Ask the doctor - Indianapolis Star - September 2008

As published in the Indianapolis Star September 2, 2008

Ask the doctor

Rhinoplasty (nose job) is complicated surgery

By: SHARI RUDAVSKY

Question: How often do people need revisions on their nose jobs?

Answer: It's very common for me to see the problem, because I'm known to fix noses. One of the ways that we evaluate our procedure is we see how many revisions of the nasal tip we are doing. If I do a rhinoplasty (nose job) and everything looks just fine but the healing process creates a situation where a bump shows up or there's a small depression or a slight asymmetry, those are variables that we have to deal with. We may need to do some degree of revision at least 3 percent to as high as 10 percent of the time. Those are pretty easy to do, and I do correct them.

Q: What about more serious problems?

A: It's an entirely different story when there are surgeons doing the operations that are not supporting the nose or taking too much cartilage and bone away and there's a collapse of the bridge or pinching of the nostrils, which creates breathing problems, asymmetries in the appearance of the nasal tip, or the nose remains quite crooked.

Q: Can such problems be prevented?

A: Of all the facial plastic surgeries that I do, rhinoplasty is the most technically demanding and the most difficult to predict the exact results. Every person's basic anatomy is different. There are trends in different types of noses, but when you look at a population, there's tremendous variability.

Q: Is a more extensive revision more difficult than the original surgery?

A: It is, and that's important for people to understand. Choosing the best surgeon they can the first time puts them miles ahead. It's one operation that you do not shop by price. If it doesn't turn out right, it will cost more and be more involved than the first time because it's more complex. Primary surgeries can range from $6,000 to $7,500. The second operation ranges from $7,000 to $10,000.

It usually takes not only modifying what had happened before, but bringing in building blocks, which include the person's own cartilage, which is usually obtained from the septum. If I can't use that, I need to use the next most available cartilage, which is ear cartilage.

Q: Can you usually fix problems?

A: We can rebuild the tip, the bridge of the nose. The beauty of this is it's much easier on the patient.

Q: How would someone know that they need revision surgery?

A: Sometimes it's kind of obvious, the fact that the nose doesn't look normal. It doesn't look right with their face, they hate their profile, or they have breathing difficulties. They snore more, because the nostrils or valve in the nose may be pinching in or collapsing. It's always unfortunate when things don't turn out right, but the good news is that something can be done, and that's really worth knowing.

Have a topic for Ask the Doctor? Contact Star reporter Shari Rudavsky at (317) 444-6354 or via e-mail at shari.rudavsky@indystar.com.

Dr. Stephen Perkins is a facial plastic surgeon with Meridian Plastic Surgeons.