Cindy 35*

Procedure:
Revision rhinoplasty

Performed by:
Dr. K. Conrad

*Patient name has been changed

Elevate: Tell me about the first surgery... what prompted it and what went wrong?
Cindy: It sounds stupid, but mainly I did it because two of my friends were doing it so I did it, too. I didn't even do a lot of research into the doctor; I just went to the same doctor my friends went to. But I had never liked my nose. I got teased growing up. This was 1997.

Elevate: What was the key problem with the outcome?
Cindy: I didn't look horrible and I didn't hate it, but I think it was done wrong. As time went by, the scar tissue built up to the point where I started having breathing problems. This was about two or three years later. Of my two friends, one I haven't talked to in years, but the other has had problems as well.

Elevate: So, at what point did you resolve to address the issue?
Cindy: I am a massage therapist and my breathing was affecting my work. I mean, can you imagine getting a massage from someone that sounds like Darth Vader? It was disturbing and creepy. No amount of Enya could drown that out.

Elevate: So how did you find and decide upon Dr. Conrad?
Cindy: I went to my GP, who referred me to an ear, nose and throat doctor, who referred me to Dr. Conrad. And then it came up: Did I want a cosmetic enhancement at the same time, and I said, 'Sure, why not?' And I actually started crying when I met with Dr. Conrad, because he could tell right away the trouble I was having and he told me I'd get my career as a massage therapist back. This would have been around 2002. I mean, I didn't think I'd be able to work in my chosen profession... now I have my own business, and I really don't think that would have happened had I not had the second surgery.

Elevate: How was the recovery the second time around?
Cindy: The first time, my eyes were swollen shut and my lips were so fat they cracked and bled. With Dr. Conrad, it was a lot less — a little bruising and maybe one black eye, but that was because I fell asleep with my head to the side which he told me not to do, so he was very good with his instructions.

Elevate: What advice would you give to someone considering revision rhinoplasty?
Cindy: Don't be afraid to shop around until you find a surgeon you are comfortable with, so that no matter what happens they are going to find the answer
with you.

Ask the Doctor

Dr. K. Conrad, MD, FRCS, FRCSC, FACS
plasticsurgery-toronto.com

Apart from overall dissatisfaction, is there another common reason people seek out revision rhinoplasty?
Dr. Conrad: Rhinoplasty is very intricate and unusual for a number of reasons. The nose is right in the centre of the face, so it's prominent. We are operating very close to the eyes and the brain; it's the upper-most extent of the respiratory system and the area we're working in is quite small. It requires more training, artistry, scientific knowledge and experience than any other cosmetic procedure we perform. So even in the best hands in the world, there is a five to 15 per cent chance that a touch-up or a tune-up will be required. And sometimes these are carried out at my insistence rather than the patient, because I feel I can come closer to perfection, although Cindy's case was not that.

Within that five to 15 per cent margin, what percentage of revision or touch-up surgeries are cosmetic and what percentage are medical?
Dr. Conrad: Usually cosmetic and it's usually related to the healing, which is very difficult to predict and varies from person to person depending on age, gender and so on. There might be some depression or fullness in the nasal pyramid that requires some adjustment. And it takes months to determine what, if anything, is needed.

Yet in Cindy's case, breathing seemed to be a bigger issue than aesthetics.
Dr. Conrad: Yes and no. We discussed how to refine her nasal anatomy and make it more natural and suitable for her beautiful facial features and at the same time, we agreed that she desperately needed to improve her nasal physiology in order to improve her breathing.

Is helping the patient overcome fear or cynicism about undergoing a second surgery part of the treatment?
Dr. Conrad: It's a major portion of this treatment. The patient must have tremendous trust in the surgeon's skills. Plus it's elective surgery and they can postpone it comfortably for a couple of years, so it's a very difficult decision to make.

What is the average cost of revision rhinoplasty?
Dr. Conrad: The cost of revision rhinoplasty is definitely higher than the cost of primary rhinoplasty, which starts at about $10,000. The cost goes upward from there depending on how complicated the revision is, the experience level of the surgeon and so on. But the main reward for the surgeon performing this operation is not the fee but the patient's happiness and, in some instances, in closing the case after many operations.