10-15 percent of nasal reshaping surgeries will eventually require a revision. This procedure is known as a revision rhinoplasty. A patient may want or need a revision rhinoplasty because they have had difficulty healing, as the result of unplanned anatomical complications encountered during surgery, or simply because they are dissatisfied with the results of their previous rhinoplasty.
This article will briefly discuss the most common reasons patients have a revision rhinoplasty: their previous rhinoplasty has created an undesirable change in appearance such as a hump or depression on the bridge of the nose, an asymmetrical tip, a twisted nose, wide nostrils, or a wide middle third of the nose; or their previous rhinoplasty created or uncovered a functional problem that must be corrected, like a deviated nasal septum or collapsed nasal valve. The doctor can often perform the revision rhinoplasty through the nostrils with a closed rhinoplasty (minimal scarring), although sometimes an open rhinoplasty is required for more complex corrections.
Indications for Revision Rhinoplasty
There are several different conditions for which a revision rhinoplasty may be an appropriate treatment option:
A Hump on the Nose
After a rhinoplasty, the nasal bones will sometimes form a bump. This can be a result of inadequate removal, a slight collapse of the connected septal cartilage after removal, or growth occurring after surgery. Humps are treatable by removing the bone and cartilage extending from the bridge of the nose. The doctor may need to bring the nasal bones together to recreate the natural shape of the nose.
The nose tip is primarily soft tissue and cartilage, which will heal and change in shape for many years after surgery and as the patient ages. The doctor can correct a bulbous or irregular tip with conservative removal of the top edge of the lower lateral cartilage, and by bringing the left and right lower lateral cartilages together.
A nasal bone fracture may make the nose appear twisted. A deviated septum may change the outside shape of the nose. Correcting the deviated septum or an osteotomy of the nasal bone can straighten a twisted nose.
Over time, an operated nose may form excessive scar tissue. This excess scarring is usually a result of poor healing, surgical technique or grafting, or improper follow-up care. The doctor may need to administer steroid injections or surgically remove some scar tissue in order to reshape the nose.
Depressed Bridge of Nose (“Saddle Nose” or Ski-Jump”)
If too much dorsum cartilage or nasal bone has been removed, the nose may drop too much when viewed from the side. If the middle of the nose is depressed, it can be elevated by building it up with cartilage or a synthetic graft.
The nostrils can be narrowed by removing small wedges of skin at the nostril base. It is very straightforward to remove nostril tissue, but very difficult to add tissue to this area. Nostril narrowing should therefore be done with caution. Nostril reduction (alar base reduction) is done at the end of surgery, and can be done in the office if necessary.
Nasal Valve Collapse
Rhinoplasties are the primary cause of nasal valve collapse. If the doctor detaches the nose’s upper lateral cartilage when removing nasal bone, this will result in an internal valve collapse and/or an ‘inverted-V deformity’. Removal of too much lower lateral cartilage can collapse the sides of the nose causing external valve collapse. Treatment of an external nasal valve collapse in generally treated with an alar batten graft. The doctor may use grafts from ear or nasal septum cartilage to restore the strength and symmetry of the nose.
A patient’s ability to breathe may suffer if the outside of the nose is reduced without regard to an already existing deviated nasal septum. A deviated septum itself can change the external shape of the nose. Deviated septum surgery can be performed during a rhinoplasty procedure. Insurance will generally pay for a deviated septum repair.
Occasionally, use of additional tissue is necessary to achieve the patient’s desired results. Often, the doctor can use cartilage from the septum or non-structural area of the ear for this purpose.
The ability to breathe comfortably can promote a better night’s sleep and is an important part of a healthy lifestyle. Dr. Bennett treats many patients referred by other surgeons with complex breathing issues or whose previous surgery uncovered or created breathing concerns. He is well-known for his revision rhinoplasty method, which restores the patients’ ability to breathe and improves the nose’s appearance by rebuilding previously removed cartilage or bone.
Your Revision Rhinoplasty Consultation
Dr. Bennett will individualize your revision rhinoplasty plan and care. A minimum of half an hour is needed to fully understand your expectations and to get a complete history and evaluation of the inside and outside of your nose. Knowing what to expect will make the entire experience more pleasant and increase your satisfaction with the surgical results. Dr. Bennett will discuss the cosmetic and functional expectations of your revision rhinoplasty in detail to make sure all of your questions are answered. Your photo will be reviewed with you and a projected computer image will be shown to you to make sure we are on the same page.
Computer Imaging for Revision Rhinoplasty
Dr. Bennett uses the state-of-the-art United Imaging System (UIS) program to show patients the potential results of a revision rhinoplasty. Reviewing photographs of your nose from several different angles gives you the opportunity say what you like or dislike about your nose, and what you would like to change. Computer imaging provides an additional step where doctor and patient can agree on a final goal for the procedure. Computer imaging is not a guarantee of outcome and individual results may vary.
The Revision Rhinoplasty
Knowing what to expect will make for a smoother and more enjoyable experience. Dr. Bennett performs the revision rhinoplasty at Lenox Hill Hospital or at a state-of-the-art Upper East Side ambulatory facility.
- You will need to arrive one hour before your procedure is scheduled to begin.
- You will speak with the nurse and anesthesiologist about your medical history and what to expect during the procedure.
- Dr. Bennett will discuss your treatment and goals before you receive any medications. You will then receive some medicine to relax you, followed most times by a general anesthetic.
- Dr. Bennett will come to speak with you again after you have awakened from the procedure. He will have already spoken to the person taking you home.
- You are given the supplies needed to take care of your healing nose. You will leave the ambulatory center with your chaperone about an hour after surgery.
Dr. Bennett’s techniques minimize the recovery period and allow most patients to return to a normal routine the week after surgery.
The Week after Revision Rhinoplasty
- Dr. Bennett places a small plastic splint over the healing nose for protection (he rarely finds it necessary to pack the nose).
- It is normal to have a mild headache for a day or two. You will be given some prescription pain medicine, although most patients take only a couple of doses and then switch to Tylenol.
- You should keep a dressing under the nostrils to avoid sniffling when you have any nasal discharge.
- You will probably feel a lot of congestion, although some people can breathe very well immediately after surgery.
- You may have bruising and swelling around the nose and eyes. This will start to resolve within a few days. Most swelling will go down after a couple of weeks, but changes in the nose can continue for a year or more.
- Avoid strenuous exercise for three weeks.
- Avoid wearing glasses for six weeks (If your nasal bones were broken during surgery).
You will return to the office one week after surgery to have the bandage removed and then return as needed to have the nose checked.
Dr. Bennett employs both the advanced closed (endonasal) and open (external) surgical techniques to sculpt an attractive and natural-looking nose with minimal incisions and rapid recovery time. Most often no excisions are required on the outside of the nose. When performing a revision rhinoplasty, Dr. Bennett emphasizes preservation or recreation of nasal breathing and structural support. A natural-looking nose is also very important. These concepts are the basis for an excellent long-term outcome.
To see the results of some of Dr. Bennett’s revision rhinoplasty procedures, please visit the photo gallery.
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