Revision Rhinoplasty Information
Every year, thousands of patients undergo a very popular cosmetic surgical procedure called Rhinoplasty (commonly known as a “Nose Job”). Ideally, the surgery should always be successful resulting in an improved appearance and boost in self-esteem. Unfortunately, this is not always the case. Rhinoplasty Surgeon Dr. Slupchynskyj sees many patients who require a second procedure, known as Revision Rhinoplasty, to correct mistakes or repair oversights that were not addressed during the initial surgery with another surgeon. Below, we examine the causes behind Revision Rhinoplasty, the techniques used in the procedure and ways to reduce the need for a second operation.
Rhinoplasty is the name given to a surgical modification of the nose to alter its appearance and/or improve breathing function. Dr. Slupchynskyj performs Nose Surgery to rectify breathing problems associated with the nose or to repair deformities attributed to injury or birth defects. He performs Rhinoplasty on noses to greatly improve their appearance and contours. The procedure can either decrease or increase the size of the nose, or adjust the size or shape of the bridge, the tip or nostrils.
Revision Rhinoplasty (also called “Secondary Rhinoplasty”) refers to a surgical procedure that corrects any problems that occur after a Primary Rhinoplasty operation. On a national average, up to twenty percent of patients who have had a their first Nose Surgery undergo a Secondary procedure. Revision Rhinoplasty Surgery is often a complex and delicate surgery, especially if the initial operation significantly affected nasal function.
The surgical manuevers typical to Revision Nose Surgery involve correcting complications either created by the first surgery or addressing pre-existing issues which were not taken care of the first time, (i.e. breathing obstruction, or a misshapen nasal tip). Complications which resulted from a poorly executed Primary Rhinoplasty include a hooked nose (also called a “Pollybeak” due to its resemblance to a parrot beek), a pinched or narrow tip, saddle nose deformity, nasal valve collapse, Hanging Columella, retracted columella, and over shortened nose.
Since the Primary Rhinoplasty procedure often makes major alterations in the structure of the nose, the techniques required for a revision are far different than those used in the initial procedure. Revision Nose Surgery is considered among the most difficult cosmetic procedures to execute successfully. Improper techniques employed in Primary Rhinoplasty can frequently undermine the structural support of the nose in order to remove bumps and reduce nose’s overall size.
In Revision Rhinoplasty, implant material (cartilage from a different area of the body or synthetic) may be required to replace the over-resected or damaged nasal tissue. If cartilage is the best option for the patient, this can be taken from the ear, the ribs, or the septum (the “wall” between the nostrils). In some cases, cartilage may not always be able provide sufficient structural support to the nose. Synthetic substances, such as Silastic implants, provide the necessary support when cartilage cannot. Dr. Slupchynskyj never uses just preformed “one-size-fits-all” implants. He custom carves every implant into the precise contours required to achieve the best possible result.
Open vs. Closed Rhinoplasty
In Revision Surgery, it is usually necessary to utilize the advanced “Open” technique. In this setting, Dr. Slupchynskyj can directly access the nasal architecture, rather than through the nostrils with the traditional Closed technique, which limits what a surgeon can and cannot surgically address or alter. The open technique gives the surgeon control in precisely reshaping all areas within the nose.
A Facial Plastic Surgeon with extensive training and experience in Revision Rhinoplasty is able to reduce the chance of further complications while bringing the patient’s appearance into alignment with their expectations.
Conditions Requiring Revision Rhinoplasty
Several types of nasal deformities encountered after a Primary Rhinoplasty procedure often require Revision Surgery to correct. These can range from over-reduction of the structural cartilage to reshaping the nostrils and nasal tip.
The bridge of the nose (also called the “nasal dorsum”) is one of the major areas of the nose targeted for reshaping during a Primary Rhinoplasty procedure. In many cases requiring revision surgery, much of the cartilage of the nasal dorsum has been removed due to over-resection. The removal of an excessive amount of nasal bridge cartilage can lead to both cosmetic issues (flattened, narrow or misshapen nose) and structural damage (lack of support for the septum and nostrils).
The “Pollybeak” Deformity (also known as “supratip fullness”) comes as a result of improper removal of tissue around the nasal tip. The deformity resembles a bird’s beak, in that the nasal tip extends below the edge of the nose (columella). This condition can also occur in patients with thick skin in the nasal tip area. In cases where the pollybeak occurs due to inadequate supporting tissues, the surgeon can graft additional cartilage to bring up the tip.
A Saddle Nose (also called “pug nose” or “boxer’s nose”) resembles the opposite condition of the Pollybeak Deformity: the nasal tip is turned up and the supporting tissue in the nasal bridge curves inward, resembling a saddle. The condition occurs due to a lack up support from the septum. Some overaggressive surgeons may remove too much cartilage from the septum in order to reshape the nasal bridge. Without that support, the bridge collapses inward.
In addition to the cosmetic concerns surrounding the saddle-shaped deformity, the lack of support from the septum can lead to respiratory problems. The collapsing cartilage in the nasal bridge can restrict the airflow through the nostrils, which can lead to snoring and other breathing issues. The most effective treatment during a Revision Rhinoplasty procedure to correct this problem is to rebuild the septum and reinforce the outer structure of the nose.
A midnasal deformity, such as a deviated septum, can occur as a result of trauma, birth defects, or irregular growths in the bone and cartilage. The condition can also occur when a Cosmetic Surgeon attempts to correct facial asymmetries by removing excessive amounts of the upper lateral cartilage. Since the nasal structure rarely exhibits perfect symmetry, the results of a Primary Rhinoplasty procedure can exacerbate or overcompensate for these slight flaws.
Midnasal deformities can be addressed through a Secondary procedure that begins when the surgeon makes small incisions between the layers of cartilage, creating small pockets in which he/she can place grafts. These grafts can be made from artificial materials, or from the patient’s own cartilage, usually extracted from the ear or ribs.
Nasal tip deformities are among the most noticeable cosmetic issues surrounding Rhinoplasty. Some deformities of the nasal tip include tip ptosis (“drooping nose”), Hanging Columella, and excessive soft tissue buildup. Revision Rhinoplasty procedures to correct these problems requires specific knowledge of how the tip structure looked and function prior to the Primary Rhinoplasty Surgery.
The surgeon conducting the Revision procedure must have a deep understanding of the structural relationship between the tip, the columella and surrounding cartilage. A proper diagnosis of the origins of nasal tip deformities establishes the criteria for the Revision surgery. While the structural issues related to tip deformity correction are often less than those involving the septum or nasal bridge, patients often have high aesthetic demands on the results of such procedures.
The area around the nostrils, columella and ala (the cartilage over the nostril openings) can be among the most problematic to correct during Primary Rhinoplasty procedures. A nose that may be aesthetically pleasing in other areas can suffer if a lack of proportion in this region appears. While most surgeons focus their attentions on the tip or the nasal bridge, the “wing” areas of the nose are frequently neglected. After surgery, some patients may have smaller nostrils, which can lead to collapse of the external nasal valve, while others have wide, flat nostrils that can hamper their appearance.
The surgeon implementing the revision procedure can harvest cartilage from other areas, or use a hypoallergenic artificial substance to reshape the lower nasal region. The surgeon will also be aware of the potential for thick scar tissue to develop around this area and will reshape the nose to reduce its prevalence.
“Bossae” (singular: “bossa”) is the clinical term for paired extrusions or bumps that appear on the nasal tip. These paired bumps are connected by a bridge of cartilage that stretches across the “dome” of the nose. These extrusions occur when the sidewalls around the nostrils (the “lateral crurae”) have had excessive amounts of tissue removed during Primary Rhinoplasty. The bossae are typically not visible until the swelling in the area recedes, but can become prominent after recovery.
In years past, the revision procedure involved shaving down the bossae to remove the bumps and smooth out the dome; however, studies have show that such a procedure further weakens the nasal tip structure. Two techniques to address this complication involves either tightening the dome area to remove the bumps, or covering them with additional cartilage. The choice between these options can be determined by the shape of the patient’s nasal tip and the thickness of the overlying skin.
In some patients, the columella is too short and becomes retracted from the nasal tip. Since the columella forms the base of the nose, a columellar retraction can affect the shape of the entire nose. With that in mind, the surgeon must evaluate how the revision procedure will affect both the aesthetic appeal and functional structure of the nose will be affected by correcting the retraction, especially around the alar and nasolabial regions.
Just as the columella can become retracted after a Primary Rhinoplasty procedure, so can the alar cartilages that span over the nostrils. Alar retraction leads to the appearance of small nostrils and an extended columella. The reasons for alar retraction can include poor positioning of the alar cartilages, excessive resection of the lateral crurae, and thickened tissue in the columella.
About Dr. Oleh Slupchynskyj
Over the years, many New York Ethnic Rhinoplasty patients have achieved the look they desire under the skilled surgical hand of Dr. Oleh Slupchynskyj. Regarded as one of the Best Nose Surgeons in the area, Dr. Slupchynskyj uses the latest surgical techniques and tools to deliver beautiful, aesthetically-pleasing results. He is pleased to provide care to a diverse range of patients including Female Rhinoplasty, Male Rhinoplasty, and Revision Nose Surgery New York patients. To schedule a comprehensive consultation, and learn more about Rhinoplasty, including specifics of the procedure, benefits, and cost of Nose Surgery, contact the Aesthetic Institute of New York and New Jersey today.