While rhinoplasty is performed to improve the appearance or function of the nose, results cannot be guaranteed and sometimes revision surgery is necessary. A number of problems can develop or worsen as the result of previous nasal surgery. Common issues that necessitate revision surgery include improper diagnosis, unexpected healing, poor technique or even later injury to the nose. Revision nasal surgery is less likely to be necessary the more qualified and experienced the surgeon is; yet, it is always a possibility.
Dr. Hobgood is a revision rhinoplasty specialist. About 40% of all of his cases are revision in nature. We see patients from all around the world requesting consideration for revision rhinoplasty. We hope to collect all before and after photographs, as well as operative procedure notes, before completing a consultation. As we tend to see patients visiting from great distances, we will often recommend an initial phone or video consultation to maximize efficiency for both Dr. Hobgood as well as our valued patients.
What is Revision Rhinoplasty?
Also called secondary or tertiary rhinoplasty, this surgical procedure is designed to correct or improve the results of a previous rhinoplasty that was unsatisfactory for one reason or another. This procedure may be used to correct functional problems that affect breathing as well as cosmetic issues. While rhinoplasty is one of the most complicated cosmetic surgery procedures, secondary rhinoplasty is even more complex with a higher revision rate than other procedures. Revision surgery requires a Board Certified Plastic Surgeon who has extensive experience performing this delicate surgery. Insurance companies do not cover revision rhinoplasty as it is the consequence of previous elective cosmetic surgery.
Common Reasons for Secondary Rhinoplasty
Revision nasal surgery may be performed due to dissatisfaction with the appearance of the nose or dissatisfaction with the function of the nose. The following are common reasons patients seek revision surgery.
If the tip of the nose seems pinched, it is usually because too much tip cartilage was removed or it did not heal well. Cartilage is typically added back to the nasal tip in a revision procedure.
Inverted V: After a hump is reduced, the middle section of the nose occasionally collapses inward and creates an inverted V. This can be corrected with grafts.
Parrot beak appearance: This can happen if a hump on the bridge is not reduced enough just behind the tip of the nose or there is a build-up of scar tissue.
Bump or callous: In some cases, a bump or callous may form on the dorsum up to 12 months after rhinoplasty. It can typically be corrected with a minor procedure.
Asymmetry: If your nose appears asymmetrical after rhinoplasty, it may be the result of uncontrollable post-operative scarring that causes an uneven appearance.
Disappointing results: Some patients are simply unhappy with the results of their primary rhinoplasty, which may be the result of complications, misjudgment on the surgeon’s part, unclear communication about what you wanted, or unrealistic expectations.
The Revision Rhinoplasty Procedure
Revision nasal surgery typically takes longer than a primary procedure, which may take 1–2 hours. General anesthesia or sedation with local anesthesia may be used. Surgical techniques used depend greatly on the issues that need to be addressed. Both closed and open rhinoplasty may be used during the procedure. Closed rhinoplasty means incisions are confined to the inside of the nose, although some corrections may require an open rhinoplasty, in which a small incision is made between the nostrils on the underside of the nose.
In many cases of revision surgery, additional cartilage is necessary to correct the function or appearance of the nose. If the previous surgery removed too much cartilage from the septum, Dr. Hobgood will use cartilage from the ears or from even the ribs and create a cartilage graft to reshape the nose and give it the foundation and support it needs. If cartilage is taken from the ears, the incisions are placed in the crease of the ear and hidden. The cartilage taken will not change the structure or appearance of the ear.
Revision Rhinoplasty Recovery
After your surgery, a dressing will be applied to the nose. Swelling and light bruising are normal, and your nose may feel stiff or sore for up to one week. Any stitches will be removed a few days after the surgery. Most patients are able to return to work after one week (after the dressing is removed). Strenuous activities, however, should be avoided for two to three weeks. Any activity that may bump or injure the nose should be avoided for eight weeks. Most swelling will fade within two weeks, but it can take up to one year for all swelling to dissipate.
Are You a Candidate?
A good candidate for this procedure is physically healthy with realistic expectations about the results of the revision surgery. The candidate is unhappy with the function or appearance of the nose after the initial nose surgery. Revision surgery cannot be performed immediately after primary surgery, as the nose requires between 6 and 12 months for all swelling to resolve itself.