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Revision Rhinoplasty

Rhinoplasty is a very specialized and complex part of plastic surgery, and revision rhinoplasty is frequently considered the most difficult procedure in cosmetic plastic surgery. The goal of revision rhinoplasty is to improve and correct problems caused by a prior surgery and/or to improve upon inferior or unsatisfactory results. When performing revision rhinoplasty, Dr. Ransom believes it is essential to address not only the aesthetic issues (the way it looks), but also the functional issues of breathing problems. As a nose surgery specialist, Dr. Ransom plans each surgery with the goal of improving both form and function.

Many patients have suffered self-image problems or have been traumatized by one or more complications from their prior procedure. In some cases, they have simply experienced an undesirable rhinoplasty result. Dr. Ransom is a revision rhinoplasty specialist, and, with his background and specialty training in cosmetic facial surgery, facial reconstructive surgery, and nasal surgery of all kinds, he is uniquely qualified to help patients with aesthetic or functional issues from prior nasal surgery. Some examples of breathing problems which may be treated during your revision surgery include a deviated septum, septal spurs, nasal obstruction from enlarged turbinates, internal or external nasal valve collapse, nasal valve stenosis, or nostril stenosis. Dr. Ransom recognizes the mental and emotional concerns of patients seeking revision rhinoplasty, and works closely with them throughout this difficult time.

Revision rhinoplasty frequently requires that the nose be reduced in size, either the entire nose or one specific part that was not completely treated in the primary surgery. Common problems include a dorsal hump (bump on the bridge) being partially or completely left behind, a tip that remains too wide (“bulbous tip” or “boxy tip”) or lacks definition, a tip that droops or hangs, or nostrils that are too large or too wide (alar flaring). When there is fullness above the tip region that causes an unpleasant hook in the profile, this is sometimes called a “polly beak” deformity because the nose looks a little like a parrot beak. The problems encountered in revision rhinoplasty are different for every patient, so the surgery is customized for each patient’s unique issues, anatomy, and breathing function. The specific maneuvers necessary may be as simple as removing excess cartilage or bone on the bridge, or as complex as straightening a crooked nose or reshaping the tip and nostrils.

Less often, the nose has been made too small (“over-resected”) during the first surgery. In these cases, it must be reconstructed by adding grafts. Materials commonly used include the septal cartilage, ear cartilage (from the “bowl” of the ear), or even rib cartilage in extreme cases or with multiple revisions. If too much cartilage is removed or the septum has been severely damaged, this may result in collapse of the bridge (“saddle nose”). Performing cartilage grafting is essential, to support the nose structurally, to maintain or improve breathing, and also to avoid an unnatural “pinched tip”, upturned or “pig nose”, or a collapsed middle part of the bridge called an “inverted V” deformity because the contour looks like an upside down letter “V”. Whenever possible, Dr. Ransom prefers to use the patient’s own tissue for nasal reconstruction or revision rhinoplasty. Dr. Ransom would be happy to discuss revision rhinoplasty in detail during your consultation.


Am I a candidate?

Anyone who has had a previous rhinoplasty and was not satisfied by either the appearance of the nose or its function (breathing, smell, etc.). In most cases, revision rhinoplasty is performed using an open technique; this is especially true for patients with a crooked nose, a history of nasal trauma (for example, an untreated fracture), or significant functional concerns (breathing problems). The exception would be for patients who have already undergone multiple surgeries, and further work would be unlikely to improve the current nose or would create further functional or aesthetic compromise.

Some surgeons use synthetic materials or implants during rhinoplasty surgery. These materials, unfortunately, have a relatively high rate of complications – including infection, weakening of the underlying bony or cartilaginous structure of the nose, or even extrusion (meaning that the material breaks through the skin, either on the outside of the nose or into the nasal passages). In patients with synthetics or implants, it is often necessary to remove these materials during the revision rhinoplasty. Dr. Ransom can then replace them with your own tissues, by using soft tissue and cartilage grafts from other parts of the body. If the implanted materials have become infected or are extruding, you may require an extended antibiotic treatment prior to your revision rhinoplasty. This is essential to guarantee the best possible result.


Frequently asked questions

Q: What should I expect after my procedure?

A: You will have a plastic cast on the outside of the nose for about a week after the surgery. This helps to protect the nose from accidental trauma, and also stabilizes the bones during the initial healing phase. No packing is used in the nose, which makes recovery much more comfortable. Your nose may feel “stuffed up” for a few days. Pain is generally not severe. You will likely feel tired for a couple days and should limit your activities and concentrate on resting and recovery. Contact sports, racket and ball sports, heavy lifting, and straining must be avoided until Dr. Ransom gives you the “okay” – this is typically a couple weeks. You will also be given clear instructions regarding blowing your nose, sneezing, and digital manipulation; in general, these are to be minimized as much as possible or avoided completely.


Q: How long is the recovery from a revision rhinoplasty?

A: For most patients, the initial recovery is relatively quick – typically a week or so. Bruising is related to the amount of work performed on the nasal bones. Though some swelling will occur throughout the nose, much of this resolves over the two weeks. Some swelling will persist after this time and will take longer to go away completely; this time period is longer in revision surgery. Most plastic surgeons agree that the final result of a revision rhinoplasty is not seen for at least nine months, and it is common to see subtle changes up to a year or more from the surgery.


Q: Will revision rhinoplasty change my breathing?

A: Breathing problems after a primary rhinoplasty are actually a common reason for revision rhinoplasty consultation, and any issues pertaining to breathing should be discussed at this time. After the swelling resolves, there should not be any changes to your breathing. In fact, Dr. Ransom is a nose specialist and uses this knowledge to make sure that his patients’ breathing is not negatively affected by nose reshaping. In some cases where the septum is crooked or functional issues (difficult nasal breathing) exist before surgery, Dr. Ransom can actually improve the breathing during your rhinoplasty.