Is it possible to do too many revision rhinoplasties?
Well, the simple answer is that no it’s not.
A patient can always do a revision if there’s something that you’re unhappy about. Patients should always be presented with realistic expectations regarding what the next rhinoplasty is going to achieve. In general, after the first revision rhinoplasty we start becoming less confident that the results that we produce or 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. These tissue plains are clean and 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 there’s too much cartilage there.
Your Second or Third Rhinoplasty
In revision rhinoplasty it’s tough to know what happened in the past and how things have healed. We don’t know where the scar tissue formed. Many times I don’t know how much tissue was taken out from some of the important nasal structures including the septum and the lower lateral cartilages. More revision rhinoplasties are performed by an inexperienced surgeon, the more often too much 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.
Your Fourth or Fifth Rhinoplasty
When you start getting into the third, fourth, fifth revision really 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.
That’s why if there’s something obvious that’s simple or easy to fix, or if maybe someone had an accident afterwards, those types of things we approach pretty readily. When it comes to fine tuning a revision rhinoplasty after the third or fourth time, those fine adjustments can be pretty difficult to get to stick even if you get it right in the operating room.
When you have that much scar tissue, sometimes the blood supply can be not as robust as it once was so we worry more about infections, implants resorbing or getting infected or even extruding.