Rhinoplasty: Why Do Revisions Still Occur?

Benjamin C. Marcus, MD

Why do rhinoplasty revisions still occur? This editorial gives the editor's brief thoughts on the nature of the nose and surgery.

Rhinoplasty is often described as the most complicated of all plastic surgery operations. While the technical aspects of the operation are significant—the real enemy of our efforts are the ravages of time. Even the most experienced of rhinoplasty physicians have seen what started out as a good result falter and change over time.

In the modern era of structural rhinoplasty, the astute surgeon spends a nearly equal amount of time planning the surgical maneuvers for the aesthetic changes desired as well as the structural changes to ensure that the result is stable over time.

Given our advanced and improving understanding of how to stabilize the nose over time, the question remains—why do revisions still occur? It would be easy to assume that all revision rhinoplasty cases emanate from surgeons who do not have the knowledge or experience that a rhinoplasty specialist has. As a busy rhinoplasty surgeon, I can assure you this is not the case. Even the most talented colleagues I have (many of whom have authored chapters in this volume) find their own patients returning with concerns. Perhaps not at one year but sometimes 3, 5, or 10 years after the fact.

In truth, while we desire to change the shape of the nose the healing forces that occur over time can overcome even the best of plans. Rhinoplasty surgery will never be without revisions. However, our goal should be to craft surgeries that limit the eventual and inevitable changes as much as possible. Many of the chapters in this volume will detail management of difficult postoperative concerns. Our goal should be to perform primary rhinoplasty in a way that limits later revisions to minor corrections. While that is a worthy goal—as rhinoplasty surgeons we will always encounter cases that require significant improvement—the manuscripts in this volume will cover most of the key aspects of these secondary operations.