What Is A Revision Rhinoplasty?

A revision rhinoplasty, also known as secondary rhinoplasty, is a plastic surgery procedure that is performed to correct or improve the results of a previous primary rhinoplasty. It is typically performed when a patient is not satisfied with the appearance or function of their nose after the initial surgery.

Revision rhinoplasty is a more complex procedure than a primary rhinoplasty and requires a high level of skill and expertise from the surgeon. The procedure is performed under general anesthesia and typically takes between 2 to 4 hours to complete, depending on the complexity of the case.

The procedure is similar to a primary rhinoplasty, but the surgeon will have to work with the existing structures, which may have been altered during the initial surgery. The surgeon will make incisions either inside the nostrils or across the columella (the skin between the nostrils) to access the underlying bone and cartilage.

Once the incisions are made, the surgeon will reshape the bone and cartilage as necessary to achieve the desired shape of the nose. This may involve removing excess bone or cartilage, reshaping the cartilage, or adding cartilage or other materials to build up certain areas.

After reshaping the nose, the skin and soft tissues are redraped over the new shape, and the incisions are closed. A splint is applied to the nose to help maintain its shape during the healing process.

Recovery time for revision rhinoplasty is usually longer than primary rhinoplasty. Bruising and swelling are common side effects and can take several weeks to subside. Some patients may require additional revision surgeries to achieve the desired result.

It’s important to note that revision rhinoplasty carries a higher risk of complications than a primary rhinoplasty due to the fact that the nose has already been operated on before, and it’s essential to choose a highly experienced and qualified surgeon to perform the procedure. Also, as with any plastic surgery, it’s important to have realistic expectations and understand that achieving the desired result may take multiple surgeries.

What Are Some Common Causes For Revision Rhinoplasty?

1. Unsatisfactory cosmetic appearance: The most common reason for revision rhinoplasty is dissatisfaction with the appearance of the nose after the initial surgery. This may include issues such as an asymmetrical or unnatural appearance, a pinched or over-rotated tip, or a hump on the bridge of the nose.
2. Breathing difficulties: Some patients may experience difficulty breathing through the nose after the initial surgery. This can be due to a number of factors, such as a narrowed or blocked nasal passage, or an incorrect alignment of the septum.
3. Scar tissue formation: Scar tissue can form after surgery and may cause the nose to appear distorted or asymmetrical.
4. Changes in the structure of the nose: The shape of the nose can change over time due to aging, injury, or other factors. In some cases, revision rhinoplasty may be needed to address these changes.
5. Improper healing: In some cases, the nose may not heal properly after the initial surgery, leading to asymmetry or other issues.

What Is Different About Revision Rhinoplasty From My First Surgery?

Revision rhinoplasty is different from a primary rhinoplasty in a number of ways. The main differences include:

1. Complexity: Revision rhinoplasty is a more complex procedure than a primary rhinoplasty. The surgeon will have to work with the existing structures, which may have been altered during the initial surgery, and this can make the procedure more challenging.
2. Risk of complications: Revision rhinoplasty carries a higher risk of complications than a primary rhinoplasty, particularly if the patient has had multiple previous surgeries.
3. Longer recovery time: Recovery time for revision rhinoplasty is usually longer than primary rhinoplasty. The patient may experience more swelling and bruising and may need additional revision surgeries to achieve the desired result.
4. More challenging to predict the outcome: It’s more challenging to predict the outcome of revision rhinoplasty than a primary rhinoplasty, as the surgeon will have to work with existing structures that may have been altered during the initial surgery.
5. More specialized surgeon: It’s essential to choose a highly experienced and qualified surgeon to perform a revision rhinoplasty as the procedure is more complex and carries more risks than a primary rhinoplasty.
6. Realistic expectations: It’s important to have realistic expectations when considering revision rhinoplasty. The results may not be as predictable as a primary rhinoplasty and it may take multiple surgeries to achieve the desired result.

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 grafting, ear grafting, free grafting, in addition to local and regional reconstruction. 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, rib grafting, local reconstruction, regional reconstruction, and microvascular reconstruction. Fortunately, Dr. Mourad has advanced training in all aspects of primary and revision rhinoplasty, giving you the best possible results.

Procedure Details

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 over 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, 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.