At Seattle Face & Skin, we aim to partner with our patients to provide the best possible care for aesthetic facial rejuvenation and reconstruction. From the moment you contact our office, we focus on your needs to ensure you fully understand the possibilities, limitations, and opportunities available to produce the best outcome for you. Our team is led by Dr. Amit D. Bhrany, a double board-certified in Facial Plastic Surgery and Otolaryngology (Ear Nose, and Throat Surgery) and an active member of AAFPRS (American Academy of Facial Plastic & Reconstructive Surgery). After earning his bachelor’s degree in biomedical engineering and doctorate in medicine from Boston University, he completed his residency in Otolaryngology-Head and Neck Surgery at the University of Washington (UW). Dr. Bhrany then spent two years of additional sub-specialty training, developing skills for cosmetic facial plastic surgery, reconstructing all aspects of the head and neck, as well as head and neck cancer surgery and microsurgical reconstruction after being awarded fellowships in Head and Neck Surgery at the University of Auckland in New Zealand and Facial Plastic Surgery at UW.
What is Revision Rhinoplasty?
If your goals are not met after a rhinoplasty, the thought of needing a revision rhinoplasty is often disappointing. We specialize in revision rhinoplasty and understand that situation. Our goal is to ensure that this procedure is the right choice for you and, if so, that you achieve the best result possible. Revision rhinoplasty is sought for a variety of reasons including issues that were not fully corrected during the initial rhinoplasty or undesirable effects as a result of the rhinoplasty. Each specific issue necessitates its solution and common problems that arise include the following:
- Polly Beak Deformity: A “polly beak” refers to post-operative fullness of the nasal bridge just a little bit higher above the tip, which is called the supratip, giving the nose a parrot’s beak type of appearance. This deformity may occur for a variety of reasons after primary rhinoplasty including failure to maintain adequate tip support resulting in a droopy tip, inadequate cartilage hump removal, or from scar formation in the supratip region. Revision surgery addresses the specific cause of the polly beak.
- Profile Deformities: Persistent Hump Deformity or a Collapsed Nasal Bridge (Saddle Deformity): Persistent deviation after rhinoplasty may occur at the upper nasal bridge (bony nasal vault), middle nasal bridge (cartilaginous vault), or tip of the nose. Bony vault deviations typically require re-fracturing the nose (osteotomies) whereas cartilaginous vault and nasal tip asymmetries often require re-straightening the septum or placing a number of cartilage grafts to maintain symmetry.
- Collapsed/Pinched Nasal Tip: A collapsed or pinched nasal tip can result after rhinoplasty if too much cartilage of the nasal tip is removed. Not only can the nasal tip become pinched, but nasal obstruction can also result. Correction involves using cartilage grafts to strengthen and shape the nasal tip to a more natural appearance with improved function.
- Tip Bossae (Knuckling): A bossae is a knuckling of the nasal tip cartilage at the nasal tip that can occur with healing forces acting on weakened cartilage. Patients with thin skin are especially at risk. Correction can involve trimming or excising the offending cartilage. In some cases, the area is covered with a thin wafer of cartilage, fascia, or other material to smooth the area further.
- Alar (Nostril Rim) Retraction: Alar (Nostril rim) retraction can occur with healing after rhinoplasty if the tip cartilages are weakened or not reinforced. Retraction results in the pulling up of the nostril rim with an excessive show of the columella or septum and tip asymmetry. Retraction and asymmetry can be corrected with the release of the scar and placement of cartilage grafts. An example of corrected alar retraction is shown above.
