Re-do Nose Jobs in Ventura: How Many Rhinoplasties is Too Many?

Recently, a patient from Ventura, California, named Ms. CE presented to my office with the following story:

I am a 36-year-old woman, and I have had three cosmetic operations on my nose.  [By the way, all the operations were performed in Beverly Hills--certainly a much over-rated spot for plastic surgery.]  Yet, I am still unhappy.  I have trouble breathing through both nostrils (especially the right), and I don't like the way it looks.  Is it possible for me to have another surgery, or should I just live with my nose?

This is a very tough situation.  Re-do nose jobs (also known as secondary rhinoplasties, or tertiary rhinoplasties, or--in this patient's case--quaternary rhinoplasties) are extremely challenging.  Amongst aesthetic plastic surgery operations, they are considered the most difficult of surgeries.  Just look at Michael Jackson; no amount of money, time, expertise, or intelligence is going to help his nose!

The problem with repeat surgery is that each operation creates scar tissue, weakens nasal support, and reduces the blood supply to the nose.  If the operation does not go perfectly, then the situation is progressively more difficult to remedy.

When I meet a patient to discuss re-do rhinoplasties, I carefully evaluate...

• the quality of the overlying skin
• the quality and presence of the structural support (the cartilage and the bone)
• the quality and condition of the inner nasal lining (the mucosa)
• whether there are functional airway problems (such as collapsed nasal passages)
• the overall aesthetics

Sometimes, the skin, cartilage, bone, and mucosa are perfectly healthy--almost as if the first surgery had left no scar tissue.  In these rare circumstances, there is a good chance that a secondary procedure will be completely successful.

More frequently, however, there is significant scarring and failure of the cartilages.  In these circumstances, the patient and I must make compromises.  She and I must identify the area or issue that bothers her most, and then we need to focus on that.

In the case of Ms. CE the issue that bothered her most was her breathing.  Based upon her degree of scarring, I thought that it would be unlikely that I could optimize both her airway and her appearance.  So, my revision surgery focused on opering up her nostrils so that she can breathe better during exercise and sports.

After she had healed from surgery, I used Juvederm and Radiesse to remold her nose non-surgically.  Her aesthetic appearance is now acceptable, albeit not perfect.

If Ms. CE had been unreasonable--expecting me to correct both her airway and her appearance with a heroic fourth rhinoplasty--I would have had to decline surgery altogether.  Repeat surgery is just not as accurate and predictable as I wish it were.