Some patients actually believe that a surgical revision rhinoplasty is to be expected, or is the norm. That is incorrect. The rhinoplasty super-specialists generally have a very low rate of revision rhinoplasty.
- A. Norman Enright
Medical Writer
Dr. Robert Kotler is a revision rhinoplasty specialist in Beverly Hills that has performed thousands of secondary nose jobs. When other less experienced surgeons have not achieved the natural result their patients were hoping for, Dr. Kotler is the best rhinoplasty revision doctor people turn to as he is the nose super specialist.
Due to the practice’s predominant focus on perfecting the nose, any prospective patient can view our unmatched collection of revision rhinoplasty before and afters from our happy patients that have experienced a rhinoplasty gone wrong just like you may have before seeing Dr. Kotler.
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. And for the past several decades, Dr. Kotler has been performing several types of revision rhinoplasty, including ethnic revision rhinoplasty and permanent non-surgical revision nose jobs. Patients can find comfort in knowing Dr. Kotler is truly the most experienced revision nose surgeon and the best doctor in Beverly Hills for anybody seeking their secondary rhinoplasty.
Revision Rhinoplasty Before and Afters
#1 Rated BEVERLY HILLS REVISION RHINOPLASTY surgeon
Dr. Kotler’s high level of training and specialization has given him 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 rhinoplasty surgeon, Dr. Kotler, can help you achieve the results you deserve.
Most revision rhinoplasty patients are particularly worried of how your revision rhinoplasty will look, but at our practice you don’t have to be because there are no surprises. Dr. Kotler has computer imaging technology so you can see what your secondary nose job will look like before you have the procedure done. This visual will give you a good idea of what to expect and provides an open door of communication for sharing your desired results with Dr. Kotler.
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.
Why Revision Rhinoplasty?
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
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.
What To Expect From Surgery And Recovery
Objective: 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.
Total Surgery 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.
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 saline injections, Dr. Kotler can show patients what results they can ultimately achieve if they decide to go with a permanent filler after rhinoplasty. 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.
