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Revision Rhinoplasty

March 7, 2012

Written by Christine G. Adamo

What is Revision Rhinoplasty?

Did you know that rhinoplasty has roots in antiquity which reach as far back as 800 B.C.E.? While the field of facial plastic surgery has grown and developed tremendously, it’s still unrealistic to expect perfection from any single procedure. That’s why revision rhinoplasty is sometimes necessary.

Any time initial Rhinoplasty or prior revision rhinoplasty doesn’t deliver the desired results, a plastic surgeon may suggest revision rhinoplasty – a common but complex procedure which may be required if:
  • You had unrealistic, initial expectations
  • You had trouble explaining your wants & needs
  • Prior surgery didn’t provide you with lasting effects
  • Your aesthetic & functional needs weren’t equally addressed

Function vs. Aesthetics

According to the American Society of Plastic Surgeons, “(revision) rhinoplasty is a surgical procedure that is performed to change the shape and/or size of the nose or to correct a broad range of nasal defects”.

So, (2) key topics to discuss with your plastic surgeon are:
  • Function – correcting nasal abnormalities or damaged nasal structures
  • & Aesthetics – transforming the appearance of your nose cosmetically

Placing emphasis on both function and aesthetics can ensure greater success with initial and revision rhinoplasty. During your consultation, set clear goals with your plastic surgeon. Be sure to ask yourself if they’re purely cosmetic or functional, too.

Aesthetic, or cosmetic, goals address size, shape and symmetry. If your plastic surgeon suggests functional goals, as well, it’s because removing nasal obstructions will improve your breathing. Patients often benefit from some combination of both.

If your nose is out of proportion with the rest of your face, you have an aesthetic need. But, your satisfaction with revision rhinoplasty will increased if you follow your plastic surgeon’s advice to take a combined approach that benefits you in more ways than one.

A caring plastic surgeon will closely examine both the inside and outside of your nose to ensure that its internal structure can support revision rhinoplasty. Making your face appear more symmetrical is equally important, but will be of secondary concern.

Revision Rhinoplasty & Your Readiness

A successful “nose job” can change the look of your nose, alter nostril width and/or modify the angle at which your nose and upper lip meet. It may include a septoplasty or turbinoplasty to correct internal, nasal deformities which block air flow.

Revision rhinoplasty is often needed when initial surgery doesn’t achieve those things.

And it may not be your plastic surgeon’s fault. Even after being corrected a once deviated septum – the tissue dividing the inside of your nose – can resist change. Over time, it can deviate again. If you want to breathe freely, you need revision rhinoplasty.

Yet, not everyone’s a good candidate. Are you?
  • Have you had multiple, unsuccessful consultations?
  • Were you unhappy with surgical outcomes in the past?
  • Why do you want surgery & are the reasons major or minor?
  • Do you have persistent body image or age-related concerns?
  • After initial rhinoplasty, did you follow recovery instructions?
  • Do you hope surgery will change your life drastically?
  • Did someone else suggest that you have surgery?
  • Can you explain why it is you want surgery?
Use those questions to evaluate your readiness in consultation with a plastic surgeon.

Revision Rhinoplasty Surgery

To get the best possible results from revision rhinoplasty, you should be healed from prior surgery (1+ year) with no residual swelling. If you’ve had revision rhinoplasty before, new healing may take longer.

There are (2) basic revision rhinoplasty techniques:

Open Rhinoplasty Technique

Your plastic surgeon makes an incision at the columella (exterior tissue separating the nostrils); this option gives your plastic surgeon a better view and can help pinpoint why a revision is needed

Closed Rhinoplasty Technique

Your plastic surgeon works from within your nose, making incisions inside the nostrils; this option is not generally used in revision rhinoplasty

Things you should know about surgery include:
  • You may be treated as an outpatient or stay overnight in a hospital
  • Local (sedated but awake) or general (sleeping) aesthesia may be used
  • Surgery typically takes 1-2 hours (confirm times with your plastic surgeon)
  • The skin of your nose may be separated from supporting bone & cartilage
  • Bone & cartilage are then sculpted to achieve your desired nose shape
  • If the skin needs to be draped back in place (open), it’s then sutured
  • Packing & splints are inserted to support your nose’s new shape

After surgery you won’t be able to drive, so be sure to pre-arrange a ride.

Revision Rhinoplasty Recovery & Side Effects

Here’s a general timetable for your revision rhinoplasty recovery:

24 to 36 Hrs.* – Your nose will ache, your face will be swollen/puffy and you may need pain medication. Bloody, nasal discharge is normal; if bleeding persists, call your doctor. Rest continually in a bed or recliner with your head elevated. Swelling, bruising and black eyes are common; use cold compresses, but not on your nose.

48 Hrs. to 2 Weeks* – Most bruises and swelling will have disappeared and you’ll be looking healthy. A few days after surgery, your plastic surgeon will likely remove packing materials. Other splints, packing and sutures are usually removed within two weeks.

  * To facilitate healing, don’t blow your nose for 7+ days

Side effects and other problems associated with revision rhinoplasty can include:
  • Red Spots – caused by burst blood vessels
  • Scarring – inside your nose after “closed” surgery
  • Small Scar – under your nose after “open” surgery
  • Minor Corrective Revision Rhinoplasty – in 10% of all cases

Red spots generally fade, but can persist. Inside scarring isn’t visible, but you’ll feel it. Outside scarring is minor, but may remain (albeit barely) visible. Minor, corrective surgery may be needed despite exceptional surgical care.

Final Words About Revision Rhinoplasty

Remember, revision rhinoplasty can permanently change the way you see yourself…

A knowledgeable, experienced and caring plastic surgeon won’t promise you the world. Instead, they’ll give you a realistic idea of what to expect. That applies to revision rhinoplasty cost, as well. Know what you’re getting into by asking questions.

Be sure your plastic surgeon has gotten proven, positive results in the past. Ask to see revision rhinoplasty before and after photos before scheduling surgery. Take it one step further by asking for a list of client names and contact information. 

 
 


 
 

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