A closer look at corrective rhinoplasty techniques

Many patients are familiar with rhinoplasty – or the more colloquial term, "nose job" – but fewer are as informed about a procedure that can sometimes follow. Corrective rhinoplasty, also known as revision rhinoplasty, is a procedure that is used to address issues that have arisen from a previous rhinoplasty.

The reason for a corrective rhinoplasty can vary from the patient not being satisfied with the overall appearance to the need to address full structural changes within the nose. Corrective rhinoplasty is a highly individualized procedure, as exact needs differ from patient to patient and techniques vary from surgeon to surgeon.

What goes into a successful corrective rhinoplasty procedure? Who are the patients that this type of procedure is best suited for? How do you determine the right steps to take to correct a previous rhinoplasty procedure?

To gather more insight into the field of corrective rhinoplasty and what this procedure entails, we reached out to ASPS Member Surgeon Richard Reish, MD, FACS. He provided invaluable insights into this topic, best practices for corrective rhinoplasty patients and thoughts on how to identify the right surgeon to perform your procedure.

The patient profile for corrective rhinoplasty

As with many highly individualized procedures, corrective rhinoplasty has no one patient profile. The primary commonality is that each patient pursuing this type of procedure has already undergone at least one rhinoplasty with unsatisfactory or unsuccessful results.

"In my practice, I see patients of all ages who have had one surgery and those who have had 10 surgeries," said Dr. Reish. "I have patients in my office with terrible results and some that have good results but want better. A lot of other patients we see have breathing difficulties – we have a lot of different techniques that can address this issue and rebuild the internal structure."

Yet, corrective rhinoplasty isn't an option for everyone.

"There are a few different types of patients that should avoid corrective rhinoplasty altogether," said Dr. Reish. "One, patients with body dysmorphia. These are patients with very small imperfections in their results, and they often view it as ruining their lives and have a disconnect with what they look like in reality. As a surgeon, it's important to make your patients happy and help them, but sometimes you need to take a step back and say, 'I'm not going to offer you harm by performing this surgery.'"

Another consideration for plastic surgeons to take into account is the patient's attitude towards their previous surgeon.

"I do not perform surgery on patients who express anger or say negative things about their previous surgeon – they're still in the stage of anger," said Dr. Reish. "One of my goals in my practice is to support the previous surgeon, both to the patient and to my staff. I will never say the name of the previous surgeon in front of any of my staff, residents, patients or visitors, following what I like to call the 'No Name Rule.' You never know – your patient could be in their operating room the next day. You want to be good and kind and fair to other surgeons out there."

Determining the proper steps for corrective rhinoplasty

Once a surgeon has decided to move forward with corrective rhinoplasty for their patient, the next step is to determine the right approach to take. Many, if not all, surgeons will ask patients for their perspective on what they want their results to look like using before and after images of other patients from their practice.

"My best advice to patients is to only use the surgeon's photos for a vision board," said Dr. Reish. "We as surgeons have to be good, ethical people and help patients make educated decisions about whether or not they should have surgery. Part of that is being honest about your before and after pictures."

With before and after images, it's of the utmost importance to have patients look through their surgeon's actual photos. That's because many patients fall into the trap of bringing photos of their favorite celebrities or from social media.

"I publicize it so much on social media that I only want images sourced from my own website or my own work, but some patients will sometimes come in with photos, and I have to tell them no," said Dr. Reish. "With social media, you run the risk of filters and editing. You can never really know what the person looks like in real life."

Some plastic surgeons use 3D simulations to demonstrate what the patient's results will look like after the revision. This can help patients visualize their goals and what they may look like following the full recovery process, but 3D simulations can be misused among surgeons and can mislead the patient.

"Just because you're seeing it in a 3D simulation doesn't mean that the surgeon can actually do it or has the intention of doing it during your surgery," said Dr. Reish. "If a good surgeon who has lots of experience and great before and after images and is using this as a tool to communicate goals, that's totally fine. On the other hand, if they're using it to sell surgery or as marketing gimmicks to show maneuvers that they don't have experience in or intentions of doing, it's unethical. It will lead to bad results."

Next, it's important that the patient and surgeon have open communication. Their physician should inform them of the process from start to finish and be easily reachable with questions or concerns prior to and following the procedure.

"For me, it's all about communication, even before surgery," said Dr. Reish. "During the consultation, I give each patient my personal cell phone. I keep a hands-on approach with everything that I do. The major advantage in this is that I like to keep really close tabs on my patients, and it facilitates them reaching out to me directly versus finding bad information through other means."

Revision rhinoplasty may be the key to correcting a procedure that was unsuccessful or did not help a patient reach their original aesthetic goal. Surgeons and patients should work closely together to identify how to achieve their aesthetic goals.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.