FAILED NASAL SURGERY
A botched rhinoplasty is not the same as a rhinoplasty that simply needs more time or would benefit from a minor refinement.
Mr Annakan Navaratnam, Consultant ENT and Facial Plastic Surgeon, reserves this term for a more serious and specific group of outcomes: those where significant reconstruction is needed – for functional reasons, aesthetic reasons, or both – and where the result is genuinely worse than the starting point.
Understanding that difference matters, because it shapes how a problem should be assessed and how it can be corrected.
ASSESSMENT
What is considered a Botched Rhinoplasty?
A result can be considered botched, rather than simply in need of refinement, when it involves one or more of the following:
- A structural problem serious enough to require substantial reconstruction, not a small adjustment.
- An aesthetic outcome that is significantly worse than the nose the patient had before surgery.
- A combination of functional and aesthetic problems that together significantly affect day-to-day life.
By contrast, most revisions Mr Navaratnam performs are minor refinements to an otherwise sound structure – a small residual asymmetry or more definition needed at the tip.
These are a normal and expected part of rhinoplasty, not evidence of a botched procedure, and are covered in more detail on our revision rhinoplasty page.
Common causes of a poor rhinoplasty outcome
Several factors, individually or in combination, tend to be behind the more serious outcomes described above:
Techniques that don’t reinforce the nasal structure
‘Quick fix’ approaches that reduce a hump or narrow a bridge without rebuilding structural support can look promising immediately, then change as swelling resolves and the nose settles over the following months.
Heavy or non-standard grafting
Some techniques use large amounts of a patient’s own cartilage, leaving little available for later correction, which can make a future revision considerably more complex and require external grafting from cartilage from the ear or rib.
An ‘off-the-shelf’ approach
A nose shaped to a fixed template rather than the individual’s face, skin thickness, and existing anatomy is less likely to heal or age well and may look unnatural.
Insufficient consultation and consent
Fewer consultations than are really needed to understand what a patient wants – or communication difficulties between surgeon and patient – increase the risk that the surgery performed doesn’t match what the patient expected.
Unrealistic expectations set by on-table or immediately post-operative photography
Lighting, oils and flattering angles can make a freshly operated nose look better than it will once swelling resolves, because the nose continues to change for months afterwards.
Reduced continuity of care
Where in-person follow-up is limited, whether because a patient has travelled for surgery or a service simply doesn’t build in review appointments, early complications can go unmanaged for longer than they should.
Untreated infection
Left unaddressed, infection can be serious and, in rare cases, affect the nose’s structural integrity.
Recognising the signs
The signs of a genuinely poor outcome tend to fall into two categories and can overlap:
Functional signs of a botched rhinoplasty:
- Breathing difficulty or nasal obstruction
- Collapse of the nasal valve on breathing in
Aesthetic signs of a failed primary rhinoplasty:
- A collapsed bridge or saddle deformity
- A pinched, notched or overly narrow tip
- Visible asymmetry that hasn’t settled with time
- An over-operated or unnatural appearance
- Retraction of the nostril rim (alar retraction)
Botched, or does it just need time – or a minor revision?
Most people disappointed with their results in the early months aren’t looking at a botched outcome; they’re looking at a nose that is still healing. Swelling resolves unevenly over roughly the first twelve months, and the tip can take the longest to settle.
Functional concerns, such as breathing, can also take time to become fully apparent. If concerns persist well beyond this point or fall into the more serious functional or structural territory described above, it’s reasonable to seek an assessment.
Correcting a botched rhinoplasty
Correcting a significantly poor outcome starts with a thorough assessment: examining the existing structure, the cartilage still available to work with, skin thickness and quality, and the techniques used in the original surgery.
From there, Mr Navaratnam works on a shared decision-making basis – explaining honestly what is achievable, what the trade-offs are, and, where necessary, whether the correction needs to be staged rather than completed in a single operation. Because these cases often involve rebuilding structure rather than simply refining it, they are generally more complex and typically take longer to plan and to recover from than a first-time rhinoplasty.
Choosing a surgeon to correct a botched rhinoplasty
A few things are worth checking before deciding who should undertake a correction:
- Ask to see the surgeon’s own revision results, from multiple angles, not just their preferred views.
- Confirm they routinely carry out revision surgery; not every surgeon who performs primary rhinoplasty also undertakes revisions, and a surgeon who doesn’t, may not be able to help if a further problem arises.
- Check the procedure will take place in a properly regulated UK hospital setting, with appropriate insurance in place.
- Ask what aftercare and follow-up is included, and for how long.
- Make sure you’re given enough consultation time before surgery – at least two consultations are typical – to be properly examined and to have a realistic conversation about what surgery can and can’t achieve
This lady had undergone surgery abroad and had an undesired outcome. I performed a complex revision to lower the nasal tip and restore a more natural appearance. These are her photos at two months after surgery.
“Choosing a surgeon for revision rhinoplasty was one of the most daunting decisions I’ve ever had to make. After already having a poor experience with my first rhinoplasty, I was anxious about putting my trust in someone again.
“I’m now just two months post-op, and I’m honestly still amazed every time I look in the mirror. My nose looks so natural, fits my face perfectly, and has given me a level of confidence I haven’t felt in years. It’s difficult to put into words just how much this has changed my life.”