Medical literature has suggested that the revision rate of rhinoplasty or nose surgery is between 10-15 percent due to its innate complexity and the anatomical details of the treated area. Also, other factors such as the patient’s gender, facial features, ethnicity, skin thickness, and cosmetic goals could also add up to the challenges.
Simply put, your nasal anatomies and their limitations, your plastic surgeon’s skills, and your motives should all be in the same direction to achieve good results from the surgery and to reduce the incidence of reoperation as well.
In the event that you need a revision rhinoplasty, one of the most important factors is your plastic surgeon’s qualifications.
Leading Beverly Hills plastic surgeon Dr. Karan Dhir says the starting point is to find a rhinoplasty surgeon certified by The American Board of Plastic Surgery (ABPS), American Board of Facial Plastic and Reconstructive Surgery (ABFPRS), or American Board of Otolaryngology (ABOto).
Oftentimes, facial plastic surgeons start their training in otolaryngology (ear and throat) and head/neck surgery and then do fellowship in facial plastic surgery. Plastic surgeons, meanwhile, start off in general surgery and then fellowship program in plastic surgery, he adds.
These two “backgrounds,” Dr. Dhir says, can help a surgeon deliver good results from revision rhinoplasties.
But bear in mind that a revision rhinoplasty is more complex than the initial nose surgery because the cartilage and bone, which is the underlying structure that gives the nose its intrinsic shape, has already been reshaped and manipulated. Thus your baseline has already been changed, contributing to the procedure’s difficulty level.
Further complicating things is the presence of scars, which could lead to a thicker skin that is harder to work with. Nevertheless, in the hands of a “seasoned” surgeon you can expect a good amount of improvement, assuming that you have realistic goals and expectations.
Surveys have suggested that “bona fide” board-certified plastic surgeons have a very low complication rate because of their training (fellowship program) and that they have been carefully selected (i.e., they undergo rigorous oral and written exams every 10 years). Also, their code of conduct requires them to operate only in an accredited outpatient surgical facility or hospital.
When considering revision rhinoplasty, make sure that your doctor regularly performs the procedure to the point that he is already considered a specialist in the field. Take note that someone who is good at primary nose job does not necessarily mean that he or she can deliver great results from a secondary operation.
Plastic surgeons performing revision rhinoplasty, or corrective nose surgery, are facing technical challenges due to the presence of scar tissue, nasal cartilage or bone that has been previously reshaped, and oftentimes depressed and upset patients.
As with any elective plastic surgery, having realistic expectations is one of the keys to achieve high patient satisfaction. Meanwhile, individuals with very high and unrealistic motives are less likely to be happy with the results no matter how terrific they look.
According to a recent study, about 21 percent of patients requesting rhinoplasty exhibited signs of body dysmorphic disorder (BDD), which is characterized by obsession with an imagined or minor flaws in one’s appearance, causing severe emotional distress, relationship problems, and difficulties in everyday functions.
If you are considering revision rhinoplasty, or any type of cosmetic plastic surgery, the most crucial thing you should do is assess your motives and goals and be honest with yourself, as suggested by celebrity Beverly Hills plastic surgeon Dr. Karan Dhir.
The decision to undergo revision rhinoplasty is a highly personal one, although the surgeon’s good judgment also plays a crucial role in the success rate. Take note that a prudent doctor will turn down individuals with unrealistic goals and expectations, and those with excessive scar tissue caused by too many surgeries in the past.
Sometimes, the potential risks are much higher compared with the probable benefit of another surgery that the best course of action is to leave the nose alone, warns Dr. Dhir.
Even the best rhinoplastic surgeon cannot deliver an anatomically perfect nose, thus your main goal should be all about achieving a realistic amount of cosmetic improvement, rather than perfection. Also bear in mind that aside from his or her surgical skills, the results is also largely determined by your anatomies, specifically your skin thickness, nasal cartilage, and bone.
Sometimes, revision rhinoplaty is requested not because of cosmetic flaws, but to address breathing difficulties or function-related problems. If this is the case, Dr. Dhir highlights the importance of preserving the structural integrity of the nose through cartilage grafts, which can be harvested from the septum, or wall between the two nostrils, and bowl of the ear.
The celebrity Beverly Hills plastic surgeon says a prudent rhinoplastic doctor performing revisions will make every effort to avoid another surgery, which may include the use of 3D imaging technology that allows their patients to accurately give their input and preview the postop results.
Most of the healing after rhinoplasty or cosmetic nose surgery happens in seven to 10 days, meaning at this stage most patients can go outside without drawing some unwanted attention, although they might need to use some make-up to camouflage the swelling and bruising especially around their eyes.
Beverly Hills plastic surgery expert Dr. Karan Dhir, who mainly performs facial plastic surgeries, explains the most efficient ways to accelerate rhinoplasty recovery.
- Elevate the head to control postop swelling. The idea is to sleep with one’s head higher than the heart’s level, allowing excess fluids to go down and drain away from the nose. The patient can use a bed recliner or several pillows under their head so they are not completely flat.
- Good nutrition. Veggies, fruits, “lean” protein, and whole grains comprise the “ideal” plastic surgery diet. On the other hand, rhinoplasty patients should avoid salty and fatty foods, which often fall under the category of “empty calorie” foods.
- Avoid anything that can disrupt the recovering tissue such as rubbing, pinching, blowing, and squeezing the nose for at least two weeks, or sometimes even longer. The goal is to allow the skin to redrape to the new contour.
- Use homeopathic remedies. Arnica montana and bromelain are believed to boost the body’s own ability to recover from trauma or injury, although the consensus is that they should not be used long term because of the risk of bleeding.
- Avoid strenuous exercise for at least three weeks. The idea is to keep the blood pressure and heart rate relatively low in an attempt to prevent bleeding, persistent swelling, and poor healing. Contact sports, meanwhile, should be avoided for even longer to make sure the cartilage, bone, and skin heal without being disturbed.
- Avoid tobacco and smoking cessation products for a minimum of three weeks before and after surgery. Studies have all proven the detrimental effects of nicotine, which can significantly lead to poor blood circulation as it constricts the blood vessels responsible for bringing nutrient- and oxygen-rich blood to the surgical site. Smokers are also susceptible to infection and subsequent implant removal.
- Avoid aspirin and other blood-thinners at least three weeks before and after surgery. Many over-the-counter painkillers contain aspirin, which is known to aggravate bleeding. Some herbal supplements such as vitamin E, ginseng, ginkgo biloba, and green tea are also known to have the same detrimental effects on healing.
One of the most common goals of rhinoplasty or nose surgery is to refine the appearance of nasal tip that appears bulbous, too wide, too elevated, or too large relative to the rest of the face. To achieve results that look natural, a good rule of thumb is to work within the confines of the underlying anatomy.
The nasal tip is comprised of cartilage, which is a whitish, flexible connective tissue. During surgery, this tissue is reshaped through suture techniques, trimming, cartilage grafting, or a combination of these methods to achieve the desired cosmetic appearance without compromising the normal function of nose.
Rhinoplasty is one of the most difficult plastic surgeries to execute because it involves the smallest details. In fact, just a small error—such as removing more cartilage slightly than intended—is enough to result in botched appearance such as collapsed nostril, super narrow tip, amorphous appearance, or over-rotated look.
To prevent the botched results described above, a good rule of thumb is to refine the tip without depriving it of the much-needed structural integrity. Simply put, aggressive surgical maneuvers must be avoided so the nasal tip would not appear surgically pinched or collapsed.
The amount of reduction or alteration must also take into account the skin quality. Thicker skin, which is commonly found in ethnic patients, is susceptible to more postop swelling and bruising and does not redrape as good as the thinner nasal skin of Caucasians.
Ethnic rhinoplasty patients in general require a more conservative approach to avoid amorphous appearance, which commonly affects the tip.
Aside from skin thickness, another way to achieve natural results from tip rhinoplasty is to take into account the patient’s gender. Studies have suggested that on average, a man’s nose is 10 percent larger than a female’s even when both have the same body size.
Aggressive surgical maneuvers are particularly detrimental in male patients because they often lead to a thin, fragile-looking nose that diminishes the masculinity of the face. Another potential risk is over-rotation of the tip in which most of the nostrils become visible and the nose appears unnaturally short.
An over-rotated tip does not look attractive on men. According to a study conducted by researchers from the New York University, the ideal angle of rotation at the nasal tip for men is 90 degrees or slightly less. In fact, some plastic surgeons even allow a minimal droop to preserve the masculine appearance.
But for women, the ideal angle is between 95 and 110 degrees that leads to a slightly upturned nose, which is synonymous with a more feminine look.
While age alone is not a contraindication to rhinoplasty or nose surgery, leading facial plastic surgeon Dr. Karan Dhir says that adolescent patients have goals and skin quality (and other aspects of anatomy) different from “seniors” or at least those aged 50 and above. For this reason, they also require a different surgical approach to achieve the desired appearance.
Young people have a firmer and more elastic skin than seniors, which allows it to redrape better to the new contour, and to experience less post-operative bruising and swelling. Nevertheless, “older” patients can still achieve good results from rhinoplasty although through a more “conservative” approach.
Since rhinoplasty in general does not remove any amount of skin, the patient should have a “decent” amount of skin elasticity prior to surgery.
Compared to younger patients, seniors tend to ask for a subtler nasal improvement/change because their body image is already well imprinted. Oftentimes, their goals include a less droopy nasal tip, a straighter bridge line, a less prominent hump at their dorsum, etc.
In fact, most “older” patients simply want to regain some of their youthful appearance through rhinoplasty. Younger patients, meanwhile, tend to ask for more “changes” or “improvements,” although these should still remain within the confines of anatomy to avoid breathing problem, unnatural appearance, and weakness of the nasal structure.
Some anecdotal reports have also suggested that older rhinoplasty patients tend to report higher satisfaction than younger individuals, probably because they are more certain about their cosmetic goals and they already have a well-imprinted body image.
Drooping of the nasal tip, which is largely associated with aging, can lead to breathing problem in addition to a nose that appears longer than ideal. These factors are taken into consideration prior to surgery to achieve the desired results.
Among younger patients asking for rhinoplasty, breathing difficulty is rarely an issue.
- Age-related medical condition
While the patient’s chronological age does not determine whether she’s a good candidate for a nose surgery or not, any prudent surgeon takes into account that seniors are more likely to have delayed wound healing, high blood pressure, and cardiovascular disorder than younger individuals.
Nevertheless, the patient’s health is way more important than her chronological age and visual appearance, thus a comprehensive physical and laboratory exam is crucial to determine any contraindication that could make the surgery unduly risky.
To minimize complications, most rhinoplasty surgeons require their senior patients to obtain medical clearance from their specialist or primary care physician.