It is important that these limitations are also illustrated in any photo impressions of the operation result. Photo impressions should give an idea of a realistic result, rather than of an idealistic outcome.

Surgeons do encounter patients who are not quite satisfied with the result of previous operations. It is important to keep expectations realistic. The surgeon has to work in the face of several obstacles, such as very thick skin, thick nasal bones and fibrosis. In revision surgery previous scarring increases the possibility of bleeding and tissue swelling. Bruising is more likely in revision operations. Patients undergoing second or subsequent procedures would have a longer period of recovery, with swelling persisting for a longer period of time than in those individuals having surgery for the first time. If the individual’s nasal septal cartilage has already been used previously there may be a lack of cartilage, which means that the surgeon may have to harvest grafts from other places such as the ear. In revision procedures there is an increasing likelihood of irregularities of the profile due to use of cartilage grafts which may be used for support or to correct twisting.

Very often in Mediterranean noses there are deviations in the nasal cartilage due to injuries in childhood which have been long forgotten. The surgeon has got to be aware of sinusitis and nasal allergy which contribute to the problems that are faced by patients. It is not easy to correct breathing problems which arise as a result of previous cosmetic surgery to the nose. The best time to get things right is the first time, although revision may be necessary if the individual patient heals with abnormal scarring. It is very important for the patient to realise that sometimes, ensuring a good airway may need a compromise on the cosmetic result.