The Real Deal on Revision Rhinoplasty

San Francisco Facial Plastic Surgeon, David W. Kim, MD breaks down the differences between the storied surgery of the nose job, and it’s more-difficult-to-perform relative of revision rhinoplasty.

Is a revision rhinoplasty always the result of “bad surgery” or could it be other factors?

“There is not a single factor that is the cause for a patient to be dissatisfied with a rhinoplasty and seek revision. The most common problems leading to revision are an unnatural or ‘operated’ look, nasal obstruction, obvious contour irregularities or asymmetries, or a shape that is significantly different than goals. All of these problems are more likely to occur if the nose was made weaker as the result of rhinoplasty, in which case the nasal structures do not remain stable over time.”

What makes a revision rhinoplasty procedure different and is it a more difficult surgery to perform and recover from?

“Revision is more difficult because you are starting from an altered, often compromised baseline. The anatomy has been previously distorted and weakened and the soft tissue is contracted and scarred. A revision rhinoplasty is therefore more of a reconstructive procedure in which the anatomy of the nose is rebuilt, usually with the aid of structural cartilage grafts, sometimes from the ear or rib. Also, revision patients are sometimes more anxious and have a harder time with recovery given the psychological trauma of a past negative experience with rhinoplasty. For these reasons, it is helpful for revision patients to seek treatment by a specialist who does a high volume or revision rhinoplasty and has the experience to navigate these challenges.”

What advice would you give to someone considering revision rhinoplasty?

“Do your research and make sure your surgeon is experienced and does a high volume of revision rhinoplasty.

Assess benefit and risk. The complexity and risk of revision is greater than with primary rhinoplasty. If you have a severe deformity or functional problem, it makes sense you would take some risk to address the issues. If the imperfections are small, it may not make sense to take the risk.

If you decide to have revision, have expectations that your nose may be able to be significantly improved but not made to be perfect. Revision is about restoring normalcy to a nose so that one can have a nose that fits, blends, and does not draw negative attention. Pursuing perfection is a fool’s errand and can lead to one feeling worse after a surgery rather than better. Accepting improvement with small imperfections is more realistic and will allow you to move on from your nose—which is exactly what most revision patients want!”

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