Revision Rhinoplasty

Revision Rhinoplasty Surgery: The Second Time Around

Reviewed by Andrew Jacono, MD

So, you've had a nose job and it didn't turn out exactly the way you planned. You're disappointed that your problem wasn't corrected, or maybe a new one developed. Revision rhinoplasty may be an option worth considering if you want to further refine the way your nose looks or if you're having functional issues like breathing problems after primary rhinoplasty.

You're not alone. Rhinoplasty has one of the highest revision rates of all cosmetic surgery procedures. It's estimated that between 15 and 20 percent of people who have had a primary nose job opt for revision nose surgery at some point.

One important note before considering revision rhinoplasty: Give yourself and your nose some time. Most surgeons recommend waiting at least a year before deciding on a revision rhinoplasty. It can take that long for your new nose to emerge from all the nasal swelling associated with nose surgery and for the scar tissue to soften enough to be operated on. Attempting a rhinoplasty revision before these issues are resolved is a recipe for disaster.

Reasons for Revision Rhinoplasty

The two main reasons people choose revision rhinoplasty are dissatisfaction with the way their nose looks and dissatisfaction with the way it functions. The goal of revision surgery, therefore, is to restore structure and/or function.

People who are dissatisfied with the appearance of their nose following primary rhinoplasty may feel the overall effect is either too subtle or too dramatic. They may also think their results are asymmetrical, or uneven, usually due to postoperative scarring inside the nose or other healing abnormalities. Other issues include a bump or callous on the dorsum (the ridge above the tip of the nose), a twisted tip, "parrot beak" (hump on the bridge of the nose), a pinched tip or an "inverted V" that occurs when the middle vault of the nose collapses inward, all of which may have been caused by the primary rhinoplasty.

Sometimes there's no overarching reason for dissatisfaction. It could be that you were satisfied with your initial results, but over time your nose has changed subtly. Or it could be that your expectations were unrealistic, that you didn't clearly communicate your goals to your surgeon, or that complications occurred during the healing process that affected the final outcome.

A small percentage of those individuals who seek revision rhinoplasty may suffer from a mental health condition known as body dysmorphic disorder (BDD). This condition is defined as preoccupation with an imagined or slight physical flaw that causes significant stress and interferes with a person's life and interpersonal relationships. No amount of reassurance from family, friends, or medical professionals will convince a person suffering from BDD that their appearance is normal because they are convinced that their problems are surgical, not emotional. BDD is a psychological problem; treatment does not involve more surgery.

Function is another major factor in rhinoplasty revision. No matter how much you may like or dislike the way your nose looks on the outside, if it isn't working properly on the inside, there's a problem. Obstructions of the airway can cause difficulty breathing that is sometimes accompanied by a whistling noise. If this is the case, revision rhinoplasty can help.

Deciding on Secondary Nose Surgery: Is it Worth it?

Whatever the problem, it's important to carefully weigh it against revision rhinoplasty risk. It's also important that you consider the recovery time, any uncertainty you may have, and the expense of undergoing another surgery on your nose. Revision rhinoplasty can be more complicated, time consuming and expensive than a primary rhinoplasty, and the outcome is not guaranteed.

Factors that should be addressed when considering revision rhinoplasty include:

  • The nature of the revisions
  • Your expectations
  • Who will perform the revision – your original surgeon or a different surgeon who specializes in revision rhinoplasty
  • Revision rhinoplasty cost

Choosing a Revision Rhinoplasty Surgeon

Revision rhinoplasty is a highly specialized procedure, considered by many to be the most complicated of all cosmetic surgeries. That's why it's important to choose your surgeon wisely. Ask around. Request a referral from a physician or surgeon that you trust. Talk to friends or relatives who've undergone revision rhinoplasty and find out if they would recommend their surgeon. Local medical societies may also be able to help.

As you begin your search for a revision rhinoplasty surgeon, focus first on those who are board certified in facial plastic surgery or plastic surgery by the American Board of Facial Plastic and Reconstructive Surgery or American Board of Plastic Surgery, respectively. Surgeons in both categories completed residencies in otolaryngology or general surgery, and fellowships in facial plastic surgery or plastic surgery. Their education and medical experience, along with their commitment to staying on top of the latest developments and techniques in the field of cosmetic plastic surgery, make them your best bet for an optimal outcome.

Your next step should be to look at surgeons whose practices focus specifically on revision rhinoplasty and who have the specialized skill set necessary to perform this challenging procedure. Ask the surgeon how many revision rhinoplasties he or she performs on average each year; a number between 50 and 100 is a good indication that the surgeon is experienced in this specialty.

Ask to see rhinoplasty before and after pictures of patients who have undergone a revision rhinoplasty similar to the one you are seeking. Then, go a step further and ask the surgeon if you can talk to any of those patients for their feedback on the surgeon, the procedure and the revision rhinoplasty recovery process.

The Revision Rhinoplasty Consultation

Know upfront that revision rhinoplasty surgery is generally more complicated and takes longer than primary rhinoplasty surgery, which means it's also more expensive. If your primary surgeon is performing the revision because of a complication from the original surgery, he or she may foot part or all of the bill. The cost of revision rhinoplasty is seldom covered by medical insurance unless it is performed to correct a functional issue, so be ready to pay as you go.

Revision rhinoplasty is a customized procedure, just like primary rhinoplasty. The approach is as unique as the individual who is undergoing the procedure.

Revision rhinoplasty can be performed under local anesthesia with sedation or under general anesthesia, depending on the circumstances. The latter is common, since revision rhinoplasty can take up to twice as long as primary rhinoplasty.

Many of the techniques that are used in primary nose surgery are also used in revision rhinoplasty. One common technique is the addition or removal of cartilage to create symmetry, structure or function. Most often the cartilage is harvested from the nasal septum, ear or a rib. In some cases, not enough cartilage was removed during the primary rhinoplasty, in which case the revision surgeon will carefully shave away the excess.

About the Reviewer of this Article

Andrew Jacono, MD, FACS, specializes in revision rhinoplasty at his New York-based practice. He is dual board certified in facial plastic and reconstructive surgery and otolaryngology (head and neck surgery.) Dr. Jacono is section head of facial plastic and reconstructive surgery at North Shore University Hospital in Manhasset, New York, and an assistant clinical professor of facial and plastic and reconstructive surgery at the New York Eye and Ear Infirmary. Dr. Jacono is also an assistant professor of head and neck surgery at the Albert Einstein College of Medicine in the Bronx, NY. He is director of the New York Center for Facial Plastic & Laser Surgery and J SPA Medical Day Spa in Great Neck, NY. He has published several articles in peer-reviewed journals and is the author of the book FACE THE FACTS: The Truth About Plastic Surgery Procedures That Do and Don't Work. For more information on Dr. Jacono, visit www.newyorkfacialplasticsurgery.com.


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