Revision Rhinoplasty – Second Time’s a Charm
What if your rhinoplasty didn’t turn out the way you hoped it would? What if your nose looks great initially but subsequently changes in ways you don’t expect or don’t like? Or what if you aren’t able to breathe as easily following the surgery? Perhaps your surgeon will tell you he or she can refine your initial result with an additional procedure, called a revision rhinoplasty. With any cosmetic surgery, a touch-up or revision procedure is sometimes necessary. Even in the hands of the best surgeon, the need for revision sometimes occurs. And because rhinoplasty is a complex operation, it has a higher revision rate than other cosmetic procedures.
One of the most challenging tasks for a surgeon is revising a previous surgery. Revision rhinoplasty is a second, sometimes even thrid or fourth, surgical attempt at correcting cosmetic or functional nasal issues. Revising and correcting a pervious nose surgery require skill and attention to detail.
Revision rhinoplasties provide exceptional results and offer relief to patience with deviated septums or breathing issues. View before and after photos of revision rhinoplasty patients.
Due to the delicate nature of nose surgery, revisions are sometimes necessary to correct minor or significant imperfections that may become apparent as the nose heals. These might include pinched nostrils, a progressive nasal obstruction, scar contracture during the healing process, or the results of aggressive surgery. Sometimes the work of the best rhinoplasty surgeons needs to be revised to achieve the desired results. Without a doubt, revision rhinoplasty is the most difficult procedure that facial plastic and reconstructive surgeons perform.
How Do I Know If I Need A Revision Nose Job?
Revision rhinoplasty may be necessary when the primary rhinoplasty surgeon failed to pre-diagnose potential anatomical and functional abnormalities of the nose that would effect the results of surgery. For example, if the patient desires a hump reduction, the surgeon should identify short nasal bones and a narrow middle vault. This evaluation warns the surgeon that the patient is at risk for upper lateral cartilage subluxation from the nasal bones (inverted V deformity) and internal valve collapse. In revision nasal surgery, the previous surgeon missed these potential anatomical abnormalities and the revision rhinoplasty surgeon must correct the complication. We always perform a detailed anatomic and functional evaluation of the nose followed by a diagnosis of the post-operative nasal deformities and/or nasal obstruction. The incidence of post-operative nasal obstruction is approximately 10%. After the problems and potential complications are identified, we create a surgical plan while studying the preoperative photographs.
Common Reasons for Revision Rhinoplasty
The reasons why you may choose to have revision rhinoplasty fall into one of two categories: dissatisfaction with the way your nose looks or dissatisfaction with the way your nose functions, and breathing is affected.
If you are displeased with the way your nose looks, you may feel that the changes to your nose are too dramatic or perhaps too subtle. Or you may be happy with your initial results but may experience subsequent changes that alter the shape of your nose in a way you don’t like.
There are other common reasons why one might seek revision rhinoplasty.
- Asymmetry: This may occur due to no fault of your surgeon. Post-operative scarring within the nose can cause it to appear uneven from one side to the other. The nose is a three-dimensional object that can heal in unpredictable ways.
- Callous or bump: A small callous or bump may appear on the dorsum up to one year following your procedure. The cause of this is unknown, but if it occurs, it can usually be removed in a minor procedure.
- Polly beak: Sometimes called a “parrot beak,” this can occur when a hump on the bridge of the nose isn’t sufficiently reduced in the area just behind the tip or when there’s a build-up of scar tissue. Correction requires revision rhinoplasty.
- Pinched tip: When the tip of the nose appears pinched, it’s often because too much tip cartilage was removed or the cartilage didn’t heal well and collapsed. To correct this, cartilage is usually added to the nasal tip in a revision rhinoplasty procedure.
- Inverted V: When a hump is reduced, sometimes the middle vault of the nose collapses inward, causing an “inverted V” appearance. This may be corrected with the placement of grafts in a revision rhinoplasty procedure.
- Post-operative changes: In general, following primary rhinoplasty, the nose changes every year. These changes can be unpredictable, and you may not like the way these changes look.
- Disappointment with results: Despite your surgeon’s best efforts, it’s possible that you may be disappointed with your results. Disappointment may be due to unrealistic expectations on your part, unclear communication of your goals, surgical aesthetic misjudgment, or complications during the healing process.
Even if you’re completely satisfied with the way your nose looks following surgery, it is possible to experience a nasal obstruction that make it more difficult to breathe through your nose. Most nasal obstructions can be corrected with revision rhinoplasty. If your breathing is hindered in any way, you may want to consult with your surgeon about a
follow-up procedure to alleviate the problem.
No matter what your reasons are for wanting further refinements to your nose, you’ll need to wait an average of one year following your initial procedure. Why? It’s important to wait until all the swelling from your first surgery has subsided, especially if you think your reshaped nose is too big. Once your surgeon indicates that the swelling has
completely subsided (usually after one year has passed), the decision of when to have revision rhinoplasty is up to you. You can wait for a few more months or even wait a few years. In fact, revision rhinoplasty can be performed decades after your original procedure.
Special Considerations About Revision Rhinoplasty
As mentioned earlier, rhinoplasty is a complex cosmetic surgical procedure, and revision rhinoplasty is even more challenging. Scar tissue builds up within the nose following surgery, making it more difficult to sculpt the underlying structures. In addition, an inexperienced surgeon may have removed too much cartilage or bone, making grafts a necessity in a follow-up procedure. Also, the nasal skin becomes thinner with revision surgery and tends to contract more tightly around the underlying structures, creating a “shrink wrap” effect. To avoid having the underlying structures become visible under the skin, soft-tissue grafts are often necessary.
Choosing a Surgeon for Revision Rhinoplasty
If you aren’t satisfied with the results of your initial procedure, you can either return to the same surgeon for a touch-up procedure or seek out a surgeon who specializes in revision rhinoplasty. First, it’s important to remember that problems can occur even in the hands of the most experienced surgeons. If you did your homework when choosing your original surgeon, and you know that he or she was qualified and competent, you may wish to have your original surgeon perform the follow-up procedure.
In most cases, if you require only a small touch-up, you may feel comfortable having your original surgeon perform the procedure. In some cases, however, you may wish to seek out a surgeon who specializes in revision rhinoplasty. For instance, if you feel that your surgeon lacked the necessary experience to produce a satisfactory result, if you require major refinements, or if your original surgeon doesn’t have experience with follow-up procedures, it may be best to find a specialist. When looking for a surgeon to perform your follow-up procedure, be sure to ask if he or she performs revision rhinoplasty on a regular basis and insist on reviewing before-and-after photos of patients who have undergone revisional procedures.
Paying for Revision Rhinoplasty
Who pays for revision rhinoplasty? It depends. Revisional procedures performed to correct functional problems may be covered by insurance. Follow-up procedures performed solely for cosmetic purposes typically aren’t covered by insurance. However, that doesn’t necessarily mean that you’ll be responsible for the entire bill. In some cases, if you return to your original surgeon for a minor touch-up, you may pay for only a portion of the procedure. For instance, if you have a healing complication, your surgeon’s fee may be waived, but you may still be responsible for paying fees for the operating room and anesthesia. However, if you’re dissatisfied with your nose, and didn’t communicate your wishes clearly, you may be responsible for all revision surgery fees. If you decide to go to a different surgeon for revision rhinoplasty, you will be responsible for all charges. It’s a good idea to ask in advance about your surgeon’s revision policies.