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Revision Rhinoplasties – Why Are There So Many?
By admin | March 30, 2009
Last Thursday I performed four nasal surgeries. Two of the four patients each had three previous rhinoplasty surgeries!
So why are we seeing so many redos? My sense and that of other experienced nasal surgeons is that the rate of revision rhinoplasty is too high. There is a small percentage of patients, who in the best of rhinoplasty surgeons’ hands will require touchups. However, my sense is that currently the percentage of poor results and dissatisfied patients is too high and would be unacceptable in other surgical specialties such as chest surgery, heart surgery or neurosurgery.
So what is it about cosmetic nasal surgery that lends itself to a high percentage of unsuccessful results? I believe the reasons are related to the surgeons performing the procedure. Today, because there are so many cosmetic and plastic surgery procedures that can be performed, often the training in each individual procedure during residency training is diluted. Too many residency graduates have had too little experience in cosmetic procedures and hardly any nasal cosmetic surgery training. Nasal surgery is unquestionably the most technically demanding and artistic of all the cosmetic procedures. It takes many cases performed under supervision of superior surgeon-teachers to deliver great results. If one cannot get that experience as a resident, the likelihood of practice success with those procedures, unless additional training is pursued, is dismal.
Dr. Kotler's patient - Revision Rhinoplasty before/after photo
Further, patients bear some responsibility. They practice poor decision-making. The best-informed patients, who did their homework, realize that this is the age of superspecialists. Surgeons who offer a multi-page menu of services are not likely to be superior at any of them. Conversely, those cosmetic and plastic surgeons who offer a very limited menu, who operated as a boutique, rather than a department store, are more likely to deliver better results and, therefore, have a lower dissatisfaction rate.
In my career, having performed over 4,000 nasal surgeries, including rhinoplasty septoplasty and turbinate surgeries to improve the airway, I have tackled some very difficult cases. I do not think I would feel comfortable managing them were it not for my long experience, my superior training at several universities and my preceptorships plus my experience as a military surgeon during the Vietnam War.
In my book, Secrets of a Beverly Hills Cosmetic Surgeon, I mention that great training and long experience plus superspecialization is the formula for success in nasal plastic and nasal cosmetic surgery.
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