The majority of rhinoplasty patients express satisfaction with the outcomes of their surgery. So why do so many people have their nose surgeries redone? 

Surgeons describe rhinoplasty as a combination of art and science, making it one of the most difficult procedures to master. Even tiny changes to the nose shape or structure can create breathing issues and change a person’s appearance.

Multiple studies show that revision rhinoplasty is requested in 5 to 15 percent of cases. According to a 2009 New York Times article, When Plastic Surgery Calls for a Do-Over, this rate could even be as high as 20 percent. Nose surgery is tricky, because healing and the quality of the building materials are not always within the control of the surgeon. The nose cartilage may end up being too thick or too flimsy, and the skin when draped over a newly restructured nose may not shrink the way the surgeon expects it to.

Dr James C. Grotting, a plastic surgeon and the editor of the textbook Reoperative Aesthetic and Reconstructive Plastic Surgery, is quoted in the Times as saying “It’s a difficult operation with a lot of variables.” According to Dr Grotting, even in the best of hands, with surgeons who perform only rhinoplasty, there can be a revision rate of up to 20 percent.

The New York Times also reported that according to Dr. Mark B. Constantian, a nose specialist whose practice is 75 percent revisions, rhinoplasty is a unique procedure where you can lose ground every time. With other kinds of cosmetic surgery, patients do not end up worse off than when they started. The second study we refer to below—150 patients—is research by Dr Constantian.

In spite of these dismal facts, people want to get their noses reshaped anyway, mostly for cosmetic reasons. And here’s the funny part. A lot of the people who undergo nose reshaping surgery the first time claim to be satisfied with the results. Yet some—and in far bigger numbers than most other cosmetic procedures—then proceed with a revision nose reshaping procedure. Why? This is what we are looking at in this article.

Motivations for primary rhinoplasty

The most common motivation for seeking primary rhinoplasty is simple enough—a person feels the need to change her or his nose. Seeing the results of nose reshaping surgery on someone else is also a common motivator. Other motivations are external, such as seeing oneself on a video or pressure from friends and loved ones.

You can read more about what motivates people to get their noses reshaped the first time round in a previous article on Costhetics.

Revision rhinoplasty rates are high

Whether you peg the revision rates at 5, 15, 20 per cent or somewhere in between, it is still pretty high compared to most other cosmetic surgery procedures. Most of the studies, however, have been based on surgeons’ objective and qualitative evaluations rather than patient concerns.

Put yourself in a patient’s shoes for a moment. Regardless of your surgeon, or indeed what other surgeons say, if you are unhappy with your nose reshaping results, you are going to want a revision. Rather than rational or objective, your evaluation is likely to be about what you feel, both physically and emotionally. And since the most people seeking rhinoplasty do so because of their own prompting, and they are used to taking action to make themselves feel better, onward they go for the revision rhinoplasty. In fact, high rates of revision rhinoplasty should be a naturally predictable thing, especially in view of the original aspirations of the primary rhinoplasty patients.

What are the common reasons?

Patients give both aesthetic and functional reasons as prompting a request for revision nose reshaping surgery. We discuss the findings of two such studies.

Tip asymmetry tops a survey among 104 revision rhinoplasty patients

The results of a survey among 104 revision rhinoplasty patients and their surgeons, published in the Archives of Plastic Surgery journal in 2010, showed that the most commonly reported complaint was nasal tip asymmetry. This was the case when surveying the patients only and also when both patients and surgeons were surveyed. This makes tip asymmetry the top reason for revisions.

In the survey conducted at the Department of Otolaryngology/Head and Neck Surgery at Columbia College in New York, around 64 percent of the patients reported functional issues, such as nasal blockage or difficulty in breathing. For patients, this was the second most troubling complaint leading to revision surgery.

The third reason for patients requesting revision nose surgery was a crooked middle third of the nose.

Overall, it was clear that most patients were not imagining things. On average, around 79 percent of the patient concerns were also expressed by their surgeons.

The same study showed that when both patients’ and surgeons’ concerns were taken into consideration, the top aesthetic reasons for opting for revision rhinoplasty were tip asymmetry, a crooked middle third of the nose and upper third irregularity.

A new deformity is the commonest reason in study with 150 patients

Findings of a study using the charts of 150 consecutive patients—121 women and 29 men— who had undergone secondary rhinoplasty in 2007 and 2008 in New Hampshire in the U.S., showed that the most common reason (41%) was the development of a new deformity after a previous procedure.

Failure to correct the original deformity was the second most cited reason, accounting for a third of the revision cases (33%).

Other findings of the study:

  • On average a person in the sample had undergone between 3 and 4 previous nose operations.
  • 15% of the revisions had to do with an intolerable perceived loss of personal, familial, or ethnic characteristics.
  • 10% had the desire for further improvement in an already acceptable result.
  • 1% had a new or unrelieved airway obstruction.
  • Around 27% of the patients were depressed before surgery, and 3% showed evidence of body dysmorphic disorder. The researchers found that the depressed and dysmorphic patients did not have worse deformities compared with the others.

The study results were published in the Plastic and Reconstructive Surgery journal in September 2012.

When both studies are considered, we can see that aesthetic, functional, emotional and practical considerations come into play in revision rhinoplasty procedures.

Combining the difficulty of rhinoplasty procedures with poor choice in surgeon can lead to higher complications and the need for rhinoplasty revision surgery. This is especially the case for those who end up with a failure to correct their original deformity.

Beyond this, most of the other factors—how your nose cartilage, skin and other tissue will respond, how trouble-free the healing will be and what unanticipated structural or aesthetic issues may crop up afterwards—you will have to take on faith and trust. Even the best rhinoplasty surgeons cannot guarantee that there will be no problems.

For more information

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