Why Revision Rhinoplasty is More Difficult than Primary Rhinoplasty

Rhinoplasty accounts for over 210,000 surgeries every year. Though most rhinoplasty surgeries provide satisfactory results, about 15% of these patients end up getting revision rhinoplasty. That means that every year, more than 30,000 people choose a second rhinoplasty because the first one wasn’t done to their liking.

A significant procedure in itself, rhinoplasty involves the modification of nasal cartilage and bones, with tissue being added or taken away. This is tricky the first time – but once the original nasal structure has been modified, it becomes more difficult to safely and accurately provide outstanding aesthetic and functional results.

Here, the expert team at Plastic Surgery Services of Fredericksburg explains the importance of getting rhinoplasty done correctly the first time, and why revision rhinoplasty is more complicated than primary rhinoplasty.

Why Might Patients want revision Rhinoplasty?

Patients who seek revision rhinoplasty often do so on the basis of being unhappy with the results from the first operation. This can be because of aesthetic or functional problems. 

  • Their new nose looks unnatural
  • Their new nose is not in balance and harmony with their other facial features
  • The results of their new nose are not as pronounced as they would have liked
  • It is difficult to inhale and exhale through their new nose
  • Their new nose either didn’t adequately address their snoring or has caused them to snore 

In some cases, accidents such as falls or motor vehicle collisions can damage a rhinoplasty-d nose, which necessitates revision rhinoplasty. 

In any case, regardless of the motivation driving the revision rhinoplasty, it is a more laborious surgery than the initial procedure for several reasons.

Compromised Structural Integrity

Once the cartilage and bones of the nose have been modified in a primary rhinoplasty (the first rhinoplasty procedure), their relative strength and integrity can become weakened. Surgeons usually require extra cartilage from other parts of the body to reinforce the region during revision surgery. 

In primary rhinoplasties, surgeons use cartilage from the septum to reinforce the structure of the nose. Septal cartilage is ideal for this purpose due to its pliability and relative strength. 

In revision rhinoplasty, the septal cartilage is no longer available, requiring the surgeon to harvest cartilage from other parts of the body, such as the ear or ribs. Recently, we have used MTF cartilage grafts (cadaver cartilage) with great success. This eliminates morbidity from having a secondary donor site. While effective in providing structural support, cartilage from the ear and rib is far harder to manipulate than septal cartilage, and it takes more skill and experience for your surgeon to use this cartilage successfully in revision rhinoplasty.   

Scar Tissue

Scarring from the initial rhinoplasty procedure is one of the biggest challenges faced by revision rhinoplasty surgeons. How this impacts the second procedure depends on the extent of scarring, but there is always internal scar tissue from primary rhinoplasty. 

The more scar tissue there is surrounding the nasal passage and bones, the longer and harder the revision rhinoplasty procedure becomes. The revision rhinoplasty surgeon must make very precise incisions to change the aesthetic of the nose, without further contributing to additional scarring. 

Scarring dramatically impacts the way in which the nose heals and settles after the procedure, and patterns can be unpredictable if the surgeon performing the revision rhinoplasty is not experienced or careful enough during the procedure.  

Unforeseen Complications

When performing primary rhinoplasty, surgeons know what to expect – they know the structure of a human nose and can plan their operation accordingly. 

In the case of revision rhinoplasty, surgeons might have a rough idea of what their patients’ internal nasal structure and cavities will look like, but because they are operating on a modified body part, they can’t be 100% sure what to expect. This requires split-second decision making and experience to provide the best possible results from revision rhinoplasty. 

Because of these complications, the vast majority of board-certified surgeons don’t offer revision rhinoplasty. It’s not worth their reputation – the procedure is complicated, and many surgeons can’t get it right. This is why it is so important to choose the right surgeon for your primary rhinoplasty. 

If, however, you are seeking revision rhinoplasty, the expert board of doctors at Plastic Surgery Services of Fredericksburg, composed of Dr. Howard Heppe, MD, Harold Bautista, MD and Pejman Aflaki, MD, have each handled a wide range of rhinoplasty challenges on patients of all ages and ethnicities. Call 540 371 7730 or fill out our online form to arrange your consultation and fix your nose properly.

Unhappy with Your Rhinoplasty? Revision Rhinoplasty Explained

In an ideal world, every surgery would turn out exactly as expected. Unfortunately, when it comes to rhinoplasty, a number of variables exist that are beyond even the most skilled surgeon’s control. Most notably, the way scar tissue contracts can differ substantially from person to person, and this can make it difficult to predict the results of rhinoplasty with 100 percent accuracy. Fortunately, if you’re not happy with your rhinoplasty (or you develop breathing problems after having a rhinoplasty), you can have what is known as a “revision rhinoplasty.” During this procedure, structural and/or cosmetic issues created by your prior rhinoplasty will be corrected. Here’s what you need to know before you book a consultation:

5 Things to Consider Before Having a Revision Rhinoplasty

1. You will need to let your initial rhinoplasty heal completely before having revision surgery.

Before you decide to have revision rhinoplasty surgery, you should be aware that it takes a long time for the results of rhinoplasty surgery to “settle.” It can take up to one full year for your nose cartilage to completely heal, and before that occurs, your rhinoplasty may not look as good as you hoped it would. Waiting until your nose surgery has healed will help you determine whether or not you actually need revision surgery.

Furthermore, operating on the nose too soon after rhinoplasty can cause damage to the delicate structural tissues within the nose. You must wait until your nose is strong enough to handle a second round of surgery before proceeding with a revision rhinoplasty.

2. You should choose the most experienced and skilled surgeon you can find when having this procedure.

Revision rhinoplasty is much more complicated than initial rhinoplasty surgery. Revision rhinoplasties often need to be performed as “open” surgeries. This means that the surgeon will need to make additional incisions around the nose and lift some of the nasal tissue in order to make the desired alterations. As such, finding a highly skilled surgeon who is deeply familiar with advanced surgical techniques is of paramount importance. Take the time to verify your chosen surgeon’s credentials and make sure he or she has performed successful revision rhinoplasties in the past.

3. You’ll probably need to take more time off work in order to recover from revision rhinoplasty surgery.

Many patients feel better about one week after having revision rhinoplasty surgery. However, the initial stages of recovery from this procedure sometimes last as long as two weeks because of the more invasive nature of this operation. It’s therefore a good idea to err on the side of caution and plan to take at least two weeks off work.

4. There’s a limit to how many revision rhinoplasties you can have.

The tissue of the nose gets progressively more fragile with each subsequent rhinoplasty operation, so you won’t be able to have a succession of revisions until you are 100 percent satisfied with the appearance of your nose. It usually is not possible to have more than two revision rhinoplasties without risking serious damage to the nose.

The best way to make sure that you will be satisfied with the results of your surgery is to choose a skilled surgeon and develop realistic expectations. It’s important to realize that while rhinoplasty surgery can make your nose much more photogenic and proportional, it cannot give you a nose that is completely different to the one you were born with. Plastic surgeons cannot, for example, make a very large hooked nose into a tiny button nose. They must work with the structural tissues that are already in place while making changes to the shape of your nose.

5. You will need to budget for the additional cost of this surgery.

The complex nature of revision rhinoplasty surgery adds substantially to its price tag. As such, you will probably need to research what kind of financing options are offered by your chosen plastic surgery practice before proceeding with this operation. (Note that we can arrange financing through Care Credit in order to help you afford complicated surgeries like revision rhinoplasty.) You may also be eligible for assistance from your insurance company if you are having trouble breathing due to your initial rhinoplasty.

Having revision rhinoplasty surgery can improve the functionality and appearance of your nose, but only if you choose your surgeon carefully. Selecting a surgeon with decades of experience, such as PSSF’s board-certified surgeons, is strongly advised when considering this type of procedure.