Revision Rhinoplasty Newport Beach
Revision rhinoplasty is one of the most complex facial procedures. The average reported revision rate after a primary rhinoplasty is between 5-15%. This number includes all patients and some may be very small issues, functional problems, or severe structural defects. These can be come very complicated due to the fact that functionality of the nose is of paramount importance, and needs to balance with the aesthetic appearance. Finding a surgeon who is well versed in revision surgery is very important.
Revision Rhinoplasty FAQ’s
Revision rhinoplasty cost depends on the work needed to achieve the desired goals. Many times this surgery is much more complicated than primary rhinoplasty surgery and is therefore more expensive. The surgery usually takes more time, so the operating room and anesthesia expenses may be more. Each case is individual so after your consultation, the price can be assessed.
The general rule is one year from the primary surgery. There are two categories of patients who ask this question. Some patients think their nose still looks too large or not refined enough after the initial surgery. These patients should wait the entire year because it is usually in the second half of the year where refinement takes place. If after one year the concerns persist, revision rhinoplasty may be warranted. The other group of patients has a specific abnormality (dent, collapsed tip, narrowed nostrils, etc.) that will likely not improve if given more time. These patients I suggest waiting at least 6-9 months before undergoing revision surgery just to let the majority of the swelling resolve.
Cartilage is used during rhinoplasty for either structural grafts or to achieve cosmetic changes. The cartilage in the septum is very well suited for these purposes. Many times during revision surgery, the cartilage available in the septum has been taken or damaged in the initial surgery, and there are limited other sites to obtain strong and straight cartilage. The ears may be used but the cartilage is soft and curved – this is not a good option if you need structural support. A rib graft is obtained from the cartilage portion of the ribcage where the rib bones join the breastplate or sternum. In women, an incision is made in the crease below the breast so it will ultimately not be visible. The cartilage is removed and there is ample supply to use for any grafting purpose.
The main risk to this procedure is pain. Initially it will hurt more than the nasal surgery portion and you will feel twinges of pain for a few weeks though it will improve day by day. The other risk is that a small tear can occur on the undersurface of the cartilage. This can let air into the chest cavity and is called a pneumothorax. This is managed in a number of ways but usually requires one or two x-rays to confirm that the air collection is resolving normally.
Each case is handled on an individual basis. In general, a strong piece of cartilage can be used to lengthen and counter rotate the tip of the nose. The normal tip cartilages are then sutured to the extended graft and provide a stable platform for the new shape of the nose.
Spreader grafts are used when narrowing or collapse of the middle portion of the nose is causing either a cosmetic or functional defect. These are small rectangular pieces of cartilage that are placed alongside the septum. They physically increase the space between the septum and the cartilage that supports the side of the nose. This will widen the middle portion of the nose slightly, but usually is a positive cosmetic change.
A poly beak deformity is when the tip of the nose remains full after all the swelling has resolved. Early in the healing process, the swelling in the supra-tip can mimic this finding, but this will resolve. When the dorsum is lowered too much and the cartilage at the tip not enough, this deformity can result. It looks very rounded from the profile view with an ill-defined tip. It can also result from the tip cartilages that are very curved and give the illusion of fullness to the tip – though they are just tenting it up.
Another problem that can arise from primary rhinoplasty is collapse of the middle portion of the nose. The cartilage support for the side of the nose can fall in from their natural attachment. This shows up as an upside down “V” on photographs. There is a shadow below the nasal bones and above where these cartilages should be attached. This can be corrected with the placement of spreader grafts or other combination of maneuvers with a revision rhinoplasty.