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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 a revision rhinoplasty 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 own solution and common problems that arise include the following:
A polly beak refers to post-operative fullness of the nasal bridge just above the tip (supratip area), with the supratip being higher than the tip. It gives 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. An example of a corrected polly beak is shown above.
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. An example of a corrected saddle deformity is shown above.
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, 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. An example of revised pinched tip is shown above.
A bossa is a knuckling of the nasal tip cartilage at the nasal tip that can occur with healing forces acting on weakened cartilages. 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 further smooth the area. An example of revised nasal tip bossa is shown above.
Alar (Nostril rim) retraction can occur with healing after rhinoplasty if the tip cartilages are weakened or not reinforced. Retraction results in pulling up of the nostril rim with excessive show of the columella or septum and tip asymmetry. Retraction and asymmetry can be corrected with release of scar and placement of cartilage grafts. An example of corrected alar retraction is shown above.
Revision rhinoplasty can achieve many of the same goals of a primary rhinoplasty including the following: removing a dorsal hump, straightening a crooked nose, refining (narrowing) a nasal tip, elevating the nasal tip, increasing tip rotation, shortening a nose or even lengthening a nose if so desired. But, as described above, additional issues often arise in the need for revision rhinoplasty and the overall the goal is to create a naturally appearing nose that fits your face and identity. Revision rhinoplasty often requires using cartilage or soft tissue grafts that may be harvested from your ear, rib, or scalp.
The initial consultation centers around your goals of nasal surgery, an examination of your nose in the context of an overall head and neck examination and a discussion of how best to meet your vision.
During your consultation, a variety of techniques for rhinoplasty may be discussed. A method is chosen that results in the best cosmetic and functional outcome for you (Link to Learn About Rhinoplasty.ppt). Pre and post-operative examples of other similar rhinoplasties are often reviewed. The details of the procedure and post-operative care are explained, and any questions you may have are answered. If a plan is confirmed to move forward with surgery, you meet with our patient care coordinator to schedule a surgery date.
Prior to your surgery, you may have one more pre-operative visit. This visit typically involves a pre-operative history and physical at our office. This visit is performed to assess any medical issues you may have and to ensure that your surgery is conducted in the safest manner. Pre and post-operative instructions are reviewed, and this visit is also an opportunity for you to ask additional questions that may have arisen after your initial consultation.
Once in the pre-operative area, you will meet the nursing and anesthesiology staff who will take care of you during your procedure. Your surgeon will meet with you and your family prior to the procedure to review the procedure and discuss any last minute questions you have. After the procedure is performed, you will be taken to the recovery room. You will have a nasal cast and likely intranasal splints in place that will be removed at your post-operative visit. All rhinoplasty procedures are performed as outpatient surgery, and you will be sent home with detailed post-operative instructions and pain medication. We will call you on the night of surgery to ensure that you are doing well and to answer any questions you may have.
Your first post-operative visit will be approximately one week after surgery to remove your sutures, nasal cast and any intranasal splints. You will then follow-up at one month after surgery and usually every three months for the first year after your surgery to ensure adequate healing.
As with any surgical procedure, there are risks such as bleeding, infection, poor healing and risks related to undergoing anesthesia. Specific to rhinoplasty, there are risks of deformity under-correction, over-correction, asymmetry, nasal obstruction, persistent numbness and stiffness, and the need for additional revision surgery. Revision rhinoplasty is more challenging than primary rhinoplasty given that your anatomy is altered from your previous procedure and scarring is present in the nose.