Revision Rhinoplasty

What Is A Revision Rhinoplasty?

Rhinoplasty is one of the most commonly performed cosmetic procedures in the United States and around the world. Outcomes may vary, and sometimes the results may not be what you expected. In such circumstances, you may want a second, or sometimes even a third surgery to achieve your desired outcome. Such surgeries are termed, “Revision Rhinoplasty”, where you undergo a procedure to alter the outcome of the original surgery.

 

What Are Some Common Causes For Revision Rhinoplasty?

The need for a revision rhinoplasty may vary. The most common cause of revision rhinoplasty is new or persistent nasal breathing issues (link to nasal airway/valves here on the functional site). These issues may have started immediately after the original surgery or may occur several years later. Surgically altering the nose can compromise some of the internal structures, especially as we heal and form scar tissue. As we continue to age, the nose may also weaken leading to breathing issues. A revision rhinoplasty may be required to reinforce and strengthen the nose, improving its function (nasal valve collapse link).
Other needs for revision rhinoplasty may be an undesirable aesthetic outcome. Common complaints include persistent or new nasal humps, irregularities in the nasal skin, drooping tips, over rotated tips (upturned nose), or crookedness of the nose. Whether the changes required are minor or major, it is important that your surgeon is trained and capable of performing your revision rhinoplasty.

 

What Is Different About Revision Rhinoplasty From My First Surgery?

Depending on the type of changes you are seeking, a second or third surgery of the nose should be approached more carefully, and only by a highly skilled surgeon. The original surgery may have altered the internal and external structures of the nose. Critical structures of the nose like the cartilage and bone may be missing, weakened, altered in size, or shape. Additionally, the nose may have significant scar tissue, that if altered by a second surgery may weaken the nose even more. The goal of revision surgery is to restore the aesthetics and function of the nose, without causing further compromise. Even if your complaint is minor, your surgeon should carefully approach the nose with diligence and care in order to maximize the outcome. The surgeon should be well trained in the techniques required to restore the function and structure of the nose including rib (link to rib grafting) grafting, ear grafting (link to ear grafting), free grafting (link to free grafting), in addition to local and regional reconstruction (link to reconstruction link). Fortunately, Dr. Mourad has advanced training in all the surgical techniques required to give you the best outcome.

 

Are There Alternatives To Having A Revision Surgery?

Depending on your complaint, you may only require minor touch ups that can be performed in the office, or under local anesthetic. These complaints are often times minor and aesthetic in nature. Common changes that can be made are the removal of nasal humps, slight changes to the rotation of the nose, or minor tip modifications. However, complaints that involve nasal breathing issues and major deformities may require more involved interventions. Other alternatives include the use of injectables and fillers to change small imperfections. However, these interventions are usually temporary, lasting only about 9-12 months, and are associated with risks and complications. Finally, the use of injectables and fillers may compromise the internal structure of the nose (leading to unfavorable scarring) that may increase the risk of complications when you decide to have a more permanent surgery. For these reasons, Dr. Mourad does not endorse or perform injectables and fillers on the nose. He values giving his patients a permanent and long-lasting result.

 

What Are Some Things I Need To Consider Prior To Having A Major Revision Rhinoplasty?

Every time you have surgery on the nose, you are inadvertently compromising its structure and blood flow. For these reasons, these surgeries have a higher risk of complications including unfavorable scarring, numbness, infection, skin loss, and poor aesthetic outcomes. The chance of these complications increases with each subsequent surgery. It is important that your surgeon be well trained in the area of revision rhinoplasty to minimize the chances of complications.

Often, your revision surgeon may be different from the original surgery. It is important to understand exactly what was performed in the original surgery so that no surprises are anticipated in the second surgery. This may not always be possible, especially if the surgery was done a long time before, and the records are not available. In such cases, the surgeon must be very meticulous in their approach to the nose and be trained in a wide variety of surgical techniques and skills that may need to be used to minimize the risk of complications. The surgeon should be well trained in free grafting (link to free grafting), rib grafting (link to rib grafting), local reconstruction (link to local reconstruction), regional reconstruction (link to regional reconstruction), and microvascular reconstruction (link to free flap). Fortunately, Dr. Mourad has advanced training in all aspects of primary and revision rhinoplasty, giving you the best possible results.

Procedure Details

Revision-Rhinoplasty-Before-After-SideRevision-Rhinoplasty-Before-After

This is a 41-year-old female who presented 1 year after rhinoplasty with complaints of 100% nasal blockage and unnaturally appearing nose. 

Left Photographs: This photo shows her at presentation to Dr. Mourad’s office 1 year after her initial surgery. The black arrows show that she had an excessive amount of her nose removed externally, causing significant scarring and contracture. This scarring narrowed her nostrils and contributed to her inability to breathe. The blue arrows show that her nose has incomplete breaks in her nasal bones causing nasal valve collapse, further making her breathing worse. In the lower picture, the purple curved arrow also shows that she has a “droopy” tip that hangs low. The deformity is also from excessive resection of the internal structures of the nose. The blue star in the photo on the profile view also shows that the previous surgeon had left a bony hump, that also was made to appear worse by the droopy tip.

Right Photographs: This is a patient 1 year after surgery once the final healing has settled in. The purpose of the surgery was to restore her ability to breathe. The patient underwent a complete nasal reconstruction using her own rib. The orange arrow shows that her nasal tip was restored to a more natural, “higher”, position, no longer with a deforming “droopy” look. Her nasal tip has smoother contour. Her ability to breathe has been completely restored with improvement in her nasal valve structures.

 

Preparation For A Revision Rhinoplasty

The preparation process for a revision rhinoplasty is very similar to the original rhinoplasty surgery. However, Dr. Mourad likes to take his time with his patients. In your first consultation, Dr. Mourad will spend an hour going everything with you. During this first consultation, Dr. Mourad will attempt to understand the exact nature of your complaints. He will identify your goals of treatment and tailor a specific treatment plan for your specific complaints. It is not uncommon that you may sit down with Dr. Mourad over the course of multiple visits. He feels that you should be comfortable with him as your surgeon, and values being entrusted to your care. Once you and Dr. Mourad agree to a specific treatment plan, his highly trained office staff will take you through everything in a painless and seamless fashion. The staff will make sure that you are set up with the surgery date, they will fill out all paperwork, and work closely with your insurance company to make sure that you maximize your benefits, minimizing any burden to you. Dr. Mourad will have your scripts sent to your pharmacy and ready to pick up prior to the surgery so you don’t have to worry about it the day of surgery.

 

Surgical Approaches To Revision Rhinoplasty

The approaches to revision rhinoplasty are similar to the first surgery

Open Rhinoplasty

This type of procedure is used in the majority of revision rhinoplasties, depending on the complaints and extent of reconstruction required. This type of procedure is performed with a small incision on the undersurface of the nose. The surgery involves exposing all of the internal structures of the nose and provides access to the nasal tip, bridge, and bones. This is the most extensive surgery that allows for the most alterations. Depending on your complaints, whether aesthetic or functional, this type of surgery is reserved for those with significant issues requiring more extensive work. Patients with crooked, enlarged, misshapen, or disfigured noses may benefit the most from an open approach. Patients with extensive breathing issues may also benefit from this type of surgery. Finally, patients with significant nasal airway abnormalities requiring extensive work such as rib grafting (link to rib grafting), would require this type of approach.

Closed Rhinoplasty

Incisions for this procedure are hidden on the inside of the nose. This type of surgery allows for making smaller modifications to the nose, including the nasal tip. Surgeons use this approach to change the tip projection, rotation, and shape. This type of surgery is suited for those type of patients with minor breathing complaints, or minor aesthetic complaints centered around the tip of the nose.

 

After Surgery Care

The surgery typically is performed on an outpatient basis. Dr. Mourad typically places nasal splints in the nose, in addition to light packing. This is important in cases of major revision surgeries as it provides an internal support structure to maximize healing and outcomes. The outside of the nose may also have a cast placed. Dr. Mourad will also give you a goodie bag to go home with that contains all the essentials needed to care for you during your week of recovery. It is recommended that you take 3 days off of work, and 1 week if possible. If your job requires your presence and is not physical in nature, then Dr. Mourad sometimes can clear you to go back to surgery the next day. During your first recovery week, Dr. Mourad requests that you limit strenuous physical activity and exercise. The delicate repair of the nose may be altered with heavy lifting or overexertion. You will have nasal saline and sprays to help keep the nose moist and promote healing. Dr. Mourad also will prescribe an ointment to be applied to the any and all incisions 3 times a day.

At 1 week after your surgery, Dr. Mourad will remove all packings and casts. Swelling during this time is normal and to be expected, and typically resolves within a few weeks of surgery. In extremely rare circumstances, the swelling may persist for up to 2 months but is not usually bothersome to patients. Dr. Mourad will then encourage continued use of the sprays and ointments. He will then see you at 3-weeks, 3-months, 6-months, and 12 months after your surgery to monitor your progress and healing. Dr. Mourad may elect to alter the schedule and keep a closer eye on you if he feels its to your benefit. You will be cleared for light cardio activity at 3 weeks, and return to full exercise at 6 weeks post-operatively.

 

Does Insurance Cover Revision Surgery?

Depending on the nature of the complaint, insurance usually can cover part or all of your surgery. If you suffer from functional issues such as inability to breathe, or a nasal deformity, insurance companies typically cover the costs of surgery. Dr. Mourad and his staff work closely with insurance companies to make sure that you receive all the benefits of your plan while minimizing your costs.

Meet Dr. Moustafa Mourad, MD, FACS

Moustafa Mourad, MD, FACS is board-certified in head and neck surgery and highly-trained in cosmetic plastic surgery and facial reconstruction. Dr. Mourad is also a Fellow of the American College of Surgeons. He treats many conditions, both cosmetic and complex, that affect the head, neck and entire facial area. Learn More »