Los Angeles Rhinoplasty in Beverly Hills - Revision Rhinoplasty

Question:
What are the most common changes you make when performing rhinoplasty on African American patients and how do you make these changes?

Answer:
Many African American patients are looking to decrease the width of the nose at the upper nasal bone area and minimize the size of the nasal tip and nostrils. It is also common to add projection on the profile view. In order to increase projection, numerous grafts like plumping grafts, a columellar strut and a shield graft can be used. Once this is achieved, the nasal bones of the bridge or dorsum are built up to match the new increase in the tip projection. The nostrils are then narrowed with a nasal base reduction in which small incisions are made on the side of the nostrils to remove tissue.

Question:
What are some of the most common reasons for revision rhinoplasty?

Answer:
The primary reason for revision rhinoplasty is a previous overaggressive rhinoplasty where the surgeon has excised too much cartilage from the nose. This is very common in patients who come in with a large nose desiring a smaller, more refined nose. In this situation, many surgeons will perform overaggressive resections of the nasal tip cartilage which will subsequently lead to problems with nasal obstruction, nasal collapse and unsightly deformities of the nose. In thick-skinned patients, often times the nose will become amorphous, asymmetric, ptotic, and collapsed. In patients with extremely thin skin, the nostrils may retract or lift up which would expose the inside of the nose more, the side walls of the tip will collapse, the tip of the nose will elevate in... continue

Question:
Are grafts always used in revision rhinoplasty cases and what are they made of? Are there any concerns when using them?

Answer:
In the majority of revision rhinoplasty cases, cartilage grafts are used for reconstruction. Cartilage grafts are used to reconstruct the tip, such as opening up the nasal valve in case someone has a pinched nose and they can't breathe versus lengthening the nose after a rhinoplasty that has been overdone, or to add cartilage to the dorsum or bridge of the nose if it’s been over-resected and now retains a scoop. In most of my cases, I use cartilage grafts which come from the patient's septum, ear, or rib. If the septum is not available, the next best cartilage which is strong and straight is rib cartilage. Rib cartilage is harvested... continue

Question:
Is skin thickness a greater factor in ethnic rhinoplasties and why?

Answer:
The skin thickness is a great factor in rhinoplasty, particularly in ethnic rhinoplasties. Many African American, Asian and Hispanic patients have thick skin which conceals the underlying cartilage of the nose. These patients also often have noses that are under-projected. The best way to make an under-projected, thick-skinned nose look better is to increase projection. So the goal to taking a very thick skinned patient and making the nose look more refined and narrow is to increase projection. In addition, over aggressive resection of cartilage in thick-skinned patients will lead to the nose looking worse.