Revision rhinoplasty, also referred to as secondary rhinoplasty, is in essence surgery to correct a previous rhinoplasty — most often a nose job done by another surgeon. A combination of cosmetic and reconstructive surgery, revision rhinoplasty is one of the most delicate and demanding of all cosmetic surgery procedures.
A small but significant minority of first-time rhinoplasty patients — between 5 and 18 percent, according to industry estimates — will undergo revision.The reasons for doing so can be numerous and overlapping. In Dr. Naderi’s experience, they come down to four categories.
Poor Patient-Doctor Communication
If you don’t do computer imaging beforehand, and you really don’t know what a facial plastic surgeon has in mind for you, when the cast comes off the result may be a complete surprise. It could be a welcome surprise, or something else entirely. Even a beautiful nose may not be the nose you wanted. Clear, honest dialogue prior to any cosmetic procedure is crucial.
Bad Surgical Decision-making and Technique
Most plastic surgeons that operate on the nose —about 70 to 80 percent —don’t understand nasal anatomy as well as they do other areas of the face and body. The nose is a complicated, three-dimensional structure that’s unlike any other focus of plastic surgery, facial or otherwise. There’s no other operation in cosmetic surgery where fractions of millimeters make a big difference in the outcome. There’s no other operation where your results change at a week, at a month, at a year and longer —even five to 10 years out.
Doing rhinoplasties correctly, in a way that reduces the likelihood of a revision, takes intensive training, dedication and practice.
Rhinoplasty and revision rhinoplasty together account for 90 percent of Dr. Naderi’s practice. Some of Washington D.C.’s top plastic surgeons won’t touch noses, and will instead refer their patients to Dr. Naderi, who is widely recognized as a rhinoplasty specialist.
You can’t fully predict how the nose will heal. A surgeon does the best job he or she can in the initial procedure, and then, over time, scar tissue, healing and nature all take their course.
A picture-perfect nose job may, five years later, develop a small oddity or unwanted feature that resulted from how the nose healed, and which will therefore require revision.
It may be a fairly quick revision —an outpatient procedure lasting five to 10 minutes, versus the 90 minutes to two hours the patient spent undergoing the first surgery. But in about five percent of all rhinoplasties, these small lapses or setbacks related to healing occur. A revision can restore a nose job to its original good form, and even improve on the first procedure.
Some patients will just never be satisfied with their noses. They may have had four, six, eight or 10rhinoplasties while seeking that perfect nose that just doesn’t exist.
Those patients have to be identified in pre-screening and consultation. Unfortunately, it’s too easy for surgeons to say, “Sure, we’ll do something,” take the money, perform another surgery and then punt that patient off to the next surgeon. At some point, the responsible surgeon has to stop and educate the patient and encourage him or her to reconsider.
Dr. Naderi has spent entire consultations trying to talk a patient out of plastic surgery. And about 20 to 25 percent of prospective patients, he will turn down. Not because their noses are complex —all noses are complex —but because it’s clear those patients are not psychologically ready for what a surgeon can realistically offer.
To learn more about revision rhinoplasty and other cosmetic and plastic surgery procedures, please contact the Naderi Center at (703) 481-0002 in Virginia or (301) 222-2020 in Maryland for a consultation today.