Rhinoplasty Revision Surgery
Rhinoplasty is one of the most intricate and nuanced cosmetic procedures performed today. The cosmetic outcome of a rhinoplasty can sometimes fall short of your expectations. Inadequate patient selection, incorrect or poorly executed surgical maneuvers and poor healing in the postoperative period may lead to asymmetry, under correction or over reduction, leaving you dissatisfied with your initial results.
The goals of a revision rhinoplasty are similar to those for primary rhinoplasty - achieving a result that is natural and harmonious with the rest of the face, while matching patient expectations. Revision rhinoplasty can be an extremely demanding procedure. Dr. Khosh is a surgeon who has anchored his cosmetic practice in excellence of performance in rhinoplasty.
Rhinoplasty Revision Specialist
Dr. Khosh acknowledges the discontent and frustration of revision rhinoplasty patients and works to help the patient overcome them. This process begins with the consultation that includes a thorough discussion of the past experiences, a careful evaluation of the external and internal nasal anatomy and computer imaging to help demonstrate the likely outcome of your revision rhinoplasty.
It may take years before a patient seeks consultation for revision rhinoplasty. This can be the result of the significant psychological and financial impact of the initial rhinoplasty operation, leaving patients unwilling to consider a revision procedure. Dr. Khosh is acutely aware of these important, sensitive considerations. He will work diligently to ease your concerns and gain your confidence before recommending surgery. Contact our practice today to schedule a consultation for yourself, a firend or a member of your family.
This 40-year-old man had undergone rhinoplasty at age 18. He complained of over-reduction of the dorsum, over-rotation of the nasal tip, and inability to breathe. Revision rhinoplasty with the use of cartilage grafts and a Gortex graft allowed the recreation of a natural looking nose with excellent breathing function.
- Patient: 40-year-old man seeking revision rhinoplasty in Manhattan
- Problem: Prior rhinoplasty causing scooped-out nose, over-rotated tip, nasal obstruction
- Procedure: Revision rhinoplasty performed through the open approach
Frequently Asked Questions
How soon can I have revision surgery after a rhinoplasty?
The general answer is six months. There are two main reasons for this timing. First, the effects of rhinoplasty take that long to settle. Second, scar tissue from the first operation needs time to mature and soften. Sometimes that timing may need to be moved up or slowed down depending on the patient and the anatomic findings.
How many times can revision rhinoplasty be repeated?
It is best to have as few procedures as possible. Each revision rhinoplasty can induce further skin damage or scar formation. When revision surgery is delayed, the skin has a chance to heal, and scar tissue softens and thins out. Most patients can tolerate three operations on the nose without significantly increased risk.
My nose is still too big after rhinoplasty; can revision rhinoplasty make my nose smaller?
Probably yes, but a physical examination will be necessary. In some patients, skin thickness in the nasal tip limits reduction in size. I use computer imaging to demonstrate likely outcome from revision surgery to the tip.
I had rhinoplasty, and now the tip of my nose looks round and unrefined; can this be fixed?
There are two main causes for such development: scar formation and/or poor nasal tip cartilage support. In revision rhinoplasty, both problems can be addressed. Frequently, cartilage grafts will be placed to add definition and support to the nasal tip region.
My nostrils look too big after rhinoplasty; can you fix this problem?
Excess nostril show is often due to over rotation of the nasal tip. In revision rhinoplasty, the nasal tip can be rotated down to eliminate an unappealing look. Sometimes, reducing the size of nostrils can alleviate such problems.
Rhinoplasty made my nose too small; can my nose be made larger?
Revision rhinoplasty is often sought to restore an overly reduced, "operated looking" nose. In these cases we employ cartilage grafts or implants to replace missing structure.
Where do you get cartilage to repair my nose during revision rhinoplasty?
The best source of cartilage for revision rhinoplasty is septum cartilage from inside the nose. Unfortunately, due to prior surgery, there may not be adequate cartilage available from inside the nose. Other sources of cartilage include: the ear, cartilage from your ribs or cadaver rib cartilage.
If ear cartilage is used for my revision rhinoplasty, will my ear look different? Will my hearing be affected?
We harvest ear cartilage from a totally hidden incision behind the ear. By removing cartilage only from designated areas, the shape of the ear will be undisturbed. Your hearing will not be affected after cartilage removal from the ear.
How do you take cartilage from my rib?
We make a small incision over one of the lower ribs, near the midline of the chest. In women, this incision can be hidden under the breast. Once an adequate length of the rib is removed, the incision is closed. Most patients stay in the hospital for one night after this procedure.
What is the difference between the open approach versus the closed approach in rhinoplasty?
Rhinoplasty and revision rhinoplasty can be preformed via the closed (endonasal) or the open (trans-columellar) approach. Both approaches entail incisions inside the nostrils. The open approach adds an incision across the columella (the skin between the two nostrils). Open approach is commonly used in rhinoplasty because it affords better visualization of the nasal tip cartilages and allows for precise manipulation of the cartilages. The open approach to rhinoplasty is bit more times consuming. Patients who undergo open rhinoplasty may experience slight numbness in the nasal tip for up to 3 months. Dr Khosh is proficient in both a[pproaches.
Revision rhinoplasty often entails associated procedures to enhance breathing, procedures such as septoplasty and nasal valve reconstruction. If there is a need for cartilage grafting, and the nasal septum is not adequate, harvest of cartilage from the ear or a rib may be necessary. In select patients, chin augmentation can enhance the rhinoplasty results by crating better balance between the lower face and the nose.