Revision rhinoplasty is distinct from the first of primary rhinoplasty. Techniques, including tissue grafting and or post-operative filler, temporary or permanent, or liquid rhinoplasty may be employed to correct deformities and even diminished breathing such that the process of altering nose size, shape and function is complete.
Revision rhinoplasty is a procedure, surgical or non-surgical that seeks to correct imperfections from one or more prior rhinoplasties.
Patients seek out revision rhinoplasty when they are dissatisfied with the result of the primary rhinoplasty or even one or more revision rhinoplasties.They are not and will not be satisfied until the end result that is appropriate for them can be achieved.
Poor communication between surgeon and patient at consultation. The patient’s desires are somehow not digested by the surgeon.
Failure to use “ Computer Imaging” by which the surgeon demonstrates what he or she believes is an appropriate result, after morphing — on a computer screen – several photo views. The patient needs to indicate if such a result would be satisfactory. Or course, the prospects for a successful outcome and thus a happy patent are increased when the surgeon delivers a result that nearly or exactly matches the computer imaged “ after”.
Substandard surgeon ability. Some surgeons have poor, inadequate specialty training . That is a bad start. This deficiency is compounded when the surgeon has little experience. Also, the less specialized surgeon is not likely to be a top performer since generalization disallows focus
The risks for surgical revision rhinoplasty are the same as for the first operation: bleeding, infection, poor healing. Generally revisions are technically more demanding, take more time to perform and still carry some level of unpredictability. They are dangerous, per se. Just require more skill and judgement.
Non-surgical revision rhinoplasty is an underused technique. Particularly the permanent non-surgical rhinoplasty technique. It is more precise, more predictable, less expensive and the patient participates in decision-making.
Surgical revision rhinoplasty is effective when there are major architectural deformities and/or uncorrected breathing problems. The non-surgical option, using fillers, is not available when the problem is imperfect structure and function.
Computer imaging is a must. Why not see the predicted result of the surgical or even the permanent non-surgical correction. You want the procedure to be your last and the better the communication with your surgeon, the less likely you will be yet again dissatisfied. Frankly, a consultation without computer imaging is nearly worthless. Would you purchase artwork without seeing the artist’s talent on a canvas?
The cost of revision rhinoplasty is never a happy expenditure. Your desire to have a satisfactory nasal surgery has been thwarted for whatever reason. So, now you face more time and money. Now, some surgeons do not charge for a surgical or non-surgical revision rhinoplasty, if performed at a reasonable time after the original surgery. That breed usually is the most talented, more experienced, most specialized and needs to perform so few revisions, that it passes muster with their accountant. Typically, if an operating room surgical revision rhinoplasty is required, there will be a fee for the anesthesiologist and charges for the surgery center. They charge by the hour; surgeons charge a set fee for the case.
Surgeon fees, if charged, and anesthesiologist and surgery center charges are a function of how much time is spent in the operating room. Typically, surgical revisions take less time than the primary. If the surgeon does not charge, the out-of-pocket for the patient is generally quite reasonable. Patients should inquire if the surgery center can offer a discount for being available on short notice, typically one week.
When you work on the nose of a revision patient, how is this process and procedure different?
Surgical revision rhinoplasty is not greatly different from a primary. The main difference is that it may be necessary to harvest bone or cartilage from the nose, ear or chest to fashion a proper result. The anesthesia and recovery are comparable to a primary procedure
Closed rhinoplasty for revision surgery has the same advantages as with the primary. No external, visible incisions. All stitches are hidden within the nose and dissolve.
Whether the closed or open rhinoplasty technique is employed, the end-result is less a function of the route into the nose than the artistry of the surgeon. When you have a super-upturned and/or pinched tip, that’s the giveaway that the surgeon is likely less well-trained, less experienced and less specialized. Likewise a too-long bridge or a nose that presents unequal nostril size and shape to the world. It’s all about judgement and remember, rhinoplasty is the most complex and sophisticated procedure in the realm of cosmetic surgery. 1/8” counts. Those who tend to major in body procedures, like breast augmentation or tummy-tucks are not likely to be the most accomplished rhinoplasty surgery. Hard to be a “ Jack of All Trades and Master of None”
There is no central registry of surgical revision rhinoplasty dissatisfaction . Several years ago, the American Academy of Facial Plastic and Reconstructive Surgery’s journal reported a 20% primary rhinoplasty dissatisfaction. Unfortunately, it can become a major patient issue when the second, third or even forth surgery fails to satisfy. Unfortunate because those unhappy patients are typically not aware of the permanent non-surgical remedy.
Typically revision rhinoplasty recovery is not much longer than that of a regular rhinoplasty recovery. There may be a little more swelling and perhaps bruising if cartilage is grafted but typically it is not double or triple the recovery time. Typically ten days to two weeks is a reasonable time for things to look quite satisfactory for public appearance.
The hallmark of revision rhinoplasty is that there is scar tissue within the nasal interior which must be navigated to successfully improve the result. This translates to more cautious and more time-consuming surgery. It often requires different techniques than what is used on a primary rhinoplasty. Scar tissue itself is not a reason not to have a revision rhinoplasty but it brings to the surgeon an additional burden that challenges his operative experience, skill, and level of talent. Are you getting a revision rhinoplasty in Beverly Hills? Schedule a consultation with Dr. Kotler to learn more about his computer imaging, his techniques, and what you can expect.
Theoretically, there is no limit, however, as we have learned from the late and great Michael Jackson, each successive rhinoplasty carries additional risk and may well bear a major complication such as loss of tissue. Infection, bleeding, and death of tissue are the feared complications and are related to the complexity of the imperfections and the particulars of the primary or additional surgeries.
Typically six to nine months is a reasonable window but that depends on many factors including the speed of healing, the thickness of skin, strength of cartilage, the degree of deformity, and whether or not grafting is anticipated. For those having permanent non-surgical revision rhinoplasty, the timeframe may be a bit shorter, perhaps three to four months, but nonetheless, that 100-day landmark is always significant. Anything prior to that point is probably ill-advised.
Typically the majority of the swelling is gone within two weeks. As for even a primary rhinoplasty, the nose will improve with time. It gets better and better and better over a period of time. At one month it looks very good, at two months it looks better, at three months it looks even better and generally, by four or five months the result has ripened to further satisfaction. Patients understand that each case is individual and that the rules of healing and swelling and bruising are never the same for all. However, the good news is that bruising disappears, swelling disappears; this is the grand law of Nature.
Revision rhinoplasty is dangerous if ill-conceived. Otherwise, yes it carries some additional risk. It is not “dangerous” per se unless one is facing insurmountable difficulties. There is a point where, primarily due to scarring of the skin to the underlying tissues where there is no “space” through which one navigates, that makes it a hazardous surgery. One of the attributes of the superior surgeon is knowing “when to operate and when not to operate.” We are fortunate to have a permanent non-surgical alternative which can be a grade hero when the odds are stacked against a successful and complication-free revision rhinoplasty.
The value to the patient is highly individual. Some patients carry an unshakable burden when they look in the mirror and are not happy.
To them, the cost of an additional procedure with the hope that satisfaction will finally be within grasp is worth it. Surgical revisions are expensive because surgery involves not only the surgeon’s fee but the anesthesiologist’s fee and the outpatient surgery center charges. If one is a candidate for permanent non-surgical revision rhinoplasty, there is no question that has enormous value since the cost is typically 25% of surgical revision rhinoplasty.
One has to do a bit of homework and determine from either personal referrals and/or scrutinization of websites who is a competent revision rhinoplasty specialist. Typically the revision rhinoplasty specialist will be the same person who is a superior primary rhinoplasty super-specialist. The more the practice is honed down on one or more procedures the greater the likelihood that you are in the hands of the proper specialists. We are now in a world of enormous super-specialization within the entire medical profession. We have surgeons who do only burn surgery, surgeons who do only hip and knee replacements, surgeons who perform only hand surgery, and surgeons who perform only certain neurosurgical procedures such as correction of congenital deformities. Generally, the rule is the more specialized the surgeon the greater the likelihood of success.
Closed revision rhinoplasty is merely revision rhinoplasty done through hidden internal incisions that are closed with dissolvable stitches. An open rhinoplasty involves one or more external incisions closed with stitches that have to be removed. Owing to superior technique often these incisions are nearly invisible. However, for those who are not as fortunate to have the highest level surgical performance, the unhidden evidence of a rhinoplasty is a disappointment.