Q: It seems like many people are seeking revisions (sometimes more than one) after a Rhinoplasty? Is this based on the skill of the doctor. I had my nose done over 20 years and was never satisfied. I am planning on getting a non-surgical procedure. Doctors have said that this would be a good alternative for my case. This is still happening 20 years later. Some people have gone to top notch docs and still have gotten poor results.

A: A recently published study put the revision rate at 17%, but you are right, the actual rate may be even higher than that.  Why is the rate so high?  One of the most common reasons may be a disconnect between the patient’s expectations and vision and that of the surgeon’s.  Most board-certified rhinoplasty surgeons have the intellectual and technical know-how to perform a rhinoplasty surgery.  However, unlike other surgery with concrete goals – like removing an appendix – rhinoplasty surgery is a complex interplay of what the patient desires, what is surgically attainable, and managing the patient’s expectations.

Beyond this the reasons are multifactorial, but to address the issue of patients going to top docs and still requiring revision.  1.  Healing after rhinoplasty can be unpredictable.  The nose may look perfect on the operating table, but as the skin shrinks down around the nose, funny things can happen  2.  Patients seeking improvement, not perfection, are the best candidates for rhinoplasty.  Perfection can not be achieved with rhinoplasty.  Subtle asymmetries and contour irregularities will always remain, and for individuals who seek to constantly correct these things there is no limit to the number of revisions that may be performed.