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wasperformed FacialSurgery.com
Steven M. Denenberg, M.D.
Dr. Denenberg's articles on Medium.com.


When can I have my nose redone after a previous unsatisfactory rhinoplasty?

It's important to wait one entire year after a rhinoplasty before making another attempt.

The scar tissue that forms underneath the skin of the nose after a primary (first-time) rhinoplasty is hard at first, as is any scar.  If you have a scar from an operation, such as an appendectomy, the scar starts out being quite firm; it feels like a cord underneath the skin.  With time, the scar softens, so that eventually you can't find your appendectomy scar by feeling for it -- you have to look for the scar, because it feels just like the surrounding skin.

The scar tissue in the nose starts out hard, and after a few months it starts to soften.  You can't feel much of the firmness, except perhaps at the tip of the nose, which might feel more solid than natural, but the firm scar tissue is there, underneath all of the nasal skin, until the scar has had time to soften.  It takes about a year for the scar tissue to soften completely.

If a surgeon attempts a revision rhinoplasty before that scar tissue has had a chance to soften completely, he is operating with one hand tied behind his back, because he is guaranteeing himself a difficult time trying to fight through the firm scar.  Even after it has softened, the scar tissue makes a revision operation difficult, but before it has softened, it's just impossible.

Also, as the swelling in the nose decreases after a primary operation, the nose gradually looks different, hopefully better, and it's important to wait until the swelling has resolved and the nose stops changing in appearance before attempting a revision operation.  Scar tissue under the skin of the nose can also shrink as it softens, further helping with the appearance of the nose.  If you operate too early, the surgeon may be operating to correct problems that would at least partially correct themselves as the rest of the swelling resolves.  He doesn't really know how much to do if he operates too early.

Re-operating on a nose too early can be likened to building a house on a soil foundation that is still settling: you want everything to stop moving before you decide exactly what changes to make and attempt those changes.

Finally, we have said that a revision rhinoplasty is much more difficult than a primary rhinoplasty.  A third-time operation is even harder yet.  You want to give yourself every possible advantage before having a secondary operation, to absolutely minimize the chances that you'll need or want a third operation.

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