Revision Rhinoplasty

Revision Rhinoplasty

Dr. Colin Pero devotes the majority of his practice to rhinoplasty and revision rhinoplasty.

Dr. Pero has a special interest in rhinoplasty and was trained in primary and revision surgery by world-renowned rhinoplasty expert Dean M. Toriumi, M.D., in Chicago, Illinois.

What is Revision Rhinoplasty?

Revision rhinoplasty is an operation to change the shape of the nose when previous surgery was performed on the nose. This may involve performing a small “touch-up” revision of an acceptable previous result or re-operating on a nose to reconstruct a previous poor result or following a subsequent injury.

Performing a small “touch-up” revision of an acceptable previous result. In this instance, the patient may be happy with the overall appearance of the nose but is looking for a small improvement, such as a small tiny bump was left on the bridge or a small visible edge on the tip.

For these cases

  • The patient is typically content with having the surgery performed by the original surgeon since trust is not lost.
  • The surgery is less involved.

Re-operating on a nose to reconstruct a previous poor result.

For these cases

  • The patient may have sought out a different facial plastic surgeon for the revision rhinoplasty.
  • Patients may feel emotionally upset feeling that the result of the rhinoplasty was worse in appearance than the original nose.
  • The surgery may be more involved to reconstruct a previous poor result.

What Factors Contribute to a Failed Rhinoplasty?

A failed rhinoplasty may be attributed to technical errors during surgery, such as an improperly placed incision, aggressive removal of cartilage and bone of the nasal bridge, and aggressive removal of nasal tip cartilage. These can all lead to poor structural support and can lead to an unnatural and awkward appearance of the nose.

How is the Framework of the Nose Corrected?

For revision rhinoplasty, the nasal structure must be recreated using cartilage grafts to mimic the framework of a virgin, or non-operated, nose. The reconstruction must, therefore, be exact and flow together in a 3-dimensional fashion to give the appearance of an attractive nose that will balance the patient’s facial features.

Any issues of restoring function (breathing), may require strengthening those elements of the nose responsible for maintaining open air passages.

Are There Risks Associated with Revision Rhinoplasty?

As with any surgery, there are risks associated with revision rhinoplasty, including bleeding and infection that occur less than one percent (1%) of the time. If bleeding occurs, it can be controlled with cauterization or light packing. If an infection occurs, it can be treated with oral antibiotics.

What is the Importance of Skin in Revision Rhinoplasty?

Because the surgeon must recreate the structural framework of the nose during a revision rhinoplasty there are varying risks for patients who have thin versus thick skin. The skin and soft tissue envelope is a very important anatomical component of the nose.

For patients who have thin skin, they have an increased risk of

  • Visible irregularities in the procedure that may show through the skin. For example, if any of the underlying work on the bridge or tip of the nose isn’t expertly polished, any imperfections will show through the skin. This is also why some types of cartilage grafts may not be recommended for patients with thin skin or may need to be more carefully carved and covered with fascia, preventing postoperative visibility.
  • An intense inflammatory response in the nasal soft tissue because the skin and soft tissue of the remaining nasal framework are often scarred as a result of previous surgery. This scar tissue can replace the cartilage that was removed during the original surgery. Dissection of the scar tissue must, therefore, be meticulous to avoid damage to the skin (which is often thin) to prevent inflammation and scar tissue formation. Otherwise, the risk of an intense inflammatory response can damage a good cosmetic result.

In contrast, patients with thick skin have an increased risk of

  • The tendency of the weight of the skin to pull the nasal tip down. Consequently, there is a need for very strong nasal tip support to help keep the tip in the ideal position and to provide more nasal tip definition. There is also the added risk of prolonged swelling of the nasal tip for longer than a year for patients with thick skin. This happens because normal lymphatic drainage is altered during surgery and a new one needs to develop or because scar tissue formation after surgery can lead to prolonged swelling in the nasal tip. This may happen with patients with thin skin as well, but the swelling usually dissipates much sooner than those with thick skin.

Who is an Ideal Candidate for Revision Rhinoplasty?

Patients in good health who have had previous rhinoplasty and are dissatisfied with their results are potential candidates for revision rhinoplasty.

What Kind of Outcome Can Patients Expect from Revision Rhinoplasty?

Patients who wish to have revision rhinoplasty surgery need to understand that improvement of nasal shape and profile, not perfection, is the goal of this surgery.

For patients who suffer from severe nasal obstruction as a result of aggressive removal of cartilage with previous nasal surgeries, the goal may be the improvement of nasal shape and profile as well as improved breathing.

How Soon After a Primary Rhinoplasty Can You Have a Revision?

It is usually recommended that patients who have had previous rhinoplasty surgery wait at least 1 year before having revision rhinoplasty surgery. This timing is important to allow for any previous post-operative swelling to subside before undergoing another procedure.

Is a Closed or Open Approach Better for Revision Rhinoplasty?

For revision rhinoplasty, Dr. Pero prefers the open (external) approach (where a small incision is made in the columella), as there is often a great deal of asymmetry of the nasal tip cartilage that may require rebuilding and recreating the individual components of the nasal tip. With this approach, Dr. Pero can see the exact areas that are causing deformities in the nose and repair them.

What Can You Expect During Consultation for Revision Rhinoplasty?

During your consultation, Dr. Pero will talk to you about your concerns with the appearance of your nose. He will also examine the inside and outside of your nose to

  • Check your nasal septum for any deviations and palpate for the presence of cartilage.
  • Examine the internal and external nasal valves for signs of collapse.
  • Feel the nasal bridge for any humps, irregularities, or depressions.
  • Examine the nasal bones on each side for any deviations, irregularities or asymmetries.
  • Examine the tip of the nose for any asymmetries or any irregularities.

Dr. Pero will also take pictures of your nose, and then use computer imaging to give the patient an idea of what to expect after surgery.

Information gathered from this consultation will help to formulate an ideal treatment plan tailored to your specific needs and aesthetic desires.

Why Choose Dr. Pero for Revision Rhinoplasty?

For patients interested in “touch-up” revision rhinoplasty, Dr. Pero would be happy to talk to you about the additional aesthetic results you desire.

For patients who have had a failed rhinoplasty, Dr. Pero understands how devastating this experience can be for patients, especially when they feel that the result is a nose that is worse in appearance than the original nose. This unfortunate outcome often affects patient self-esteem and confidence, as well as the patient’s willingness to trust another facial plastic surgeon to correct the problem.

Dr. Pero implores these patients to seek him out to see how he can help them achieve their aesthetic goals. He is a surgeon you can trust:

  • He has a special interest in rhinoplasty and was trained in primary and revision surgery by world-renowned rhinoplasty expert Dean M. Toriumi, M.D., in Chicago, Illinois.
  • He is trained and experienced in all facial plastic surgery procedures.
  • He operates only in accredited medical facilities.
  • He adheres to a strict code of ethics.
  • He is double board certified by The American Board of Facial Plastic and Reconstructive Surgery (ABFPRS) and The American Board of Otolaryngology/Head & Neck Surgery (ABOto).

Other added benefits Dr. Pero has to offer patients:

Surgical Experience, Pre-Operative Planning, and Meticulous Surgical Technique. 

Dr. Pero believes that surgical experience, pre-operative planning, and meticulous surgical technique are essential for the best revision rhinoplasty outcome. He doesn’t follow any set of aesthetic standards when evaluating a patient for surgery. Upon consultation, clinical photographs are taken and computer imaging used to demonstrate the proposed changes. Dr. Pero only demonstrates that which his experience tells him will be able to be achievable. Of course, computer imaging is not a guarantee of your surgical outcome, but in most cases, the results are very close to the images. In fact, Dr. Pero prints and takes the photographs and the computer-imaged photographs to the operating room to act as a guide throughout the procedure.

Careful Reshaping and Support of the Existing Structures of the Nose. 

Dr. Pero’s training in rhinoplasty emphasizes adequate support of the nasal structure to resist postoperative scarring forces that result in contracture and “pinching” if inadequately supported. This results in durable, long-term results that avoid the typical “operated-on” appearance characteristic of some traditional rhinoplasty approaches. Removal of excess nasal cartilage and bone, as performed in some older rhinoplasty techniques, can result in a shortened, turned-up appearance to the nose, with pinching of the tip and middle vault areas. Dr. Pero is careful to reshape and support the existing structures of the nose in order to achieve the desired cosmetic changes while avoiding the long-term complications sometimes seen with these other techniques. Cartilage grafts taken from other areas are often used to perform the supporting type of grafts Dr. Pero employs. Nasal septal cartilage taken from the inside of the nose is the most common grafting material used in most cases. For more complex cases or in revision cases where septal cartilage has already been used, ear cartilage obtained via an incision hidden behind the ear or rib cartilage obtained via a small (~1″ long) incision hidden beneath the right breast (or chest in men) are the most common sites for cartilage grafting. Dr. Pero is one of the few surgeons in the country to perform rib cartilage grafting regularly when needed for complex or revision cases.

Revision Rhinoplasty FAQs

Dr. Pero usually takes “after” photographs of your nose every 3 months for 12 months after the procedure. At that time, he’ll also give you copies of your pre-operative photos, so you can see the aesthetic difference.

Light exercise is allowed 3 weeks after surgery. More strenuous exercise is allowed up to 6 weeks after surgery.

Patients can return to work within 1 week after surgery.

Swelling of the nasal tip takes time to recede. For most patients, seventy percent (70%) of the swelling subsides within the first month. The other thirty percent (30%) may take up to a year. For patients with thick skin, it may take longer than a year.

After surgery, a small cast is placed on the bridge of the nose. This is removed on the sixth or seventh day after surgery.

Patients should rest and relax immediately after surgery, and maintain a bland diet for the first 12 hours. Patients may also be instructed to

  • Avoid a high-salt diet. Keeping sodium intake under 2000 mg/day helps minimize swelling.
  • Keep the head elevated 30 degrees with pillows to help reduce swelling.
  • Use nasal saline rinses regularly to keep nasal airway clear. Avoid nose-blowing.
  • Clean the incision site(s) with hydrogen peroxide and apply antibiotic ointment twice per day.
  • Apply an ice pack (covered with a towel) to your eyes and cheeks for 10 minutes per hour for 48 hours to help reduce swelling.
  • Use Tylenol or over-the-counter medications for pain.

Dr. Pero takes approximately 3-6 hours to perform revision rhinoplasty surgery. In order to ensure a lasting pleasing result, the surgery requires meticulous attention to detail. As he tells patients, “I can do it in 2-3 hours, but you don’t want me to.”

This procedure is done using a general anesthetic and is usually done on an outpatient basis.

Dr. Pero requests that his patients obtain pre-operative labs several weeks before surgery. Other requirements may include

  • Patients older than 45 years of age with medical conditions will need to obtain medical clearance prior to surgery.
  • Patients will need to stop taking any anticoagulation medications, aspirin, non-steroidal anti-inflammatory products (e.g., naproxen, ibuprofen), vitamin A, ginkgo biloba, and St. John’s Wort, at least 10 days before surgery, as they can interfere with blood clotting and cause bruising.
  • Patients should not drink alcohol at least 2 days before surgery to avoid nasal swelling.
  • Patients should take Arnica montana, an herbal supplement, prior to surgery to minimize swelling and bruising. This is available over-the-counter or through his office.

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If you are interested in talking to Dr. Pero about revision rhinoplasty, call (214) 382-5100 to schedule a consultation. You may also schedule an appointment online through our website.