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Revision Rhinoplasty – Why So Special?

Revision Rhinoplasty – Why So Special?

"A young man shows his broken, twisted nose in a close-up"

Broken, Twisted Nose

An athletic 33-year-old man broke his nose playing pick-up rugby and suffered a displaced septum. He also developed a hump on his nasal bridge.

The man had a pal whose mother received a nice face lift from a plastic surgeon so the rugby player asked that surgeon do his cosmetic rhinoplasty…which turned out only so-so.

But more importantly, one nostril developed an unpleasant odor while he suffered breathing trouble during workouts. Another six years went by, leaving the weekend jock barely able to breathe through that nostril. (Continued below.)


The patient below, left, shows  how previous nasal surgery done elsewhere left her nose long and droopy. Her rhinoplasty revision, right, was done via internal stitches only. (Robert Kotler, MD, photo.

"A middle aged woman shows how her long, droopy nose was made to look normal"





(Continued.) Long story short: the Rugby player need a master revision rhinoplasty surgeon with decades of experience. A first nose job is hard enough because most surgeons operate through the nostrils; it’s very much like operating through keyholes.

But a second (or third or even fourth) revision rhinoplasty is even more challenging because the surgeon must deal with:

  • Excessive scar tissue
  • Different – or missing — architecture inside the nose

Once the nose job re-do was healed, the man’s nose hump had been filed away and his deviated septum (the paper-thin wall separating the nostrils) was put back in the middle of his nose. Because the septum was no longer blocking normal drainage, his nose could take in air while draining normally. Plus, no more foul odor!

But what did that revision require?

Because the rugby player suffered so long, a donation of cartilage was taken from a rib, creating a new septum which also must support the nose. During the procedure, nose skin was lifted, giving the surgeon access to the bony bump which was shaved down. After removing the bump, the nasal bones were narrowed by a tiny but very carefully controlled break exactly where the bones of the nose join the cheek bones. That allows the surgeon to arrange those bones closer for a natural look.

Revision rhinoplasty is done with specially made, miniature surgical tools that require the master surgeon’s hand.  Even putting in and tying stitches deep inside the nose is a major challenge.

So where did the rugby player with the broken nose make the fatal step? It wasn’t on the field; noses are broken many ways. He took a wrong step when he went with a friend’s surgeon recommendation…with no more research.

Moral of story: revision rhinoplasty is best done by top surgeons only.

(Read more about finding revision rhinoplasty surgeons.)