NYC Rhinoplasty Surgeon, Dr. Sam Rizk

Roughly 10-15 percent of rhinoplasty patients are dissatisfied with their primary rhinoplasty nationwide and seek revision rhinoplasty, also known as secondary rhinoplasty. But is it harmful to undergo multiple revision rhinoplasties? It depends on a number of factors.

First and foremost, it is important to note that it depends more on what was done in prior surgeries, and on factors specific to your anatomy, than it does on how many rhinoplasty procedures you have undergone. Factors that must be considered by you and your surgeon include the following:

• Integrity of the nasal skin
• Thickness of the skin (if you have naturally thin skin or if it’s thinner due to prior rhinoplasty procedures, the risk of undergoing additional procedures may be too high)
• How much cartilage was removed
• Whether you need skin grafting
• Amount of scar tissue
• Extent of deformities
• Psychological condition of the patient

Revision rhinoplasty is very technically challenging, so even one revision should not be taken lightly. For this reason, it is also imperative that you select a facial plastic surgeon specializing in revision rhinoplasty to perform any additional revisions.

Also, it is very important that you have realistic expectations. With each successive procedure, the odds of a successful outcome diminish. The only way to know for sure is to get an evaluation from a qualified revision rhinoplasty specialist.

More often than not, patients requiring secondary rhinoplasty or revision rhinoplasty have had too much cartilage removed during their primary procedure. An area of the nasal structure may collapse if too much of the area is resected. For example, the saddle of the nose may collapse, resulting in a “scoop” look and possibly leading to breathing difficulty. The internal or external nasal valve is another area that can collapse if cartilage is removed improperly, or if too much cartilage is removed.

Unfortunately, many secondary rhinoplasty or revision rhinoplasty patients have already undergone a few rhinoplasty procedures before reaching out to New York City Facial Plastic Surgeon, Sam Rizk, MD, FACS. Many of these patients have cartilage depletion or a lack of cartilage in their nose.

Dr. Rizk is known for a revision method that both rebuilds cartilage or bone and restores proper breathing. He may use auricular (ear) cartilage, nasal septum cartilage, irradiated rib cartilage, or alloplastic biocompatible implants, depending on the nature of the problem as well as the patient’s unique needs.

For internal and external nasal valve collapse, Dr. Rizk may use spreader and nasal batton grafts. Saddle nose deformities may be repaired using dorsal grafts and/or spreaders. The grafts are harvested and then shaped to create the proper size, thickness, shape and dimension, and occasionally depending on the size and number of cartilages needed to be grafted, an open rhinoplasty approach may be needed. Dr. Rizk uses the endonasal approach to create a precise pocket to accommodate the graft. This approach is minimally invasive and results in less scar tissue formation, as well as better healing.

For more information, contact Dr. Rizk.

If you are unsatisfied with the results of your primary rhinoplasty surgery (the original procedure), what you need to look for this time is a nose specialist. This is very important because revision rhinoplasty is a complex procedure – perhaps the most complex of all cosmetic procedures. But how do you determine who is and isn’t a rhinoplasty specialist?

A good way to narrow your search is to focus on board-certified facial plastic surgeons. Though general plastic surgeons are also qualified to perform rhinoplasty, they rarely specialize in procedures of the face. As a general rule, facial plastic surgeons perform more rhinoplasty procedures on a monthly and yearly basis than general plastic surgeons do. The American Board of Facial Plastic and Reconstructive Surgery (AAFPRS) has strict requirements that surgeons must meet to acquire and maintain certification.

Note that not all facial plastic surgeons specialize in rhinoplasty. So, to further winnow down your list, focus on surgeons who perform a large number of rhinoplasty procedures. Your surgeon should have experience using advanced grafting techniques with different types of cartilage (ear cartilage, irradiated rib cartilage, etc.). In addition to having experience with revision rhinoplasty, he or she should also have extensive experience performing rhinoplasty on different types of noses, including different ethnicities and shapes.

Ask your surgeon to see pictures of rhinoplasty patients. This is important because you and your surgeon may not share the same sense of aesthetics. Ask to see examples that are similar to your situation. Also ask to see some that are different, as different nasal characteristics look good on different faces. Some surgeons have a signature look; this isn’t a good thing, because everyone’s face is different.

A good tool for determining if you and your surgeon are on the same page is 3D imaging. This technology can help you understand if your prospective surgeon understands what you’re looking to achieve in your secondary surgery.

Also make sure to read testimonials from other patients, and ask to speak with patients who have undergone revision rhinoplasty with your surgeon.

In the end, trust your gut. If you have a bad feeling about a particular surgeon, don’t be afraid to walk away.

Generally, Double Board Certified, New York City Facial Plastic Surgeon, Sam Rizk, MD, FACS, advises patients to wait at least a year following their primary rhinoplasty procedure before undergoing revision rhinoplasty (secondary rhinoplasty).

Although some problems, such as displaced cartilage or bone, can be addressed as soon as a few months after the original rhinoplasty procedure, most cannot. This is because it takes a year or more for the scar tissue that develops to soften, and because the skin and soft tissue that surround the structural components of the nose remain swollen for a year or longer. Most facial plastic surgeons agree that some residual swelling lasts even longer. Until swelling has fully subsided, your surgeon will be unable to determine the right course of action. You yourself might decide that you don’t need revision once the swelling is gone.

Of course, as with any cosmetic procedure, the amount of time you need to wait before having revision rhinoplasty depends on the specifics of your situation. It also depends on what you are trying to achieve. There is no one-size-fits-all answer to this question.

It is important to note that while primary rhinoplasty is considered a very complex procedure, secondary rhinoplasty is even more complicated – perhaps the most complicated of all cosmetic surgeries – so it is extremely important that you enlist the services of a highly qualified, experienced rhinoplasty specialist such as Dr. Rizk. If a surgeon advises you to have revision rhinoplasty too early, the results may be disastrous. Some of the most serious complications associated with nose surgery can occur as a result of a prior revision surgery that was performed too soon. Performing surgery too soon can also lead to poor healing.

In sum, if you recently underwent primary rhinoplasty, patience is important. Contact Dr. Rizk for a thorough evaluation.

Before	After
24 yo female who underwent revision rhinoplasty with Dr. Sam Rizk using banked rib cartilage and temporalis fascia to correct an overshortened, scooped nose with multiple areas of collapse secondary to previous rhinoplasties. Patient is shown 1 year following revision rhinoplasty with Dr. Rizk. The short nose is one of the most difficult deformities to correct.

Watch this patient’s testimonial video

Plastic surgery does not always go the way it should. Unfortunately, very often the outcomes of plastic surgery do not meet the expectations of many patients. With revision rhinoplasty, sometimes a surgical mistake or poor healing can result in a bad outcome requiring revision rhinoplasty.

Dr. Sam Rizk is a double board certified top facial plastic surgeon in New York who does revision rhinoplasty. In one of the cases shown on the FOX National News segment about Plastic Surgery Nightmares, Dr. Rizk helps correct multiple areas of the patient’s nose, damaged by previous plastic surgeries. After the reconstructive operation, the patient’s nose looks straighter, more defined, and has improved breathing capability.