Revision of anything means that the first time was unsatisfactory and is essentially a do-over. The first revision is termed secondary. The third revision is termed tertiary. As I have said before, the best time for the best outcome is the first time. This is especially when it comes to surgery. Tertiary rhinoplasty is a term meaning a third cosmetic nose job surgery.
The first time, the tissues are untouched and the surgeon has optimal anatomic access. And, hopefully, a clear vision of the intended result. Occasionally, and we see this more often than not, the first or second time by other surgeons is unsatisfactory and displeasing to the patient. This situation can be very frustrating and expensive for the patient. However, in the right hands, and once the patient and surgeon reach a shared vision and a meeting of the minds, hope is created.
The dissatisfaction with the first and second outcomes can take many forms. Breathing may be a problem. The tip width, tip position, tip to lip distance and angle may be a problem. The profile may be a problem. Or, the middle third may be unsatisfactory. In order for these tertiary patients to achieve their best result, it is essential to choose the right surgeon the first time. It is unpleasant to have to go through tertiary rhinoplasty.
With tertiary rhinoplasty, grafting may be required. Reduction and resection of certain areas may also be required. All of these details and the changes that they require to achieve the best result are in the mind of the operating surgeon as he or she performs a complete and thorough evaluation of the nose including measurements and palpation. A deep internal examination with excellent lighting is required. The patient also must understand that extensive scarring is most likely present when it comes to tertiary rhinoplasty and may serve as a deterrent to achieving the most perfect result.
An aesthetic nose on any particular individual has very specific characteristics within a very small range. Each measurement and the associated thorough discussion with the patient moves us closer to achieving the best aesthetic result. Once there is a meeting of the minds and the surgeon has a surgical plan in mind – the road to repair, revision – and the best result is in sight.
Primary rhinoplasty is very, very rewarding when the patient achieves their goals and are very happy with the look of their nose. Revisions especially tertiary rhinoplasty are also very fulfilling for both the patient and the doctor. Revisions and especially tertiary are very challenging procedures. They should only be done by board-certified surgeons with much experience. Surgeons who have demonstrated consistent results. Surgeons who have results in a gallery of before-and-afters.