Redo or revision Rhinoplasty can be performed to complete the goals of a previous surgery such as take down more of the bridge or narrow it more or it can be performed to treat a complication of previous surgery. Simple revisions can be performed awake under local anesthesia.
If the previous surgery was covered by health insurance the revision is usually covered as well. If your policy has a rider that excludes coverage of the treatment of cosmetic surgery complications and the previous surgery was non-covered cosmetic surgery they will usually not cover the revision even if the nasal airway is obstructed because of the prior surgery.
This 55 year old patient had rhinoplasty surgery some years previously that resulted in a pinched tip that hampered airflow through the nose. At redo surgery, using an open approach, this was corrected by rebuilding the cartilage framework with lateral crural batton implants that provided shape and support to the nostrils and tip of the nose.
Read Dr. Stone’s blogs related to rhinoplasty surgeryThe role of facial proportions analysis in preparing for rhinoplasty surgery
The drooping nasal tip – droooping tip of nose
Redo or revision rhinoplasty can enhance your appearance and your self confidence and improve your breathing. Realistic expectations are important to be happy with any surgery. As each patient is an individual, different results can be expected in each patient.
A non-surgical liquid rhinoplasty, which involves the injection of dermal fillers to the nose has become popular. Given the temporary nature of the injections and the limits of what can be done by just putting things in the nose in the absence of cartilage defects I do not see this as a replacement for surgery. Improperly placed injections can impede tissue blood flow, kill the overlying skin and leave you with an open wound that heals into a bad scar.
As with any type of surgery there is the risk of infection or bleeding. Infection can melt grafts or force the removal of implants if any have been placed. Implants can extrude or shift out of position over time. Cartilage grafts may warp and/or partially or completely dissolve many years after the operation. If the tissues are thin the edges of implants or grafts may be visible necessitating placement of fascial grafts to hide those edges.
Infrequently a permanent perforation may result from operation on the septum or scar tissue (synechiae) may form between the nasal septum and nasal sidewalls. These phenomena can also occur in the absence of surgery. The treatment of synechiae is straightforward but septal perforation can be very difficult to treat. The incidence of septal perforation dramatically increases if there is a history of cocaine use or chronic use of nasal allergy sprays.
Rhinoplasty surgery involves changes to the cartilage and bone framework of the nose which then must be reflected through the skin in the end result. Thick unwieldy skin or scar tissue formed under the skin often has a mind of its own and may not conform to the changes made in the underlying framework. A perfect refined chiseled nasal tip may therefore not be achievable if this thick type of skin is present.
Skin that is adherent to the bone due to prior surgery, trauma or eyeglass wear can tear when the skin is elevated off the bone during surgery.
Surgery to straighten the nose may not result in a perfectly straight nose or the deviation may completely or partially recur some time after surgery due to cartilage shape memory.
Revision surgery can improve breathing and result in nasal aesthetics that are more harmonious with your overall facial dimensions.
There will be swelling for an indeterminate period. Much of the swelling will normally disappear in a few days but the remainder may require several weeks, or even months to disappear completely. Resolution of the swelling may be uneven resulting in temporary asymmetry of the nasal tip. There will be discoloration (black and blue marks) on and about the face, principally around the eyes, for several days or longer.
Ice compresses are applied for the first 24 hours. You can place 3 wet washcloths in the freezer & serially apply them. Alternatively, a bag of frozen peas can be used as a compress.
The head is kept elevated, no lying flat or head down position for 1 week. A splint is kept over the nose for about a week in most cases. If septal splints and/or nasal packing are used they will stay in place for 5 to 7 days. You should not remove either of them on your own. The outer drip gauze can be changed as needed as it absorbs any bloody nasal discharge that can occur in the first 2 to 4 days
No vigorous or strenuous physical activity for 3 weeks, even jogging at 1 week can cause a problem. Normal non-strenous activities & work may be resumed within 1 week after the operation. Contact sports are prohibited for 3 months.
For 7 weeks after splint removal only contacts or eyeglasses taped to the forehead can be worn. For 4 weeks after splint removal the sides of the nose are massaged as instructed to prevent shifting of the nasal bones and possible asymmetries.
90% of the swelling resolves within 10 days but it may take up to 6 months for the remainder to resolve especially the tip of the nose after open rhinoplasty.
For 8 weeks after surgery protect the nose from excess sun exposure with #15 or greater sunscreen and/or wide brim hats.
Dr. Aaron Stone
Call today for a consultation!120 South Spalding Dr, Suite 330
Beverly Hills, Los Angeles,CA 90212