Rhinoplasty Revision

Revision rhinoplasty is a surgery done to correct or alter any changes that were created by a previous nose job operation. The revision can be either cosmetic or functional.  A cosmetic revision is if the patient has some lingering issues that he, or she, is not happy with such as wanting the tip of the nose to be narrower.  A functional revision occurs when the patient needs additional surgery if they are having trouble breathing as a result of the previous surgery. Revision rhinoplasty is not necessary done after every nose job and is actually determined on a case-by-case basis. The goal with revision rhinoplasty is to make sure patients look natural with an aesthetically pleasing nose that fits their face. When too much rhinoplasty work is done, the shape of the nose no longer fits the face.

Am I a Good Candidate for Revision Rhinoplasty?

As mentioned above, revision rhinoplasty is not necessary for all rhinoplasty patients. GOOD CANDIDATES for the procedure include:

• A person whose skin is not too thin or thick because thin skin will not allow proper camouflage if there are any irregularities and thick skin will not allow proper definition to be seen
• A person who is not happy with the results of a previous rhinoplasty surgery
• Patients who suffer from underresection (not enough taken off) or overresection (too much taken off)
• A person whose nose has suffered some form of trauma or injury since the previous rhinoplasty

On the other hand, patients who are NOT GOOD CANDIDATES include:

• Patients who have really thick skin like Asians and African-Americans. If they had a previous surgery, and still feel like their nose needs to be narrowed, the doctor cannot control the thickness of their skin and will not be able to show all the changes underneath. The thicker skin also makes it is harder to get the tip of the nose to be more defined.
• Someone who has not waited long enough for the results of a previous surgery to heal to see the final results.
• Patients who have unrealistic views of what can be accomplished by a revision procedure.

How is Revision Rhinoplasty Performed?

The procedure can be performed under general or local anesthesia. Revision rhinoplasty might take longer since the surgeon is correcting an issue from the first surgery.

Incisions for revision rhinoplasty can be made on either the inside of the nose (closed rhinoplasty) or the underside of the nose (open rhinoplasty). In general, if the nose needs major structural changes, doctors often perform an open rhinoplasty so they can have a better view of the nasal structure. Minor corrections are usually performed via a closed technique.

When revising the nose, there are a few steps the surgeon can take depending on the needs of the patient:

• The surgeon might use a cartilage graft (from another part of the body) to replace tissue and cartilage lost during the first surgery
• If a patient does not need a cartilage graft, the surgeon simply works to refine and reposition what is already in place
• If the results from the initial surgery were not as pronounced as the patient desired, the surgeon may remove additional tissue to reduce the bridge of the nose or narrow the nostrils

Other Options to Consider:

The first thing to consider is if the surgery is worth doing in the first place. Minor asymmetries between the two sides are usually not a good reason to do surgery. Fillers are a non-surgical option that can add volume and alter the appearance of the nose. Fillers offer good results with minimal recovery time and few complications.

What is the Cost of Revision Rhinoplasty?

The final cost for revision rhinoplasty depends on a number of factors:

• Insurance might cover some of the costs if the surgery is determined to be medically necessary to help with breathing and other functional issues
• Whether the surgery was an open or closed rhinoplasty
• The area of the country where it was performed
• Any fees charged by the doctor or the facility

In general, the price of revision rhinoplasty is anywhere from $10,000-$20,000.

Recovery and Downtime

The RECOVERY for revision rhinoplasty is similar to the initial rhinoplasty surgery:

• Nasal packing will be used to reduce any post-surgery bleeding and swelling
• Patients will need to elevate their heads while sleeping for at least a week after surgery
• Patients should avoid blowing their nose for 2 to 3 weeks
• Any trauma to the nose should be avoided after surgery

Patients should expect about a week of DOWNTIME after the surgery. Any additional downtime might be necessary if the surgeon had to remove cartilage for the revision. The area where the cartilage was removed will be sore and might be more sensitive than the nose itself.

The nose usually does not hurt a lot after surgery. There might be some pressure but not a lot of pain. Most people are presentable after ten days and are able to go out and not have anybody notice they had surgery. People are able to lightly exercise two weeks after the surgery.

Results

The results of revision rhinoplasty are permanent as long as the patient does not experience trauma to the nose or wish to have further revisions made to the nose.

It takes about four months for the swelling of the nose to completely dissipate. Overall, it can take up to a year for the final results to be visible.

Limitations and Risks of Revision Rhinoplasty

While revision rhinoplasty can create great results, there are some LIMITATIONS to the procedure:

• There is a limit to how much any asymmetry on the nose can be adjusted while still having the nose look balanced with the rest of the face
• Any scarring from a previous rhinoplasty can make it harder to reshape and mold the nose during a revision surgery
• While there is not really a limit to the amount of revisions that can be performed, the more revisions that are done, the harder it is to achieve good results due to scarring and lack of available cartilage to use
• There is no guarantee that the patient’s breathing will be back to 100% even if the aesthetic appearance of the nose is achieved

Some revision rhinoplasty RISKS include:

• Septal perforation as previous rhinoplasty may have resulted In dissection on the septum (in the middle of the nose) and there is a higher chance that dissection in this area again can lead to injury and creation of a hole in the middle of the nose
• Temporary loss of smell
• Prolonged swelling
• Scarring
• Reaction to the anesthesia
• Numbness
• Persistent asymmetry

Proper Research is Necessary 

Rhinoplasty is a complicated procedure that requires someone with a lot of experience and skill. A patient needs to put a lot of time and effort into researching surgeons so they can get the desired results the first time and avoid a revision surgery. If there are any physical changes to the nose that bother the patient, they can likely be remedied with revision rhinoplasty. It is very important that the doctor be aware of what the patient is looking for in order to make sure the person is a viable candidate for revision surgery.

Written by Cosmetic Town Editorial Team - MA

Based on an exclusive interview with Kristina Tansavatdi, MD in Westlake, CA