Revision Rhinoplasty after a botched nose surgery

My nose job surgery was a nightmare, and it isn't over yet. My former doctor somehow managed to make the bridge of my nose disappear, while doing nothing about my nostrils, making my entire face look out of proportion. I've been so devastated by the results that I barely go out anymore. I'm always afraid of being seen in public by someone I know. I know there are doctors that specialize in fixing other doctors' mistakes, but how can I trust anyone now? Besides pay for the most expensive surgeon money can buy, what can I possibly do to influence the outcome?

katevenus

F, 37, Georgia

Rhinoplasty consistently rates as one of the plastic surgery procedures with a lower patient satisfaction rate. Approximately 15% of patients are unhappy with their postoperative outcome, although this figure does tend to be lower among the patients of highly experienced surgeons who specialize in rhinoplasty.

In truth, rhinoplasty is commonly regarded as the most difficult of all cosmetic procedures. Even a subtle change in nasal contour demands a sophisticated understanding of nasal anatomy, precise surgical technique, and awareness of possible complications that may arise.

For most surgeons, near total dedication to the study and practice of this demanding operation is needed to achieve mastery. The most competent rhinoplasty surgeons often focus on rhinoplasty to the exclusion of other plastic surgery procedures. That being said, there are still patients who require revision rhinoplasty, even in the hands of the most experienced surgeon.

It is very unfortunate that the results of your cosmetic surgery have resulted in a such a distressing outcome. It’s difficult for me to determine the cause of your unsatisfactory postoperative results by a description alone. A secondary procedure may be needed due to:

  • Poor tissue quality
  • Poor healing
  • A discrepancy between the patient's expectations and the surgeon's understanding of the patient's expectations
  • Poor surgical technique and judgment

Ultimately, the responsibility of each of these falls on the surgeon's shoulders: it’s their job to thoroughly assess your nose tissue to determine if it’s suitable for surgery and undertake an assessment of surgical risk. They should be able to clarify the outcome you were hoping to achieve and tell you if it’s feasible.

I would suggest that you do your research and find a surgeon with considerable experience in revision rhinoplasty. Revision rhinoplasty is quite a different procedure from primary rhinoplasty so finding a surgeon specialized in this procedure is critical. Ensure you have a lengthy consultation before you commit to anything: revision rhinoplasty isn’t right for every patient and may in some cases lead to further complications or unhappiness. The surgeon's photo gallery of previous patients can be a useful way to gauge the results you may expect as a result of a secondary procedure. I wish you all the best.

Dr. Frederic Corbin has 1 Nose job before & after:

Nose job before image performed by Dr. Frederic CorbinNose job after image performed by Dr. Frederic Corbin

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First of all, I'm very sorry to hear about your experience. Unfortunately, approximately 10% of rhinoplasty patients are dissatisfied with the outcome of their surgery and make the decision to undergo a revision procedure. Revision surgery can be necessary to correct a breathing difficulty that has arisen as a result of surgery, or for aesthetic reasons, such as inadequate dorsal hump resection.

Rhinoplasty is an extremely precise plastic surgery procedure with a very limited margin for error. Millimeters can make a difference between a cosmetically beautiful outcome and one that is less aesthetically pleasing. There are revision rhinoplasty surgeons who specialize in addressing issues or complications that have resulted from primary rhinoplasty.

Revision rhinoplasty is sometimes a very simple procedure. However, as a general rule of thumb, it is usually easier to remove residual bone or cartilage than to add it. It sounds like you’ve had too much bone or cartilage removed from your nasal bridge. It’s a more challenging secondary procedure when a patient has had excess tissue removed from their nose resulting in a deformity. These revision rhinoplasties are long, complex surgeries which require tissue grafts from donor sites such as the ear, rib or temples to restore the cartilage or bone that has been lost. The skin and soft tissue enveloping the nose will also affect the outcome: the more invasive the procedure, the greater the likelihood of scarring and surface irregularities, so surgeons must also take this into account.

It certainly sounds as though you would benefit from getting another opinion from a plastic surgeon with experience in revision rhinoplasty. Ask to see before-and-after photos of their work on other revision rhinoplasty patients so you can gain an idea of the kinds of results that are possible.

Your rapport with the surgeon is also an essential consideration. The best surgeons will walk you through your options and explain any possible complications or issues that may arise so you are well-informed and confident you are in safe hands. In cases of major revision surgery, it’s important to have a realistic idea about what can be achieved before committing to surgery again, as it can require a significant financial outlay and recovery time.

Between 10 and 15% of rhinoplasty patients undergo a secondary, or revision, procedure. While not ideal, there are a number of specialized surgeons in the U.S. who focus on repairing nose jobs that have gone wrong. Revision rhinoplasty is, however, very challenging to perform so the plastic surgeon performing the surgery should have extensive experience with the procedure.

Revision rhinoplasty is most commonly needed because excess cartilage or bone has been removed. As the nose heals, the nasal skin wraps around what remains of the nasal structure. The nose appears misshapen and may also have compromised breathing ability. It sounds as though your dissatisfaction with the outcome of your rhinoplasty is due to the removal of too much nasal tissue. Although revision rhinoplasty can be complex, correction of the first rhinoplasty can be achieved. Surgeons may rebuild the architecture of the nose by using cartilage grafts from the ears or ribs, or synthetic porous implants.

Revision rhinoplasty takes 2-3 hours on average, depending on the complexity of the procedure. The recovery period usually lasts from 10-14 days, although many patients return to work after one week. Ideally, scarring should be minimal with the scar concealed beneath the tip or within the nose.

For patients such as yourself whose self-confidence has been detrimentally affected by the results of botched plastic surgery, revision rhinoplasty can be a transformative procedure. In the hands of an experienced and caring surgeon, patients can see improved balance of their facial features, a better profile, and also regain confidence in their facial appearance, improving quality of life. It is important, however, to have realistic expectations of what surgery can and cannot achieve. Some surgeons have advanced computer imaging that helps patients understand how their postoperative results will look.

It is unfortunate.  How long ago did you have the surgery?   Rhinoplasty is a challenging operation.  You may/may not need revision surgery.   It is hard to tell without photographs and a physical examination.  It would probably be helpful for you to see your original surgeon and go over your concerns.   All surgeons want happy patients.  IF you are not comfortable seeing your surgeon, then perhaps you ought to seek out other opinions, but certainly give your original surgeon a chance to help  you.  AFter all, you did research to select them to be your original surgeon. 

Dr. Jonathan Berman has 1 Nose job, Chin implant before & after:

Nose job, Chin implant before image performed by Dr. Jonathan BermanNose job, Chin implant after image performed by Dr. Jonathan Berman

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It would be helpful to have some before and after photos of your nose.  Secondary rhinoplasty procedures may involve redoing the original surgery and may require cartilage grafts from the septum and/ or ears.  It is helpful to choose a surgeon who specializes in nasal surgery and is a member of the Rhinoplasty Society. 

Dr. Robert Walton has 5 Nose job before & afters:

Nose job before image performed by Dr. Robert WaltonNose job after image performed by Dr. Robert WaltonNasal Reconstruction before image performed by Dr. Robert WaltonNasal Reconstruction after image performed by Dr. Robert WaltonNose job before image performed by Dr. Robert WaltonNose job after image performed by Dr. Robert WaltonNose job before image performed by Dr. Robert WaltonNose job after image performed by Dr. Robert Walton

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I'm sorry your having such a difficult time. You can and should definitely see someone to address your concerns. Also always keep in mind that money does not have anything to do with quality when discussing plastic surgery. When you go for a consultation you must feel comfortable and that you are able to trust your surgeon to deliver the result your looking for. Good Luck!