Revision Rhinoplasty

If there are issues with a previous Rhinoplasty Surgery, Revision Rhinoplasty may be for you.

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Beverly Hills revision rhinoplasty specialist Dr. Robert Kotler has performed more than 4,000 nasal surgeries in his over 35-years experience. Of the narrow range of facial procedures he performs, this is the one he is best-recognized for. Because of Dr. Kotler’s core training in the specialty of head and neck surgery, he had unique training in surgery of the nose, both inside and outside. His military experience further enhanced his already considerable skills. Following his board certification and fellowship training, he studied with some of the worlds’ leading nasal surgeons, including Dr. Howard Diamond of New York City, the most prolific nasal surgeon in the history of the specialty. For those considering nasal surgery, Dr. Kotler is as specialized and as highly-trained a surgeon as you can find.

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A complication should not be confused with an imperfect outcome. Before surgery, when you officially consent-in writing-to having the procedure(s) performed is when you accept possible complications; i.e., known, inherent risks such as, infection, scarring or poor healing. Not that these other possible difficulties are likely; they are not. But in the some small percentage of cases, complications or unexpected conditions do occur. Usually, they are not the fault of the surgeon, per se. Please do not blame the surgeon; he shares the anguish. Neither of you asked for this.

Fortunately, most complications, unsatisfactory results, and disappointments can be improved upon.

The competent, concerned surgeon knows what to do and will stick with you until the problem is rectified. “With you all the way.” He wants you satisfied. You are his walking advertisement.

Some imperfections or complications improve spontaneously, so the savvy doctor knows to allow nature some time. This is one more way where experience counts. The more specialized, seasoned veterans, having seen it all, have a larger fund of experience to draw from. This helps them better predict the course of events. These pros also tend to be less anxious about the ultimate outcome because they know that either nature, they themselves, or a colleague will help correct the situation. The novice, the inexperienced practitioner, often becomes anxious, nervous and uneasy. This visible lack of confidence can spread to you. Your anxiety and worry need to be compounded by your doctor.

Your doctor should explain the problem to you, outline the possible solutions, and suggest the best course of action.

Consulting About a Rhinoplasty Redo?

Be careful! A redo or “revision” is more technically challenging for any surgeon, even the most specialized and experienced. A perfect result can never be guaranteed. The decision-making is critical; sometimes, the best decision is to not re-operate. As I advise patients: Better to keep a minor imperfection than to risk a major one.

Be Sure To Ask About non-surgical Rhinoplasty Options

For some patients, a satisfactory improvement can be obtained without another trip to the operating room. Some “bumps” or “rises” can be permanently flattened by cortisone injections under the skin. Depressions can be permanently filled with liquid medical-grade silicone. An injection of either takes only seconds and can be virtually painless following the application of a topical anesthetic.

There is one nifty and practical way for you to see immediately the obtainable result from a filling injection. The doctor injects sterile saline, under the skin, to plump up the depressed area. This salt water preparation is a safe temporary filler that fills within 20 minutes. We call this a demo or a test drive. If you like what you see, and feel, you may consider opting for this non-surgical alternative. In addition to avoiding another trip to the OR, there is zero downtime, the cost is far less, and since you are awake – with mirror in hand – you can participate in the “how much will do the job?” decision. Because it is wisest to inject a non-extractable, permanent substance, “little by little,” several sessions may be required. But most importantly, you decide when the improved appearance satisfies you. You’re in charge.

SALINE (SALT-WATER) DEMO

To demonstrate results of permanent silicone injections

What you can expect after revision nasal surgery, which is very similar to primary nasal surgery.

Additional Revision Rhinoplasty Info

Objective:

Revision cosmetic and/or functional nasal surgery aims to create a better-appearing and better-functioning nose. To render your nose more compatible with the other facial features, the changes Dr. Kotler proposes will not make the nose look “unnatural,” or “done.” The goal is to create a natural-looking nose that is pleasing and not recognized as having had surgery.

Anesthesia:

Anesthesia administered by a physician-anesthesiologist specializing in facial procedures. Under anesthesia, there is no pain and no awareness. An intravenous is started and you “drift off” to sleep.

Time:

Approximately 1 hour in the operating room.

Recovery Room:

Usually 1 hour in a fully monitored and state-of-the-art recovery room at the surgery center.

Convalescence:

Professional care is optional. If you choose to recover at home, someone must be with you the first night. As with all of our procedures, precise instruction/direction sheets are a “care package” of supplies and medications are provided.

Stitch Removal:

Since most nasal procedures are performed entirely internally, dissolving stitches are placed into the nasal interior. These generally need not be removed.

The First Week:

If your surgery has been only cosmetic, you will remove the internal nasal packing at home the day after surgery. Approximately 5 days after surgery, you will return to the office for removal of the protective cast. For patients who have functional surgery, with or without a cosmetic improvement, the packing will be removed in the office 5 days after surgery, at the same time the protective cast is removed. Contact lenses can be worn 2 to 3 days after surgery. At this time, you are free to return to work and usual activities and functions except for strenuous exercise. If there is any bruising at this time, it should disappear within the next 2 to 3 days and can be easily concealed with make-up (we will provide instruction). If you wear eyeglasses, we will teach you to suspend them from the forehead so that the glasses do not rest on the nasal bridge. This precaution must be observed for 5 weeks after surgery.

After That First Week:

Any residual swelling rapidly diminishes. The nasal airway improves daily. Since the nasal interior tends to be somewhat dry after surgery, we provide a soothing saltwater nasal spray to refresh the healing internal tissues. Optimal breathing is generally achieved within 1 month. Generally, you will be seen twice weekly in the first month after surgery to check healing and answer your questions. Thereafter, visits are infrequent. Postoperative photos are taken no sooner than 3 months after surgery. Just in case you long to see what your “old nose” looked like, we provide copies of your preoperative photos for you.

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