Revision rhinoplasty is a plastic surgery procedure which rebuilds and reshapes deformities of the nose that have resulted from a previous rhinoplasty surgery. It may also be referred to as secondary or tertiary rhinoplasty. Revision rhinoplasty is a highly customized and individualized surgery. Good candidates include healthy men and women who are unhappy with the current appearance of their nose following a previous rhinoplasty surgery and are seeking an improvement.
Why Choose Dr. Schwartz?
With over 25 years of plastic surgery experience, Dr. Schwartz is an expert in facial plastic surgery. But what sets him apart from other plastic surgeons is his ability to create aesthetically beautiful results while ensuring full proper functionality of the nose. As a double board certified doctor, Dr. Schwartz is not just a talented facial plastic surgeon but also a skilled ENT. With Dr. Schwartz you can achieve the look you want with the comfort of knowing that the air passages within the nose will not be affected. Often times, Dr. Schwartz performs revision rhinoplasties to amend surgeries performed by other doctors that either aesthetically missed the clients desires or caused breathing issues post-surgery. As an ENT, Dr. Schwartz knows how to achieve the right design without any interference with breathing. You can trust Dr. Schwartz with your surgery. Call the practice today to schedule your consultation, 561-228-5888.
Dr. Schwartz performs revision rhinoplasty in an outpatient surgical center. IV sedation or general anesthesia may be used and the surgery takes about three hours to complete. Incisions are typically made on the inside of the nose. While the exact nature of the surgery will depend upon the particular individual and the problem, the desired shape may be achieved by repositioning cartilage or replacing missing structures. In some cases, grafts may be required from another area of the body, such as the cartilage of the ear.
Recovery after revision rhinoplasty takes about one week. There tends to be less bruising, swelling, and pain than after primary rhinoplasty procedures. The stitches are removed in about five to seven days. Patients can usually return to work in about a week, though more strenuous activities should be avoided for about two weeks.
Revision Rhinoplasty Case Study
Dr. Schwartz offers a meticulous and thorough approach to patients seeking revision rhinoplasty.
Regardless of the reason for the outcome that makes a patient seek revision rhinoplasty, Dr. Schwartz understands that having already experienced one or more failed procedures, the patient is anxious, scared and somewhat disenchanted with the surgical process.
Dr. Schwartz recommends that patients look for and select a surgeon with the following qualifications for revision rhinoplasty:
- The surgeon should have dedicated interest and experience in both primary and revision rhinoplasty.
- The surgeon should have the experience to be able to correctly identify the underlying anatomic cause for the deformity.
- The surgeon should be familiar with and skilled at using a wide variety of surgical techniques which may be needed to correct the deformity. He should not have one cookbook approach to every problem.
- The surgeon should be willing to devote the necessary time to both the consultation and the operating room to achieve the desired result. Some revisions may be simple to perform, but some may require significant operative time commitment.
- The surgeon should be confident that they can achieve improvement for the patient but never promise perfection.
The following case studies of actual patients of Dr. Schwartz illustrate these principles.
Patient 1
* Each patient is unique and individual results may vary
1. On frontal view (preoperative on left) the patient demonstrates narrowing of the middle third of the nose (inverted V deformity), asymmetry, deviation and pinching of the tip and over rotation of the tip and excess nostril show. After revision (right side) the middle third is restored, the tip is more symmetric and midline, the pinching, rotation and nostril show are improved.
Base views shoe the improvement in tip pinching and nostril collapse.
Lateral and oblique views show the decrease in projection, improvement in nostril show and tip-profile harmony.
The patient is seen at 6 months post revision. Over time the skin will continue to shrink and remodel around the new tip framework resulting in a more refined appearance. Extensive revisions like this one will continue to improve over 18-24 months.
Patient 2
* Each patient is unique and individual results may vary
2. The patient (preoperative on left) has had two previous surgeries. The nose is short, tip is turned up with asymmetry and excess nostril show. After revision (left) the nose is lengthened, nostril show improved as is symmetry.
Lateral and oblique views show the lengthening, derotation and improvement in nostril show.
Patient 3
* Each patient is unique and individual results may vary
3. The patient has had two previous surgeries (preoperative on left). The first was complicated by skin necrosis. She presents with a flat bridge, deformed and scarred tip and middle vault. The problems are further worsened by the patients naturally thick skin which usually requires adding additional structure in order to achieve definition and refinement, not structural removal.
After revision (on right) there is restoration of the bridge, support of the tip and lower nose providing counterbalance to the shrunken, scarred skin.
On lateral and oblique view the restoration of bridge and tip complex are seen.
Correction of tip and nostril pinching is seen on base view.
Patient 4
* Each patient is unique and individual results may vary
4. The patient (pre operative on left) presents with scar contracture and asymmetry of his right nostril and columella with resultant tip roundness. After revision the nostril rim has been released and brought down creating better tip appearance.
Oblique view shows restoration of rim contour.
Base view shows improvement in tip distortion and contracture.
Patient 5
* Each patient is unique and individual results may vary
5. The patient (preop on left) presents after three previous surgeries. The tip is pinched in, over rotated with excess nostril show and flattening of the nasal bridge. Nine months post op the tip is derotated, the pinching improved and bridge is not washed out.
Lateral and oblique views show the derotation of the tip, lengthening of the nose, improvement in pinching and nostril show.
Base view shows the improvement in pinching and nostril collapse. As with other patients, the tip will continue to remodel and refine itself on the new framework over the next 18 months.
Dr. Schwartz’ recommendations for Revision Rhinoplasty patients:
Choosing the right rhinoplasty surgeon is extremely important. If you fall into the wrong hands, you increase your chances of botched results or complications that can compromise your health or your life. Finding a bargain is not the way to go with surgery-just because you may save on your initial surgery doesn’t mean that you’ll be happy with your results, and corrective surgery may be costly. The same goes for seeking treatment outside of the country.
While most revision cases are performed by the doctor who did the initial surgery, “not every surgeon is experienced in revision surgery,” says Dr. Schwartz. “If you have a good relationship with the surgeon who treated you, see him or her first to discuss a revision,” he adds. Should you select a new doctor, make sure they are well versed in revision procedures, especially with the part of the nose that you’re looking to have corrected.
Steps to Ensure Good Results:
Make sure your expectations are realistic. Revision surgery may not give you a picture-perfect nose but it may make you feel better about how you currently look.
Ask to see revision images. Before committing to any type of revision procedure, ask your surgeon to see his or hers before-and-after images from revision procedures (not primary procedures). This way you’ll get an idea of what problems they’ve corrected in the past and if you like the work they’ve done. You also want to make sure that the images that you review were performed by the same doctor who will be operating on you.
Know that you may need additional procedures. One revision surgery may not correct the problem completely and additional procedures may be needed to get the results you desire, especially if there are major complications or disfigurement. This is not a ”failure” of the revision procedure but part of the process in challenging noses.
Don’t look for a bargain. Revision surgery is expensive and may be as costly, if not more, than your original procedure.
Follow doctor’s orders. Surgery is only part of the process—how you care for yourself pre- and post-procedure affects the final outcome too. Make sure that your doctor provides you with a list of what you should and shouldn’t do after your surgery. These instructions may be different than what you received the first time around.
Revision Rhinoplasty FAQ
Q – What is revision rhinoplasty?
Revision rhinoplasty, also referred to as secondary and tertiary rhinoplasty, is a plastic surgery procedure which corrects deformities of the nose resulting from a prior rhinoplasty surgery.
Q – Who is a good candidate for revision rhinoplasty?
Healthy men and women who are looking to improve the appearance and/or function of the nose after a prior rhinoplasty surgery may be good candidates for revision rhinoplasty.
Q – What happens at a consultation for revision rhinoplasty?
During the consultation with Dr. Schwartz you will discuss what you dislike about your nose and what you want to achieve through surgery. Your nose will be examined, a thorough medical history taken, and your options discussed. All details of the revision rhinoplasty procedure will be explained and any questions or concerns that you may have will be addressed. Because revision rhinoplasty is a highly customized and individualized surgery, the consultation is very important.
Q – Where does the revision rhinoplasty procedure take place?
Dr. Schwartz performs revision rhinoplasty at an outpatient surgery center.
Q – What anesthesia is used for revision rhinoplasty?
Dr. Schwartz performs revision rhinoplasty with IV sedation or general anesthesia.
Q – How is the revision rhinoplasty procedure performed?
Because revision rhinoplasty is a highly customized and individualized procedure, the exact nature of the surgery will vary for each patient. In general, however, incisions may be made on the inside of the nose only or may include a small incision made on the underside of the nose between the nostrils. Once the incisions are made, the desired shape is achieved by repositioning cartilage or replacing missing structures. Grafts may be needed in some cases which may be taken from another area of the body such as the ear cartilage.
Q – How long does the revision rhinoplasty procedure take to perform?
Revision rhinoplasty takes about three hours to perform.
Q – Where are the incisions made for revision rhinoplasty?
The incisions for revision rhinoplasty made be made entirely on the inside of the nose or an additional small incision may be made between the nostrils on the underside of the nose.
Q – Will I have scars after undergoing revision rhinoplasty?
When the incisions are made entirely on the inside of the nose there is no visible scarring. When an incision is made on the underside of the nose between the nostrils it results in a small, well-concealed scar.
Q – Will I experience any pain after undergoing revision rhinoplasty?
Pain and discomfort tends to be less than after primary rhinoplasty procedures. Any discomfort that patients do experience can be managed with medication.
Q – What can I expect the recovery to be like after my revision rhinoplasty surgery?
Patients can expect a recovery time of about one week after revision rhinoplasty. Some swelling and bruising may occur, though typically less than after primary rhinoplasty procedures. Pain also tends to be less than after primary procedures and can be managed with medication. The stitches are removed after five to seven days. While patients may be able to return to work after one week, more strenuous activities will need to be postponed for about two weeks.
Q – When will I be able to return to work after my revision rhinoplasty surgery?
Patients can usually return to work in about one week after revision rhinoplasty.
Q – When will I be able to exercise after my revision rhinoplasty procedure?
Exercise and other strenuous activities should be postponed for at least two weeks after revision rhinoplasty.
Q – When are the stitches removed after the revision rhinoplasty procedure?
The stitches are removed in about five to seven days after the revision rhinoplasty procedure.
Q – What are the risks of revision rhinoplasty?
As with all types of surgery, there are potential risks associated with revision rhinoplasty and these may include adverse anesthesia reactions, excessive scarring, prolonged swelling, pulling of the nose to one side, small burst blood vessels, and the need for additional surgery.
Q – Is revision rhinoplasty covered by insurance?
Revision rhinoplasty procedures that are performed for cosmetic reasons are generally not covered by insurance. When treating problems or deformities or when used for reconstructive purposes, some coverage may be available. Patients should consult with their own insurance company.
Q – Can the revision rhinoplasty procedure be financed?
There are financing options available for many plastic surgery and cosmetic surgery procedures.