COSMETIC TOWN JOURNAL



Expert Doctor

Revision Rhinoplasty

Posted December 07, 2018

David Alessi, MD, FACS

Beverly Hills, CA

Revision Rhinoplasty

Revision rhinoplasty corrects functional or aesthetic nasal problems that occur after a previous rhinoplasty surgery. A functional revision is when a patient needs another surgery because of breathing issues such as obstruction of the nasal airways or other signs of impaired breathing. An aesthetic revision is performed to correct a nose that is too asymmetrical, crooked or droopy. Revision rhinoplasty is not necessary for every rhinoplasty patient and is performed on a case by case basis. The goal of the surgery is to make sure patients have a natural look as well as an aesthetically pleasing nose that fits the face. Revision rhinoplasty is difficult to perform since it requires cartilage reconstruction and involves the framework of the nose. Poor results from a primary rhinoplasty can be caused by a poor surgical technique or nose scarring following the initial surgery.

Am I a Good Candidate for Revision Rhinoplasty?

GOOD CANDIDATES for revision rhinoplasty include:

  • A patient that is unhappy with the results of a previous rhinoplasty procedure
  • Someone who suffered trauma or injury to the nose after a previous rhinoplasty
  • A patient who suffers from too much taken off the nose (overresection) or not enough being removed (underresection)

Patients who are NOT GOOD CANDIDATES include:

  • Patients who want to “rush the process” and don’t allow enough time for the results from the first surgery to heal and be visible
  • Patients with really thick skin, like Asians and African-Americans, since the thickness of the skin makes it harder to show all the changes underneath and it is also harder to get the tip of the nose to look more defined

How is Revision Rhinoplasty Performed?

Revision rhinoplasty might take longer to perform (than the initial surgery) since the doctor is working to correct an issue that resulted from the first surgery. The revision surgery can be performed under general or local anesthesia.

The incisions for revision rhinoplasty are made on either the inside of the nose (closed rhinoplasty) or the underside of the nose (open rhinoplasty). If the nose needs major changes to its structure, a doctor usually performs open rhinoplasty in order to get a better view of the nasal structure. Minor rhinoplasty revision is usually performed with a closed technique.

The next step of revision rhinoplasty depends on what the patient is trying to achieve with the surgery. Some of the most common surgical steps include:

Additional tissue can be removed from the nose to reduce the bridge or narrow the appearance of the nostrils.

The surgeon might use a cartilage graft, from another part of the body, to replace any cartilage or tissue lost during the first surgery or by simply refining the existing results without the use of a graft.

Non-Surgical Alternatives:

Dermal fillers can add volume and alter the appearance of the nose without the need for surgery.

Silicone strips can be used for basic types of nasal irregularities. Silicone treatment can effectively eliminate or inhibit the formation of keloids and can help with repositioning and any asymmetry of the nose. However, additional incisions are required for anything more complex.

What is the Cost of Revision Rhinoplasty?

The final cost for revision rhinoplasty depends on whether or not insurance covers part of the cost. If the surgery is determined to be medically necessary so the patient can breathe easier, insurance will most likely pay for some of the surgery.

The final cost is also determined by any facility fees, the area of the country where it is performed and whether the revision is performed by open or closed rhinoplasty.

In general, the price of revision rhinoplasty is anywhere from $8000-$20,000.

Recovery and Downtime

The RECOVERY for revision rhinoplasty is not very different from the initial surgery:

  • Any additional trauma to the nose needs to be avoided
  • Patients should wear nasal packing, and sleep with their head elevated for a week, to reduce bleeding and swelling
  • Patients should avoid blowing their nose (if possible) for 2 to 3 weeks

There will be about a week of DOWNTIME after the surgery. Additional downtime might occur if the surgery involved removing cartilage. There will be some pressure on the nose but not too much in the way of pain. Light exercise can resume two weeks after surgery.

Results

The results from revision rhinoplasty are long lasting, and even permanent, as long as a person does not undergo any additional trauma to the nose. Post-op swelling will last for 4 or 5 months and it can take about a year before the final results are visible.

Limitations of Revision Rhinoplasty

There are some limitations when it comes to revision rhinoplasty:

  • The adjustment of any asymmetry on the nose is limited to a certain amount before the nose is out of balance with the rest of the facial features
  • Scarring from the initial rhinoplasty limits the amount of molding and reshaping that can be accomplished on the nose
  • There is not a limit to the amount of revisions that can be performed on a patient but multiple revisions makes it harder to achieve the best results due to a lack of available cartilage to use and scars from previous surgeries

Risks of Revision Rhinoplasty

Some common risks of revision rhinoplasty include:

  • Calluses on the nose
  • Holes in the septum
  • Cartilage collapse after the surgery
  • Droopy tip
  • Temporary loss of smell
  • Bruising and swelling
  • Numbness
  • Asymmetry
  • Scarring

Understand the Risks before Having Revision Rhinoplasty

Patients should approach revision rhinoplasty with realistic expectations. It is important that patients find a doctor they trust and who will communicate the potential risks of the procedure. The doctor should also set realistic expectations and examine the patient to determine if open or closed rhinoplasty is the best choice to achieve the desired goals. Patients who understand the risks, and communicate their goals, are usually the ones that are most satisfied with the outcome of their procedure.

 

Written by Cosmetic Town Editorial Team- MA

Based on an exclusive interview provided by Dr. David Alessi of Alessi Institute in Beverly Hills, CA.

Article Last Updated on December 07, 2018