One of the eminent European Rhinoplasty surgeons confided during an informal conversation, in Chicago 2011, that he would revise nearly half his cases. This, not to rectify mistakes of technique or vagaries of healing, but to make little tweaks and changes to enhance the results further. Now, I quite like his results and his aesthetic sense and I have thought about our little conversation several times over the last eighteen months.
The issues to consider in Revision Rhinoplasty Surgery are:
1. Cost implications of Revision surgery. Who covers the cost ?
2. Is another “down time” acceptable ?
3. Is a second Anaesthetic required ?
4. Is the Revision rate an indication of surgical skills and expertise of the surgeon. How ?
I would be concerned if a high proportion of Revision Rhinoplasty cases were choosing a different surgeon for revision surgery. Does a high revision rate indicate a higher proportion of dissatisfaction amongst patients? The answer perhaps lies in the proportion of revision cases that are going back to the same surgeon. This to me is a very good indicator that suggests that a high proportion are going for an improvement in an otherwise improved nose operated by the surgeon they trust.
I am quite sure that a vast majority of the patients of the eminent surgeon above are already happy after the primary rhinoplasty and the trust and the doctor-patient relationship is healthy.
In my experience, several patients who insisted on a very conservative surgery during consultations for a Primary Rhinoplasty … after achieving satisfactory results … realise that the successful nasal surgery has a low morbidity … and consider further changes, albeit carefully as is their nature.
The ultimate objective is to execute a safe and predictable procedure with minimal complications. Should this be planned in one stage or are further smaller tweaks acceptable to the patient and the surgeon?
I have started sharing these issues and observations with my patients during my Rhinoplasty consultation protocol.
10% Revision Rate is a generally accepted figure in global Rhinoplasty literature.
Our rate of revision at present is below 5%.
Looking at our own revision cases over the last five years it became apparent that most of these revisions are for further improvements and about a third of the revisions were necessitated by asymmetrical healing or irregularities.
