Botched rhinoplasty, or just one that requires revision?
If you’re unhappy with how your nose looks in the weeks after surgery, most patients don’t have a bad result – they have a nose that’s still working through the healing process. That’s not me brushing off a genuine concern. It’s the single most useful thing to understand at this stage.
I’ve just returned from a run of conferences over the summer, at home and in Lisbon, and it’s left me thinking about a word I hear a lot from prospective patients but that I’m genuinely careful with: ‘botched’.
Botched rhinoplasty is a term that’s often used when a patient isn’t completely happy with the result after nasal reshaping surgery, and I think that does a disservice to a much more useful distinction. In my own practice, a botched rhinoplasty is specific: a result that needs significant reconstruction for functional reasons, aesthetic reasons, or both, where the outcome is genuinely worse than where the patient started. Most of the revisions I perform aren’t that.
They’re minor refinements to an otherwise sound structure – a small asymmetry, a little more definition at the tip – and that’s a normal part of rhinoplasty, not evidence that anything has gone wrong.
Why I’m careful with the word botched
Part of it is fairness to other surgeons. I work with people who’ve travelled to see me from all over the country, and occasionally from further afield, and it would be easy to be sensationalist about ‘nose jobs gone wrong’ and ‘cosmetic surgery tourism’. However, you can find highly skilled and specialised rhinoplasty surgeons abroad.
Calling every disappointing result ‘botched’ also carries a weight of blame that isn’t always deserved, and it isn’t something I think serves patients well either. It can make people feel embarrassed or judged for coming forward, when what they need is a calm, accurate assessment.
The trouble with judging a result too early
A nose is not a static thing. At the end of an operation, I can – within reason – make a nose look very favourable on table: good lighting, a little oil, the right angle. But that isn’t a live result, and it isn’t what the nose will look like once it heals. Skin has a memory, cartilage settles, and swelling resolves unevenly over roughly the first year, with the tip typically taking the longest. I deliberately don’t use on-table or very early post-operative photos in my own before-and-afters, because they’re not a fair representation of the long-term result, and I don’t think it’s right to set that expectation.
So, when someone tells me their result looks ‘botched’ at six weeks or three months, it is often because the nose is still settling, not because it has failed.
What leads to a genuinely poor outcome
When I do see a result that needs significant reconstruction, a handful of factors are usually behind it. Techniques that reduce or reshape the nose without reinforcing its structure – shaving down a hump without rebuilding support, for instance – can look convincing immediately and then change as they settle.
Heavy grafting, using large amounts of a patient’s own septal or ear cartilage, can leave very little to work with if a later correction turns out to be needed.
And at a recent conference I heard a presentation on what was, essentially, an off-the-shelf approach to rhinoplasty – a menu of set noses to choose from. It genuinely surprised me. A nose must fit an individual face, and it’s permanent, so treating it as a cookie-cutter choice does a disservice to the patient in front of you.
Consultation and consent matter just as much as technique. I’ve done a fair amount of work on clinical negligence and national consent guidance, and one thing comes through clearly: proper consent is a process, not a form you sign on the day. For an operation like this, I think patients need more than a single meeting – ideally at least two consultations, with time in between to think it over. When that process is compressed, or when there’s a communication gap between surgeon and patient about what’s achievable, the risk of a mismatch between expectation and outcome goes up considerably, regardless of how technically skilled the surgeon is.
A word on travelling for surgery
Medical tourism is a big part of this conversation, particularly for rhinoplasty, and I want to be fair. Good surgeons and good results exist well beyond the UK. But a few things are worth weighing up honestly.
Package-style pricing doesn’t always leave room for the multiple consultations I’d want a patient to have. Marketing images – before-and-afters in particular – are, in some markets, more likely to be altered than they would be here, which makes it harder to judge a surgeon’s real results. And continuity of care is genuinely harder to arrange from a distance: if a problem develops once you’re home, who do you call, and how quickly can they see you? None of that means the price difference isn’t real, or that people are wrong to weigh it up. It just means it’s worth asking those questions before you travel, not after.
If you think you may have had a botched rhinoplasty
A few honest bits of advice. Unless there’s something that needs urgent attention, like a sign of infection or real difficulty breathing, try to give it a year before judging the aesthetic result – it will very likely look different, and probably better, than it does now.
When you are ready to be assessed, see a surgeon who routinely performs revision rhinoplasty surgery, not only primary rhinoplasty; the two aren’t the same skill set, and not every surgeon who does one does the other. Ask to see their own revision results, from more than one angle. And expect, and ask for, more than one consultation before anyone agrees to a plan – if a surgeon is willing to book you in for a correction on the strength of a single conversation, that’s worth being cautious about.
For my own patients, I review as often as needed for up to a year after surgery, and where I’m revising my own primary operation, I don’t charge a further surgical fee – only the hospital costs involved. I think the surgeon who performs your rhinoplasty should be genuinely invested in how it turns out, well past the day of surgery itself.
If you’re unhappy with the results of your rhinoplasty surgery and wish to discuss your options, book a revision rhinoplasty consultation with Mr Annakan Navaratnam.
Mr Annakan Navaratnam is a Consultant ENT and Facial Plastic Surgeon based in London, specialising in septorhinoplasty and nasal surgery. He practises privately at Welbeck Hospital and The Clementine Churchill Hospital, with NHS consultant posts at the Royal National ENT Hospital and UCLH, and an honorary consultancy at Great Ormond Street Hospital. He is a national advisor for ENT with NHS England’s GIRFT programme and has authored over 70 peer-reviewed papers and six national clinical guidelines.
