the top ten procedures performed around the world in plastic surgery for men and women. Due to the tremendous complexity of nasal anatomy, the many different components of bone and cartilage which overlap and interdigitate, and the potential unpredictable forces of healing and scar contractures, rhinoplasty surgery results are rarely perfect. Like all plastic surgery procedures, it carries with it the risk of undesired aesthetic outcomes and the possible need or desire for revisional surgery in the future.
Historically, high revision rates particularly if one looked at very long-term results existed in rhinoplasty when the closed approach was exclusively used. Due to the now widespread practice of open approaches in rhinoplasty in the past 15 years, I am certain that the need for revisional surgery in rhinoplasty has dropped. With better visualization of nasal anatomy, an improved focus on conservative bone and cartilage removal, and improved suturing techniques with or without the use of cartilage grafts, rhinoplasty outcomes have become more predictable.
However, despite these newer techniques, the potential risk of the need for revisional rhinoplasty is not eliminated. As a general rule, I do not like to undertake revisional rhinoplasty until 6 to 12 months after surgery. While this is much longer than most patients would like to wait, it is important that you are operating on a ‘stable target’. Meaning…let all the swelling and changes take place so you know what it really looks like. The initial problems that were seen may have become less of a visible or psychological concern or the problem may actually have gotten more noticeable or more of a concern. Either way, more time allows the decision for revisional rhinoplasty surgery to become self-evident. Unless it is a major problem that a patient simply can’t tolerate, I would prefer to be on the longer side of this issue, closer to one full year after surgery. The skin over the nose is also much softer at this point and the tissues are closer to normal in their handling, although they will never be completely unscarred and always more difficult to handle than the first time.
While the need for secondary rhinoplasty is probably around 10% or less in most plastic surgeon’s experiences, the need for ‘revision of a revision’, otherwise known as tertiary rhinoplasty, is probably much higher than 10%. Fixing a previous problem, particularly if it is not a very minor one, is not easy and esults are more unpredictable than when the rhinoplasty was first done.
Dr. Barry Eppley
Indianapolis, Indiana