Alice 51*

Revision rhinoplasty

Performed by:
Dr. Jack Kolenda

*Patient name has been changed

Elevate: Tell me about the first surgery... what prompted it and what went wrong?
Alice: The first surgery took place in 1998. I had trouble breathing and consulted an ear, nose and throat specialist in Oakville, Ont., who asked whether I was interested in having rhinoplasty surgery, while my deviated septum was being done. I demurred but was convinced to do everything at once. Long story short, I was referred to a doctor in downtown Toronto who could do both, but elected not to use general anesthetic in hospital and instead completed the surgery in his office using a sedative only. But I was awake throughout, and it was quite painful, so he rushed to finish and it just wasn't done properly.

Elevate: What was the key problem with the outcome?
Alice: The breathing issue was resolved; however, the shape of my nose had completely changed and for the worse. The end of the nose was a completely different shape and more bulbous than it had been before. Plus the nostrils were completely different — and not a little but a lot.

Elevate: So at what point did you resolve to address the issue?
Alice: I waited until 2009 — 11 years. It took me that long to have any kind of appetite for another surgery. But I was completely fed up. I cringed every time I saw a picture of myself, and I just couldn't bear it any longer.

Elevate: So how did you find and decide upon Dr. Kolenda?
Alice: I got a referral from my family doctor. I wanted someone able to address medical as well as cosmetic issues. The turning point for me was that Dr. Kolenda described his procedure, which included general anesthetic. Plus, he was very experienced and knew straight away what the issue was and what needed to be done.

Elevate: How was the recovery the second time around?
Alice: It went quite well. There was some discomfort for the first couple of days, but it was very manageable. I took two weeks off but that was my choice. I could have returned to work after
one week.

Elevate: What advice would you give to someone considering revision rhinoplasty?
Alice: Do it sooner rather than later. I wish I hadn't waited as long as I did. Today, I am absolutely satisfied with the result.

Ask the Doctor

Dr. Jack Kolenda, MD, FRCSC
Oakville Facial Plastic Surgery

Apart from overall dissatisfaction, is there another common reason people seek out revision rhinoplasty?
Dr. Kolenda: It really depends on the patient. Sometimes it is a disconnect between the patient's expectation and the outcome. Sometimes infection plays a role. Other times the goals of the surgery just weren't met. And sometimes it's body dismorphism, though that wasn't the case with Alice. With her, she had certain expectations going into the surgery, and she was unhappy with the results.

Where does rhinoplasty sit on the scale of cosmetic surgical procedures that sometimes require revisions?
Dr. Kolenda: Rhinoplasty is one of the more difficult surgeries in cosmetics. Achieving good results takes skill, and any surgeon who performs the procedure will tell you there is a 10 per cent chance of revision. To put tat in perspective, the rate of revision for something like blepharoplasty (eyelid surgery) is probably one or two percent.

Is helping the patient overcome fear or cynicism about undergoing a second surgery part of the treatment?
Dr. Kolenda: Yes. Obviously the patient doesn't like what they are seeing and they want to correct it, but they fear they're going to go through this again and it won't work or that they're going to look worse than they look now. So you really need a careful examination of what the patient is looking for and what's achievable. Morphing imaging can help with that. And it's really important that the patient not rush into anything based on a first meeting.

What sort of questions should someone ask in considering a revision rhinoplasty?
Dr. Kolenda: You need to ask how experienced a surgeon is in doing that particular procedure. Ask to see before-and-after results from other surgeries. And be sure you are happy with that you are seeing.

What is the average cost of revision rhinoplasty?
Dr. Kolenda: It depends on the surgeon, but for me, I tend to charge about $6,000 for rhinoplasty. I have heard of chargesas high as $10,000, so it varies.