Is it possible to have too many revision rhinoplasties?
Well, the simple answer is that no it’s not.
You can always do a revision if there’s something that you’re unhappy about.
Patients should always have realistic expectations about what the next rhinoplasty is going to achieve. In general, after the first revision rhinoplasty we start becoming less confident with the results that we produce in the operating room will stick.
That’s just because there’s scar tissue there. Many times we don’t know what was done in the previous surgery. It’s always best to get the results on the first time because the tissue plains for surgery are untouched. They’re clean and they’re not inflamed. There’s not much scar tissue there. We know exactly what we’re getting involved with when it comes to whether there’s cartilage missing or too much there.
Problem: Scar tissue formation
In revision rhinoplasty it’s unpredictable about what’s happened in the past and how things have healed. We don’t know where the scar tissue formed.
Many times we don’t know how much tissue was taken out from some of the important nasal structures. Examples include the septum and the lower lateral cartilages.
More revision rhinoplasties are performed by inexperienced surgeons, and more often than not too much tissue has been taken out. Often with second and third revision rhinoplasties, we’re actually putting material back in to get the nose to function and to look better.
Problem: Too much scar tissue
When you start getting into the third, fourth, or fifth revision we start worrying that there’s too much scar tissue and that things have healed in a way that’s going to be difficult to move around.
Typically the scar plains hold and anchor things so that even when we lyse or cut those scar bands, they want to stay where they’ve settled. It makes it more difficult to have predictable results. The first revision or the second revision is not as unpredictable, but after the third or fourth it becomes unpredictable.
When you have that much scar tissue, sometimes the blood supply can be inadequate so we worry more about infections, implants resorbing or even extruding.