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Why is it so hard? To start with, these unfortunate patients are often traumatized from the first surgery. It is difficult to go through, the disappointment and embarrassment that can endure through the minimum of 1 year waiting to heal.
Secondly, going back into an area previously operated on is a huge unknown. It is impossible to say how the body will have reacted to whatever techniques were used, what details were emphasized and what ones ignored. Add to that scar tissue which makes the dissection much more tedious and identification of normal anatomy challenging.
Then you have the cosmetic considerations of how you are going to get from point A to point B. How to take a nose which is often in worse shape than it started and make it aesthetically pleasing, while also addressing any breathing issues. Many poor rhinoplasty results also have damage to key components for comfortable nasal airflow.
It can be truly the worst case scenario.
Fortunately, there are many great Revision Rhinoplasty surgeons out there. I am selective with the cases I take on. I only operate if I believe there’s a very good possibility to achieve my own personal high level of aesthetic standards. That said, if I see someone in consultation who I don’t believe is a good candidate, I will always offer them other possible solutions or refer them to other well known Revision Rhinoplasty specialists.