More than any other procedure, rhinoplasty surgery seems to have the highest number of revision rates. Some studies point to 15 percent, others say closer to 20. However, if we go by popular culture alone it’s safe to say that noses often get a redo. Because the nose is featured so prominently on our faces, it’s hard not to notice when our favorite stars are on their second or third nose jobs.
For the average patient, the decision to undergo a secondary or third procedure is often one fraught with fear, doubt and anxiety. While no one wants to undergo another procedure to fine tune results, the nose is not a part of the body you can ignore. It’s one of the first features you see when looking at yourself in the mirror, which is why outcomes that don’t feel or look they go with the rest of your face are often corrected. Here, top rhinoplasty surgeons share exactly what to do if you’re not vibing with your new nose and how to proceed with a rhinoplasty redo.
What’s the first thing you should do if you dislike your nose job results?
“If you just had the surgery and are less than one year after surgery, the first thing NOT to do is panic and start planning another surgery,” says New York facial plastic surgeon Edward S. Kwak, MD. “Try to keep a positive outlook and keep your scheduled follow-up appointments. Communicate with your surgeon directly your concerns and issues. Oftentimes most of these concerns are related to normal post-operative swelling and healing which your surgeon can assess and reassure.”
“If it is early after surgery, I would take a deep breath and tell yourself that bumps, swelling, and even sometimes minor crookedness can improve as sometimes these issues are the result of asymmetric swelling,” adds Chicago plastic surgeon Michael J. Lee, MD. “If the nose is too small after surgery or the tip is rotated down after surgery, these issues will not likely improve and I would advise talking to your surgeon about these issues and when they could possibly be addressed.”
How long should you wait before making a final decision on results? When are they close to permanent?
Just a few months out from surgery? Now is not the time to make a final decision say our experts, as it can take up to a full year to see your final rhinoplasty results. “The majority of swelling will resolve after the first six to 12 weeks post-operatively,” says Vero Beach, FL plastic surgeon Jimmy H. Chim, MD. So when can you really get a good idea of what your nose will look like? “At six months your rhinoplasty results will be fairly close to final and evaluation can likely begin to address concerns that may be amenable to revision.”
“Your surgeon will ask you to be patient to separate the swelling from the surgical result,” shares Campbell, CA plastic surgeon R. Laurence Berkowitz, MD. “This can take up to one year. However, in my experience, when a patient is unhappy on day one they are unlikely to be any happier—probably worse—on day 365.”
Salt Lake City facial plastic surgeon P. Daniel Ward, MD says the nose is one of the most frustrating parts of the body to heal. “It takes 12 to 18 months for all the swelling to go down and for all the scar tissue to settle,” he explains. “Patience is difficult, but it is a necessary part of the process for healing after any surgery, but especially the nose. Remember that most of the changes that you see are related to the skin and soft tissue of the nose and those areas take time to heal.”
Is there a risk or downside to getting a revision too soon?
“Fixing,” what you might see as a concern too early can lead to further unhappiness down the line, cautions Arcadia, CA, plastic surgeon Arthur Y. Yu, MD. “When the nose is still very swollen, a revision surgery could induce more scarring, affecting the final result. Furthermore, your surgeon may not be able to provide a clear diagnosis as to what happened. As a result, this type of revision might end up being a failure.”
Further swelling, edema and scarring can make it more difficult for a surgeon to get the nose to your desired shape. “It’s like driving through fog. All of this will be done in an effort to revise something that may very well resolve with time. Most plastic surgeons would likely discourage early revisionary rhinoplasty in this ‘game of millimeters,’” notes Dr. Chim.
What if I dislike my results but no one else sees the issues I do?
According to Dr. Lee, many times the dissatisfied patient is dealing with an issue of perception versus reality. In this case, the best approach is a conservative one. “If no one else sees the issues that bother you, I would strongly recommend against trying to revise it. All surgeries have risks and sometimes a revision can create thinner skin and may also result in deviation, scarring and visible cartilage grafts. If other people don’t see the issues that bother you, the ability to change and improve a minuscule issue may create more noticeable problems.”
The misperception of results is such a common issue, Dr. Berkowitz says surgeons have even developed techniques to help ease the patient into their result if the negative reaction is extreme. “This has been studied and good suggestions made for surgeons for methods to handle the dysphoric patient on the day the cast comes off,” he explains. “The following suggestions have been presented at our Rhinoplasty Society meetings by former President Dr. Ronald Gruber, who is quite knowledgeable about psychology and perception. First he recommends immediately taping the nose with beige 3M Micropore tape, which is like putting a bandaid over a blemish, and often the patient will immediately feel some relief upon reflection. Secondly, in cases of a severe reaction, treatment with a beta blocker such as propanalol helps to block the PTSD type of physiologic response the patient may be experiencing.”
“Remember that imperfections and asymmetries are part of a normal face,” shares Dr. Ward. “Focusing on one area too much can be something that causes an undue amount of pressure that you may put on yourself.”
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