Before, left: after two successful rhinoplasties done elsewhere. Robert Kotler, MD delivered the results in the after picture.
Several years ago, the American Academy of Facial Plastic & Reconstructive Surgery reckoned that about 25 percent of first rhinoplasty patients are unhappy with their cosmetic surgeries.
That statistic often generates a need for a second corrective surgery, a revision rhinoplasty.
But that re-do is more problematic than a first nose job. The revision surgeon, working in a tiny space, must deal with scar tissue and a nasal landscape with changed landmarks and anatomy.
Often complicating matters even more are revision patients some a breathing blockage inside the nose. Sometimes, the patient shows up in the cosmetic plastic surgeon’s office with:
- An uncorrected, healed broken nose
- Nasal allergies
- Complaints of seemingly constant sinus problems
All of that often requires a corrective surgery known as septoplasty to repair:
- A bent, or deviated septum and/or
- Turbinate reduction surgery
Result: not only does the patient want a better looking nose, but good medical practice also demands the first law of nasal surgery be obeyed. The dictate: the nose’s chief job is passing warmed, filtered and humidified air on to the lungs.
Thus, all of the preceding must be done at once along with the cosmetic surgery to improve the shape of the nose.
For instructors who teach cosmetic and plastic surgery, concern is high. Two specialties teach and provide cosmetic nasal surgeons – plastic surgery and head and neck surgery.
What could account for the 25 percent of unhappy rhinoplasty patients?
Surgeons with incomplete training, less experience and not as much artistic ability are more likely to provide poorly performed rhinoplasties and crestfallen patients.
However, surgeons who have concentrated on cosmetic and functional nasal surgery while undergoing ardent, protracted training combined with many hands-on rhinoplasties have fewer dissatisfied patients. It requires an extremely practiced eye but, sometimes, the prudent course of action is not to do the revision surgery at all. It may be better to live with minor nasal flaws than risk making things worse.
However, if only the outside of the nose needs correction — like in the before and after pictures at the top — there is an alternative. Nasal surgeons have available medications that flatten bumps and other substances that raise depressions, divots, divots and moguls in non-surgical revision rhinoplasty.
That procedure is also known as injection rhinoplasty.