Rhinoplasty requires a very clear plan and the technical skill tool to execute that plan. Not all plastic surgeons or ear nose and throat doctors can deliver the best rhinoplasty result. Consequently, if a patient puts themselves in the hands of a less than competent rhinoplasty surgeon they may eliminate the first-time opportunity to create the best rhinoplasty result. Consequently, revision rhinoplasty makes up about 20% of our procedures. These are patients who have had multiple rhinoplasty operations by other surgeons. Done in different process locations and have yet to achieve their best most elegant and aesthetic result.
In our practice, we have performed secondaries, tertiary, and even fourth revisions. The fundamental principles of revision apply as well to primary or first-time surgery. Structurally length, middle third width, to defining points, tip to a lower, groove and tipped the lip distances must be measured and evaluated.
It’s helpful for me to have patients show me noses that they like and find attractive. This applies to both females and male. This gives me a window into the patient’s brain and helps me to determine what that patient finds attractive. Female feminization and male masculinity are essential when conducting a consultation. And, transferring that into the surgical procedure to achieve the optimal result.
So, therefore, the answer is yes. A fourth revision is possible provided the surgeon has the skill set to achieve what he or she and the patient determine to be the best structure for that patient on that face. Keep in mind that scar tissue creates a problem. The procedure does not always take its normal course. Cartilage and bone may be missing. Or, in some instances not reduced or dealt with adequately. For example, we have faced with very wide noses as a result of spreader grafts. Which in most instances creates a wide middle third. And, it detracts from the more feminine look sought by most female patients.
Revisions are very challenging but in the right hands can be very rewarding for both the surgeon and the patient. Remember the idea is to create the most aesthetic-looking result possible on that face. I urge potential patients to look at the galleries
on our site.
BOARD-CERTIFIED PLASTIC SURGEON
MEMBER OF AMERICAN SOCIETY OF AESTHETIC PLASTIC SURGERY