Your question: Rhinoplasty Surgeon will no longer perform revision after originally agreeing to. What can I do now?
I had a primary rhinoplasty and was not happy with my results. My surgeon agreed to perform a revision waiving his fee. I had to postpone the revision. When I was ready to reschedule, my surgeon said he no longer did rhinoplasty and referred me to a surgeon who was double the price of my first surgery. I told this to my original surgeon he said he may be able to refund part of the original surgery but a week later his secretary called to say he wouldn't be able to refund me or perform a revision.
Dr. Denenberg's answer: You must start your research over from scratch.
You are probably lucky that your surgeon wouldn't operate on you again. From your previous post, it looks as though very little good happened in your first operation. Why did you think your surgeon would do a world-class brilliant job on your revision, when he did so little on the first operation? And revisions are ten times harder than primary rhinoplasties.
See the Web reference link, just below my response. I made a computer morph out of your image, to show some changes that are possible in truly expert hands. You didn't mention your profile, or post it, but it appears from your frontal view that your nose's length could be addressed in a revision as well. In the morph, I elevated the tip in addition to narrowing it and trying to straighten some of the asymmetries of the bridge.
Having a revision isn't just going in to have a revision and coming out with the nose you wanted. You must tell the surgeon exactly precisely what you don't like about your nose, and he must prove he understands what you are talking about, by using computer imaging, and he then has to prove to you that he can make those changes, by showing you his other revision rhinoplasty before and after photos. Because your surgeon sent you to this other revision surgeon, doesn't mean that the revision surgeon is qualified to operate on you. You must do the research yourself. The Web reference link gives some good advice on how to do that.
Finally, not to be too jousty here, but I'm in a mood this morning we often see an admonition something like this Be certain to consult with a board certified plastic surgeon to ensure you receive the highest-level of professionalism, knowledge, skill, treatment and care available. Let me guess your primary surgeon was board-certified. Do you feel you received the highest level of professionalism, knowledge, skill, treatment and care available? Sorry, but there is no organization out there that can always protect you. You must do your own research and protect yourself.
1) Proposed before and after:
Here's an animation of those changes. Give it a couple seconds to load:
Does this fit with what you have in mind for yourself?
2) Click here to comment on those changes, or to ask Dr. Denenberg a follow-up question.
3) Click here to see more revision rhinoplasty before and afters.
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or ask a follow-up question ...
Send your photos or questions to StevenD@FacialSurgery.com, or ...
Go here, to see how to position and take (and send) your photos.
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Plain talk about picking a plastic surgeon for your first-time or revision rhinoplasty.
I do lots and lots of revision rhinoplasties; I'll try to give you some advice here, to maximize the chances that you'll be happy after surgery, and to minimize the chances you'll need a revision.
Important!! How to tell whether your consultation was acceptable:
Photos. If a surgeon doesn't show you before and after photographs, scratch him off of your list. Period. No exceptions. Deal-breaker.
You pick a surgeon primarily from his before and after photos. Diplomas, board certifications, hospital affiliations, academic appointment, and even reputation tell you nothing: a surgeon is never tested for his skill, his artistic eye, the quality of his outcomes, or even whether he cares that his patients are happy.
You must see photos of other patients who had some features similar to your nose. For example, if your nose has a wide and drooping tip, don't accept profile-only photos of patients who had a hump carved down. You can't see the width of the tip on a profile photo.
Revision nose operations are much more difficult than first-time operations, so if you are consulting a surgeon about a revision operation, you must see photos of his revision patients.
If you do see the surgeon's photos, but you don't love them, scratch him off your list. You want to use a surgeon whose work you like. Don't assume that he'll do great on you when he didn't do great on the other people.
Thought experiment: you are going to hire a portrait painter to paint your portrait. Would you really hire the painter if he wouldn't show you any of his other portraits?! No, it would never occur to you to hire him. Well, now you're going to hire a surgeon to change your nose, in the middle of your face, and you aren't going to insist on seeing examples of his work, proof that he knows what he's doing? Think about it. Teach your friends.
Communication. If the doctor treats you disrespectfully, scratch him off your list. If he won't patiently listen to what you want for your nose, same thing. How will he know how to make you happy if he won't hear what you want for your nose?
If he conducts the consultation from behind his desk and doesn't examine your nose, deal-breaker. If it's the nurse and not the surgeon who conducts the consultation, run away fastest. All due respect to the nurse, she doesn't know what's possible and what isn't. If the plan is to see the surgeon for the first time on the morning of surgery, deal-breaker. For sure.
Computer morphing. If the surgeon doesn't do computer morphing of your nose, scratch him off your list. The morphing is crucial, so the surgeon can prove to you that he understands exactly what your goals are. Also, if the surgeon recommends some changes that you hadn't thought of, you need to see the morphs, so you can see whether you like those changes.
Your intuition. If your gut tells you "no," don't use the surgeon. Don't ever use a surgeon only because you know him, or your kids know him, or he lives on your street, or your primary care doctor referred you to him, or he did your breasts, or your tonsils, or your wisdom teeth, or you saw his advertisement, or his awards.
I hear these stories all the time from my revision rhinoplasty patients. You must do your own evaluation of any surgeon you visit. And by "evaluation," again, we're talking mostly about seeing his photos and seeing how well he communicates with you. Don't bother checking the surgeon's licensure and board certification and hospital affiliations and all that; it'll just distract you from what's important.
Conclusion. The fact is, the great majority of plastic surgeons who perform rhinoplasty shouldn't be doing the operation. It's an incredibly difficult procedure, technically demanding, requiring experience, skill, judgment, an artistic eye, an exceptional level of communication and thoughtfulness, and a rare level of empathy and caring for the patient. No hospital board protects you by judging the quality of a surgeon's rhinoplasties and prohibiting him from operating if he's terrible. It's the wild, wild west out there, folks.
More plain talk: should you let your primary surgeon perform your revision?
First, you need to consider whether things didn't turn out great on your first operation because of some unusual circumstance with the surgery or the healing, or whether things went wrong because your doctor was not expert in rhinoplasty in the first place.
Evaluate your surgeon again. Read the section above, on how to evaluate a surgeon for a rhinoplasty. If you saw lots of before and after photos of your surgeon's other patients who got excellent results, in noses at least somewhat similar to yours, then your surgeon probably knows what he is doing, and you can consider letting him perform your revision. Even the very best surgeon has the occasional disappointing result.
However, if, on looking back, you decide that you did not do excellent research on your original surgeon -- perhaps you relied on a referral, or on his board certification, without being able to see his photos -- then you probably should not have him perform the revision. If he couldn't get you close to your goal the first time because of a lack of skill, he will have no chance at all on the second try, and then you'll be in the tough position of looking for a third operation.
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