For the overwhelming majority of people, the second surgery has to do with a specific cosmetic issue such as a twisted tip or a functional issue like difficulty breathing. The problems may not be the fault of the original surgeon. Not every aspect of healing is under the surgeon’s control, and some anatomical variations can pose particular surgical problems. While statistics vary, approximately 15 percent of primary nose jobs require revisions for one reason or another.
Wait at least one year before considering revision rhinoplasty. While some of the nasal swelling goes down almost immediately, it can take a year for all the swelling to subside. Most surgeons believe a minor amount of swelling lasts even longer. It also takes at least a year for scar tissue to soften (more if you have had two or three previous rhinoplasties), and a firm scar can prevent your surgeon from making a adequate correction. If you go back for a revision rhinoplasty too soon, you can turn a minor problem into a major disaster; so be patient.
During your revision rhinoplasty consultation, our plastic surgeons will examine your skin, cartilage strength and bone structure, as well as assess the amount of cartilage that is available, because grafting is almost always required. Grafts can create a better shape and support the airway — two reasons for secondary rhinoplasty surgery.
Below are explanations of some of the most common deformities addressed in revision rhinoplasty procedures.
What it is: This type of nasal deformity is characterized by an inverted V-shaped shadow in the area of the middle vault of the nose.
How it occurs: Over resection of the upper lateral cartilages – the cartilages forming the sides of the nose’s bridge. It often occurs when the surgeon who performed the original procedure made a mistake during the removal of a nasal bump and fracturing the nasal bones. (This destabilizes the upper lateral cartilages.
How to correct it: Fillers or surgery. prefers surgery because fillers do not fix the deformity permanently. The volume gained through hyaluronic acid-based fillers, for example, lasts for about six months. Fillers are also less precise than surgery and can make the nose look larger. Moreover, they can cause inflammation and scar tissue, which can make any later surgeries more difficult to perform. Finally, fillers can move around inside the nose. For all of these reasons, favor surgery to fillers when correcting an inverted V deformity. The surgery often involves placement of a dorsal cartilage above the nasal bridge to narrow the nose and widen the middle nasal vault.
What it is: The columella is the strip of skin between the nostrils. A hanging columella, or “alar-columellar disproportion,” is one that hangs lower than desired, so that about 4mm of nostril, or more, is visible from the profile.
How it occurs: There are many potential causes of hanging columellas. Some people are born with it, in which case it is often the result of either a long septum and/or the columella cartilages pushing down on the columella. Other people end up with the deformity due to a mistake made during their primary rhinoplasty procedure.
How to correct it: This depends on the cause of the deformity. Excess tissue may be removed after making an incision, and a portion of the septum may be removed. Other cartilage may be removed or shaved. In rare cases, the nasal spine may be reduced.
What it is: A saddle-like formation in the area of the septum. This type of deformity is sometimes referred to as a “scooped nose.”
How it occurs: Something (e.g., trauma) causes the septum to lower.
How to correct it: The septum can be raised or a cartilage graft can be added to the depression, to fill it in.
What it is: External nasal valve collapse is a collapse of the nasal valve caused by weakness or narrowness in nasal valve, the most-narrow portion of the nasal airway.
How it occurs: Trauma to the nose or mistakes made during the original rhinoplasty procedure.
How to correct it: In some cases it is possible to treat by lifting the cheek tissue on the side of the nose that is blocked. In other cases surgery may be needed. There are several different surgical approaches that may be employed. For example, alar batten grafts may be grafted as appropriate if the collapse was caused by weakness in the nasal sidewall. The surgeon performing the revision rhinoplasty procedure will need to assess the cause prior to choosing which approach to adopt.
What it is: A nasal tip that appears too narrow, or “pinched.”
How it occurs: Some patients are born with pinched tips, but this type of deformity is often the result of overresection of the tip cartilages during the original rhinoplasty procedure.
How to correct it: Usually, a “tip plasty” is performed to reshape the tip with ear or other cartilage.
What it is: A nasal tip that appears pointy essentially means that the alar cartilages are too prominent and appear too pointy, or stick out too much.
How it occurs: Many patients are born with pointy nasal tips. This deformity is more common in individuals with thin skin.
How to correct it: It depends on the patient’s unique anatomy. The endonasal (internal incisions) approach is used in some patients, while an open approach is used in others. Cartilages may be shaved or trimmed. In thin-skinned patients, a soft tissue graft, or fascia, may be placed over the tip cartilages. Repairing a pointy nasal tip — or other deformity of the tip — is one of the most challenging of all rhinoplasty procedures.
What it is: A space formed when the nasal bones don’t come together near the top of the nose. An open roof deformity makes the nose appear excessively wide. Typically, nasal skin grows or droops into the space and vertical lines or depressions appear.
How to correct it: It depends on how low or high the nasal bones are positioned. Osteotomies (fractures) may be necessary, and onlay grafts may be used to close the gap between the nasal bones.
Revision rhinoplasty recovery is similar to primary rhinoplasty recovery. Nasal packing will help reduce swelling and bleeding after surgery, but you will be unable to breathe through your nose until the packing is removed.
Revision rhinoplasty costs more than primary rhinoplasty. Any part of the fee that is directly related to correcting airway problems may be covered by your health insurance, although you must cover any costs associated with cosmetic changes.