BEVERLY HILLS’ REVISION RHINOPLASTY SPECIALIST

Dr. Robert Kotler has performed over 5,000 nose procedures throughout his extensive career. His training in head and neck surgery set the foundation of excellence that has defined his approach to cosmetic and functional rhinoplasty. After his board certification and fellowship training, Dr. Kotler had the privilege of studying under one of the most renowned nasal surgeons in the world.

This high level of training and specialization has given Dr. Kotler unique insight into the common problems that may occur during and after rhinoplasty. Dr. Kotler is proud to have successfully performed this highly complex surgery on thousands of patients. Whether your initial rhinoplasty has left you with cosmetic defects or you are simply unhappy with the results, Dr. Kotler can help you achieve the results you deserve.

REASONS REVISION RHINOPLASTY IS NEEDED

Collapsed Bridge

Uneven Nostrils

A Drooping or Upturned Nose

Unsatisfactory Results

Collapsed Bridge

Cartilage plays an important role in supporting the nose and giving it shape. If too much cartilage is removed during rhinoplasty, certain parts of the nose may eventually collapse. This typically occurs over several years. Patients may notice the dorsum (the bridge) develop a depression until it gradually collapses. Depending on the severity of the collapse, it may obstruct the inside of the nose and cause breathing problems. Bridge collapse can also occur after removing a dorsal hump, especially if it involved removal of dorsum cartilage.

To rebuild the supporting structure of the nose, Dr. Kotler can use cartilage grafting to restore form and function. In some cases, he can also use the permanent filler, Silikon 1000, to build up the nasal structure. Both techniques are also used in primary rhinoplasty if the patient has a naturally flat or low dorsum and is seeking a balanced profile.

Uneven Nostrils

In some cases, rhinoplasty patients end up with asymmetric nostrils. When altering the delicate structures of the nose, special care must be taken not to overcorrect or remove too much cartilage and bone. When certain parts of the nose lack support, these weak points may collapse in and protrude to the other side, causing nostril asymmetry from the frontal view. While a certain level of asymmetry is normal, it can be frustrating to be left with a nose that appears more crooked after rhinoplasty.

Dr. Kotler addresses nostril asymmetry by correcting the protruding cartilage and building up the foundational structure of the nose. This also helps prevent future defects from developing.

A Drooping or Upturned Nose

Like many post-rhinoplasty defects, a drooping or upturned nose is frequently caused by overcorrection. When the nose lacks proper support, the nasal tip collapses backward and becomes over-rotated. Conversely, the nasal tip may become under-rotated and droop forward without adequate support. This causes an upturned appearance. An upturned nasal tip can also be caused by the contracture of scar tissue, which essentially pulls the tip backward. Dr. Kotler can reverse this cosmetic defect by restoring the supporting structure of the nose and releasing scar tissue when needed.

Unsatisfactory Results

In some cases, patients have not developed any defects of the nose, but are simply unsatisfied with the result. Dr. Kotler understands that cosmetic surgery is an emotional process, especially when performed on one of the most prominent facial features. For this reason, he closely collaborates with his patients to create a customized treatment plan that best achieves their goals. During the consultation, Dr. Kotler will discuss with you whether your desired look can be achieved and what techniques would be most appropriate for your unique anatomy.

WHAT TO EXPECT FROM SURGERY AND RECOVERY

Revision rhinoplasty is performed under anesthesia, so patients are highly comfortable and have no awareness of the surgery; the surgery itself takes about an hour and a half to complete. Afterward, patients are taken to our state-of-the-art recovery room for one hour. Patients can go home the same day as their procedure, and it is mandatory that they have a family member, friend, or caregiver to stay with them for at least the first night.

For patients whose surgery was only cosmetic, our professionals remove the internal nasal packing the day after surgery. About five days after, patients will return to our office once more to remove the protective cast. Patients who had functional surgery will also have their internal packing removed at this time.

Patients are free to resume work and regular activities at this point; light exercise like walking can be done the next day after surgery. Heavy exercise like lifting weights and cardio (anything that will elevate blood pressure) usually can be resumed in two weeks but not before.

It’s common for bruising to appear after surgery, but this usually fades within a few days. Patients cannot wear eyeglasses within the first six weeks after surgery. If you need to wear eyeglasses, we will teach you to suspend them from the forehead so that the glasses do not rest on the nasal bridge.

After the first week, swelling diminishes rapidly, and the nasal airway continues to improve. To boost patient comfort during recovery, we provide a saltwater nasal spray that soothes the healing internal nasal tissues. Optimal breathing is generally achieved within one month.

HOW LONG SHOULD PATIENTS WAIT BEFORE UNDERGOING SECONDARY RHINOPLASTY?

After cosmetic nose surgery, it’s common for swelling and postoperative effects to obscure the results. If you are still unsatisfied with your results by six months after the initial surgery, then it might be time to consider revision rhinoplasty. The standard timeframe to wait is about a year after surgery – this gives the nose time to heal fully.

ARE THERE OTHER OPTIONS BESIDES SURGICAL NOSE REVISION?

In some cases, cosmetic irregularities after nose surgery do not require additional surgical intervention. With Silikon 1000, Dr. Kotler can permanently fill in minor depressions and divots on the nose. This procedure takes just minutes to perform, and it is virtually painless when accompanied by a topical anesthetic. Post-op bumps that have developed on the nose may also be flattened and smoothed away using cortisone injections.

For patients interested in pursuing the non-surgical route, our Beverly Hills practice offers the Kotler Saline Demo. Using temporary saline injections, Dr. Kotler can show patients what results they can ultimately achieve if they decide to go with a permanent filler. The saline is safely absorbed by the body about two hours later, allowing patients to “test drive” a non-surgical rhinoplasty revision before making the final decision.