What to do if a rhinoplasty fails?
Patients who have had not just rhinoplasty but at least one, two, or three prior revisions and are now in a position where they are unsure if it is safe for them to do the treatment are one of the hardest classes of patients that we see. The Michael Jackson effect is a persistent worry among patients, who worry that they may lose their noses and wonder whether it is really safe for them to undergo the treatment. These patients frequently represent the end of the line. They believe they have lost faith and hope. They don’t know who to trust anymore when it comes to what’s feasible, so we feel an even greater obligation to be upfront with them about what they can actually achieve. We never make overly optimistic claims, but for many of those patients, if they are now in the care of revision rhinoplasty specialists with a lot of expertise in dealing with these difficulties, there may still be substantial advantages to be achieved. Most of these patients will hear us say that the skin’s quality is likely the most crucial thing to consider. There is typically little you can do if your skin doesn’t have any give. Second, if there are numerous scar tissues, you must be prepared to accept the fact that we will go in and remove every scar, and the area will then look fantastic. After a year or two, it will appear much better than it does now, but you must accept the fact that in 10-15% of those people, you will need to remove the rind once more. It’s also crucial that the surgeon doesn’t keep going back and removing more structure while he or she works. If you’re going to go back and do something, it’s crucial to stabilize and ensure that the nose can support itself and has new strength. In this situation, restoring the framework is critical. Many patients who have undergone reductive rhinoplasty have had too much cartilage removed, and if another surgeon attempts to remove even more cartilage, even more complications may result. These include collapsing, having trouble breathing, twisting, and losing support; over time, these problems tend to get worse. We are staunch fundamentalists when it comes to restoring the nose’s structure and support so that this will be the last rhinoplasty you’ll need. This will set you up for the rest of your life with a nose that remains in shape as you age and looks better than it would if you hadn’t had any work done. It’s crucial to note that boosting support and strength does not automatically result in a larger nose. These two items differ greatly from one another. If you provide support so that the skin has a place to contract, you can erase scars and other things to make the nose smaller. For some people, it does translate to having a broader nose. Many patients have had their noses scooped out or overshortened, which makes them look quite artificial. We discovered that by using rip grafting over hundreds of patients over many years, we have been able to reach a point where we can genuinely tell patients we can get a very nice change. Restoring length is one of the hardest things to do in revision rhinoplasty. We must take a tip that has been overly shortened and bring it back to its normal natural length. The skin quality is the only qualification worth mentioning. We may need to explain the restrictions of surgery if the skin has already been harmed. Even so, we often manage to do it admirably. So, what we’re suggesting is that you should consult someone with extensive editing experience if you’re wondering if you’ve done too much and if you should go farther. This type of rhinoplasty surgery cannot be performed by a surgeon who does a few cases a year; rather, 50 to 150 cases must be performed annually.