Richard E. Davis, MD FACS - The Center for Facial Restoration in Miramar, Florida

Risk Factors in Primary and Revision Rhinoplasty

In general, nasal surgery, whether functional or cosmetic, is exceedingly safe. Serious complications such as hemorrhage, infection, or allergic reactions are quite rare, and most of these complications can be treated effectively. However, cosmetic risks vary greatly according to the circumstances at hand. In general, a first time rhinoplasty (also known as primary rhinoplasty) is far less risky, particularly in the hands of an experienced rhinoplasty surgeon. Secondary, or revision rhinoplasty, in which the tissues have been previously damaged by prior surgery, is always associated with increased risk, all other factors being equal. In addition to pre-existing inflammation from prior surgery, revision rhinoplasty must also overcome increased subcutaneous scarring, diminished blood supply, reduced skin elasticity, and damaged or missing skeletal elements. In some cases, existing deformities are so severe as to preclude complete normalization of the nose in a single procedure, if at all.

While the overwhelming majority of cosmetic rhinoplasty patients avoid serious complications entirely, some patients fail to achieve the desired cosmetic result. Although an unfavorable cosmetic outcome can be due to a wide range of causes, poor technical execution is often to blame. Thus, the importance of good surgical technique cannot be overstated, as a technically flawed operation is doomed to failure from the very start. On the other hand, even a well-executed operation can be affected by unforeseen (post-operative) tissue changes. Scar formation, skin contracture, or warping of cartilage may spoil the otherwise satisfactory surgical effort. Even in comparatively favorable circumstances, slight cosmetic imperfection is inevitable, regardless of how skilled the surgeon. While a misshapen nose cannot always be transformed into a beautiful nose, particularly one without flaws, a careful pre-operative history and examination can help to avoid the possibility of an unsatisfactory outcome. Favorable findings, coupled with realistic expectations, and a skilled surgeon, usually combine to produce a successful cosmetic outcome with negligible complications.