You know when you’re finishing up your liquid eyeliner wing and you think just one more swipe of eyeliner will make it perfect, but it ends up being way too much and you have to start all over? Well, when it comes to plastic surgery, there is no starting over from scratch once you have already had work done, but Haute Beauty talked to Dr. Deepak Dugar who told us about the reasons behind revisiting rhinoplasty and how it requires a special set of skills.

Haute Beauty: What are the main reasons individuals come back for a follow-up rhinoplasty?

Dr. Deepak Dugar: People come back for a follow-up rhinoplasty, most commonly, because of miscommunication with the surgeon. Picking the right surgeon from the beginning is the most important part of getting a rhinoplasty. Unfortunately, due to the cost, many people pick a “cheaper” surgeon and end up with not-so-ideal results. Not to say you have to “overspend” but you definitely get what you pay for, sometimes. The good news is, lots of patients wanting a revision rhinoplasty may not actually need it. Sometimes they are chasing the idea of a perfect nose, which doesn’t exist. They will seek out another surgery to fix the little asymmetries or idiosyncrasies that can occur post-surgery, which ironically are what makes the nose look natural and normal. Another main reason that people come back for a follow-up rhinoplasty is due to miscommunication during the consultation process. The intended goals of surgery from the surgeon and the intended desires of the patient were slightly off, and now left with a predicament of a “nose they never wanted.” I often tell my patients, being a minimalist, that worst-case scenario you may feel that I didn’t do enough. Because you will still look like yourself, but if you do too much, sometimes there is no going back.

HB: What is different about the procedure the following time?

DD: Revision rhinoplasty surgeries carry more risk due to the inherently harder anatomy to navigate. The scar tissue (a normal phenomenon) from the first surgery, makes it more difficult to finesse the nose and therefore I usually recommend an open rhinoplasty technique with a skilled revision rhinoplasty surgeon for these patients. I truly believe revision rhinoplasty is a totally different beast and requires a different mindset from a skilled surgeon who does revision surgery on a regular basis.

HB: What is the most important aspect to consider in choosing a surgeon for the revision?

DD: The most important aspect to consider when choosing a revision rhinoplasty surgeon is that they are very comfortable with carrying out revision surgeries. This means that they have significant practice is revision rhinoplasty procedures, totally understand your specific anatomy, and you have seen their revision work and you like what they have done. They need to be very skilled in revision rhinoplasty procedures, because sometimes when the surgeon gets inside the nose, it is even worse than he/she predicted, and the surgeon has to be prepared to take apart the entire nose and rebuild it from scratch if needed.

HB: Are there any possible complications following the procedure?

DD: The main complication following a procedure is that the patient will still not like the aesthetics of the second nose job procedure. This is always a risk because beauty is in the eye of the beholder. The patient might have desired something different than what he/she expressed to the surgeon or the way the nose healed is different than what the patient expected. There is an element of nature with this procedure, as the surgeon cannot control every single element, and patients should have a realistic expectation. No one ends up on their 6th nose job by accident. It usually was a trail of surgeries meaning to improve one small thing and it continues over and over. I try to caution every single patient seeking a revision rhinoplasty the tale of Michael Jackson. You don’t get to your 4th or 5th or 6th surgery overnight, but even the patient getting their 8th revision surgery, one day, was contemplating doing their 2nd surgery – so I urge patients to be very thoughtful in their decision making. The repercussions of recurrent surgery can be severe.

HB: What can a patient expect from a follow-up procedure and the results?

DD: If the patient does great research, and the surgeon fits the patient, then they should be happy with the procedure and the results. The key is realistic expectations. Perfection does not exist.

HB: What is your favorite way to prepare for fall?

DD: I love to prepare for fall with a quick vacation! Summer is my busiest season as it is the nose season! As a busy international rhinoplasty surgeon, I have students age 16-25 from all over the world who travel to see me in Beverly Hills to get their nose done on summer break. Summer has routinely been my busiest season, so I always take a quick vacation in September to rejuvenate and recover from the physical and emotional strains of so many surgeries. I truly put my everything into each surgery, so there is a huge emotional drain that occurs and I need to recharge myself to give my full self to my patients always! I have dedicated my life to nose surgery and the world’s best results and my patients need the BEST version of Dr. Dugar at all times. Self-care is the most important part of being a great surgeon because we have to give our best to our patients daily.

HB: Where was your favorite travel destination this summer and why?

DD: Summer is impossible for me to travel much because it is the busiest nose season of the year. Given my younger clientele and international clientele, May through August are the busiest months where we may do anywhere up to 40 noses a month to keep up the demand! But Hawaii is my favorite quick getaway as it’s so easy to get to from Los Angeles. I love the culture and the climate of Hawaii and feel blessed to be able to have the ability to spend time with my family in such beautiful destinations.