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Revision Rhinoplasty Experts in Beverly Hills

We know that having to undergo revision rhinoplasty surgery in Beverly Hills is both financially constraining and emotionally draining. The important thing is that if you are ready to fix your nose, we are here to help you achieve the results you have always wanted.

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Internationally Known for Nose Revision Surgery

Written by Dr. Litner and Dr. Solieman

Whether you are interested in a small tweak or a major revision, Drs. Solieman and Litner, double board-certified highly-specialized facial plastic surgeons, will fully analyze your condition, listen to your frustrations and explain what can be realistically achieved with your revision rhinoplasty. For more information, see the following links:

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Featured Patient Story

In this patient’s particular case, her previous rhinoplasty resulted in not only significant breathing problems but also visible cosmetic concerns including a twisted nose, an over-projected look, tip bossae, and a hanging columella. However, a revision rhinoplasty with expert surgeons Drs. Solieman and Litner resulted in a natural-looking, beautiful nose that seamlessly fits and allows her to breathe normally (she also had neck liposuction which did an amazing job of improving the patient’s neckline).

*Results May Vary

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Revision Rhinoplasty Before and After Photos - female, front view, patient 1
Revision Rhinoplasty Before Treatment - female face, front view, patient 1https://beverlyhillsprofiles-10c15.kxcdn.com/wp-content/uploads/2018/09/Revision-Rhinoplasty-Set-1-1a.jpg

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Two Surgeons are Better than One

Revision rhinoplasty is an even more intricate, nuanced procedure than an original rhinoplasty. Oftentimes, the previous surgeon has removed or severely manipulated the underlying nasal cartilage. Having Drs. Solieman and Litner correct your functional nasal issues increases your chances of a highly satisfying result. This unique team approach is the reason Beverly Hills PROFILES is one of the leading rhinoplasty centers in the world.

We Stand Behind Our Work

Drs. Solieman and Litner will do their utmost to ensure that your first nose surgery with us is also your last. By working together, our surgeons are able to consistently achieve some of the highest success rates in the world.

Furthermore, we operate on patients who travel from other states and countries with a variety of cosmetic and functional problems. We work with each patient to accomplish the beautiful, natural look that is right for them.

Our Results Speak for Themselves

Feel free to browse through our revision rhinoplasty photo gallery. What you will find is that each patient’s results are unique and appropriate for him or her. Whether you come to PROFILES with an overly scooped out bridge, a crooked nose, or a deformed nasal tip, our surgeons will have the answer for you.

Our Relationships Last

Our commitment to you begins with your first visit but that is not where it ends. Drs. Litner and Solieman follow up with you for years after your procedure to ensure that you not only get the nose you have always wanted but that it stays that way.

Risks Associated with Revision Rhinoplasty

Like other cosmetic procedures, there are potential risks and temporary side-effects that come with revision rhinoplasty surgery. These include:

  • Pain and discomfort during the recovery
  • Visible swelling for up to a year
  • Adverse reaction to anesthesia
  • Bleeding
  • Minimal chance of infection

Drs. Litner and Solieman assess each patient, learn about their goals, and discuss the potential risks and possible side-effects prior to rhinoplasty surgery in order to set the right expectations.

Common Rhinoplasty Mistakes and How We Correct Them

Rhinoplasty Mistake #1: The Scooped Out Bridge

A scooped-out profile is probably one of the most common problems we see after rhinoplasty. It usually occurs after routine reduction rhinoplasty when there was a bump on the bridge that was shaved down too much. This is particularly problematic when this occurs in men, as it is a feminizing feature.

On the right is a diagram of a nasal hump reduction.

Many rhinoplasty surgeons still prefer to make a bony bump smaller using a chisel or osteotome shown below on the left. Osteotomes are sharp instruments that cut through the bone at the desired level to lower the hump. This is an all-or-nothing tool where the bump is removed in one shot. The problem is one of judgment and execution. Sometimes the angle is not right or the surgeon thinks the bone is being taken down to a certain level only to discover that he or she misjudged.

At PROFILES Beverly Hills, our expert surgeons prefer to use rasps to reduce a bump. Nasal rasps are essentially fine files, shown below on the right. These instruments can be used to slowly whittle or file down the bony bump. That way we can accomplish this three-dimensionally in a very careful and controlled way.

Osteotomes are sharp instruments that cut through the bone at a desired level to lower the hump

Moreover, it can be even easier to make a bump reduction mistake using a closed rhinoplasty approach (from inside the nostril) where this maneuver is being done under the cover of the nasal skin. In this case, it is difficult for the surgeon to see, so most of the work is done by ‘feel’. It takes a lot of experience to develop that ‘touch’ and to consistently get nasal hump reduction right.

In revision rhinoplasty, when the bone has been reduced too much, the nasal profile will look scooped and the bridge will look washed out and child-like from the front view. To fix this, we need to build the bony bridge back up again, most often with the patient’s own cartilage.

The photos below show the area of bone that was over-reduced, and what the bony profile should look like. The green shaded area is the area of the bridge to be built up.

Patient face, nose - area of bone that was over-reduced

Rhinoplasty Mistake #2: The Pollybeak Deformity

A pollybeak deformity refers to a nose in which the area just above the tip is too full. When it is very full, it can make the nose look down-turned like a parrot’s beak, thus the name. Normally, there should be a little dip or depression just above your nasal tip that defines the transition from your bridge to your tip on profile. In a woman, that little dip is a feminizing feature.

The reason the nose can look like a parrot’s beak is that the area above the tip often becomes the part of your nose that sticks out or projects the most from your face. This is not the way it should be. Your tip should be the most projecting point of your nose. Check out the photo below to see a pollybeak deformity indicated by the arrows.

A few factors can cause this deformity and they are all preventable. First, a surgeon may not reduce the cartilage enough in the area above your tip. Second, the surgeon may be overaggressive in reducing that area too much in someone with thick skin. In this case, the skin does not contract and flatten out as much as it should and, instead, the area fills in with thick scar tissue. Finally, a surgeon may not provide enough support to your nasal tip. Over time, your tip may droop and make the area above the tip look too full.

Patient face: nose - area of bone that was over-reduced

Look at the image above to see the plan for fixing this pollybeak deformity. The green area is the area of the bridge that was built up in the last rhinoplasty. The blue shaded area shows the cartilage that has to be shaved down to correct it. Notice how the tip itself also has to be deprojected or brought in closer to the face.

When fixing this issue, if just the pollybeak was taken down, without the tip being brought in, it would look too high and too pointy. Although this is not an ideal look, it is something we also see a lot after first-time rhinoplasty procedures because tip correction is considerably difficult to perform. On the right, you can see how much more balanced the tip looks now.

This is by no means a final image. In fact, the picture on the right does not show a completely improved appearance because we have not yet addressed the other problems with this nasal tip. It still looks pulled down and rounded and the nostrils have to be addressed as well.

Rhinoplasty Mistakes #3, #4 and #5: The Hanging Columella, Nostril Retraction, and Excessively Rounded Tip

Male fece, before Rhinoplasty Mistakes treatment, front view - patient 1Male fece, after Rhinoplasty Mistakes treatment, front view - patient 1BeforeAfter
Male fece, before Rhinoplasty Mistakes treatment, left side view - patient 1Male fece, after Rhinoplasty Mistakes treatment, left side view - patient 1BeforeAfter

*Results May Vary

Male fece, before Rhinoplasty Mistakes treatment, front view, patient 1Male fece, after Rhinoplasty Mistakes treatment, front view, patient 1
Male fece, before Rhinoplasty Mistakes treatment, left side view, patient 1Male fece, after Rhinoplasty Mistakes treatment, left side view, patient 1

Click here to view more actual patient photos.

*Results May Vary

Rhinoplasty Mistakes schema structure
In the previous two rhinoplasty mistakes described above, we have taken care of imaging for a poor rhinoplasty result to address problems with the nasal bridge. Now it is time to take a look at the tip. A frequent problem after an overaggressive rhinoplasty is a tip that becomes distorted and lacking in support. This usually happens when too much of the tip cartilages are removed in trying to narrow and refine the tip. Instead, you just end up with a tip that is unstable. We have lumped these 3 rhinoplasty surgery problems together because they often occur together after a rhinoplasty in which the tip cartilages collapsed.

The rhinoplasty diagram to the left shows the area of the tip cartilages (in red) that is commonly removed during a rhinoplasty. This is considered a reasonable amount in most rhinoplasty patients depending on their skin thickness. The key, of course, is not to remove too much. Many rhinoplasty surgeons are very aggressive with these maneuvers and may take out most of this cartilage or slice right through it without repairing the edges. They often do this because the short-term changes can be very dramatic as you can turn a wide boxy tip into a very narrow one. However, the long-term results are usually devastating as the tip becomes progressively pinched and distorted over the years.

Furthermore, it is important to note that if too much cartilage is removed in this area, the tip can start to collapse. It can often look asymmetrical with the formation of bossae or little deformities and bumps in the cartilage that show through the skin. Also, the tip can start to rotate up too much. Unfortunately, this gives the nose an upturned and shortened “Ms. Piggy” appearance, which most patients are extremely unhappy with. This problem can be exaggerated when surgeons also remove the nasal spine (the bone at the bottom of the tip) and the bottom part of the septum. To figure out which part of your nose we are talking about, you can feel around just inside your nostrils. If you pinch the skin between your nostrils and advance your finger and thumb back a bit, you will feel a firm, yet wiggly piece of cartilage that is at the bottom part of the septum.

Patient face nose - area of bone that was over-reduced

Maintaining the integrity of this anatomy is critical to ensuring good, strong results over time. If the above mistakes are made, the columella or structure separating the nostrils can appear to hang down too much, called a hanging columella. In addition, the rim of the nostrils can appear pulled back or retracted. Ideally, the distance between the edge of the nostril and the bottom edge of the columella should be no more than a few millimeters. Anything more creates a very unflattering look that resembles a snarl. Breathing can also be affected. These problems can be fixed but it takes a lot of expertise and complex techniques, including cartilage grafting.

Take a look at the imaged photos below to see the final step in improving the appearance of this nose with revision rhinoplasty surgery. The green shaded areas on the imaged photo are areas to be augmented or built up. The blue shaded areas are to be shaved down. You can see that the columella is pulled up, the nostril rim is pulled down, and the angle between the tip and the upper lip is better. Notice that the tip still projects outward by almost the same amount, but it looks so much less dominant and heavy when these problems are corrected.

Female fece, before Rhinoplasty Mistakes treatment, front view - patient 2Female fece, after Rhinoplasty Mistakes treatment, front view - patient 2BeforeAfter
Female fece, before Rhinoplasty Mistakes treatment, right side view - patient 2Female fece, after Rhinoplasty Mistakes treatment, right side view - patient 2BeforeAfter

*Results May Vary

Revision Rhinoplasty Before Treatment - female face, front view, patient 1Female fece, after Rhinoplasty Mistakes treatment, front view - patient 2
Female fece, before Rhinoplasty Mistakes treatment, right side view - patient 2Female fece, after Rhinoplasty Mistakes treatment, right side view - patient 2

Click here to view more actual patient photos.

*Results May Vary

THE FINAL RESULT

The rhinoplasty photos below show the original before revision rhinoplasty photo on the left, the imaged result in the middle, and the patient’s actual postoperative photo on the right.
We make the imaged photo imperfect on purpose so that we do not over-sell the possible results. However, with the imaged photo the patient can at least get an idea of what needs to be done to bring their profile back into a balanced and harmonious state.

Patient face, nose - before and after Rhinoplasty Mistakes treatment
While we cannot make the surgical result match the imaged photo exactly, we get quite close. There is still a little swelling in the 3-month after photo at this stage and we expect it to settle over the next few months. The patient was ecstatic with the results and thinks her new nose looks even better than the imaged version. We could not be happier with the results and are pleased to have achieved the patient’s aesthetic and functional goals.

Rhinoplasty Mistake #6: The Over-projected Tip

Male face, nose - before and after Rhinoplasty Mistakes treatment

A frequent mistake seen after primary rhinoplasty surgery is a persistently over-projected tip. This means that the nasal tip still appears to stick out too far from your face. There are two reasons that this mistake is so common:

The first reason is that many rhinoplasty surgery patients are initially more concerned about their bump than anything else and are happy if the bump is all that is removed. Afterward, many patients realize that the tip still appears too prominent. The second reason is that technical maneuvers to reduce the nasal tip’s projection are more sophisticated. Many rhinoplasty surgeons were never trained in these maneuvers and simply do not perform them. Many surgeons have tried in the past but have experienced problems and now choose to avoid deprojecting the tip. Lastly, it is almost impossible to achieve meaningful deprojection of the tip through a standard closed rhinoplasty approach in a way that still provides enough support.

Below is an example of one of our revision rhinoplasty surgery patients that was unhappy with her tip projection, among other things. You can see that her tip looks too prominent. Her bridge is a little too sloped as well from her previous rhinoplasty which makes her tip look even more pointy.

The patient’s Beverly Hills PROFILES revision rhinoplasty included some augmentation of the bridge with tip deprojection, effectively restoring a more natural, attractive balance to her profile. Even better, because of the way we perform this procedure, her nose is now stronger than if she never had anything done.

Rhinoplasty Mistake #7: Tip Bossae (Knuckling)

Male face, nose - before and after Rhinoplasty Mistakes treatment

Think of the tip cartilages like a pair of wings. You can get an idea of what these look like from the rhinoplasty photos below. The cartilages are like a bent spring that hold the nostril’s shape, keeping it open to allow for normal breathing.

Male face, nose - before and after Rhinoplasty Mistakes treatment, front view
In many poorly done rhinoplasty surgeries, this cartilage is aggressively cut or removed so that it loses this natural spring. Over time, whatever cartilage is left starts to bend and twist under the weight of the skin. As the cartilage twists on itself, the weak points at the ‘joints’ of this cartilage can start to form bumps or knuckles, called bossae, that are very noticeable through the skin. Check out the diagram below to see what we mean.

Male face nose - before and after Rhinoplasty Mistakes treatment, front view
Many rhinoplasty surgeons treat these bossae by going back and trimming them, weakening the cartilage even more. This is not a good long-term solution. The Beverly Hills PROFILES revision rhinoplasty experts know that the tip cartilages must be reconstructed in order to restore their natural strength and resilience while improving on the cosmetic appearance of the tip.

The revision rhinoplasty surgery photos to the right show a revision rhinoplasty patient treated at PROFILES. The patient had her tip bossae treated as well as other post-rhinoplasty concerns that are highlighted in the next few sections.

To the right is a before and after photo of a PROFILES revision rhinoplasty that treated a twisted tip with tip bossae.

Rhinoplasty Mistake #8: Nasal Valve Collapse

The nasal valve is a term used to describe the narrowest part of the nose internally. This is the area that determines if someone feels normal or obstructed breathing through the nose. When this area is overly narrowed and blocked, we call it a nasal valve collapse.

Patient nose - before and after Rhinoplasty Mistakes treatment, front view
There are two types of nasal valve collapses. The collapse of the tip cartilages described above can cause external valve collapse where the blockage is just past the nostril. However, when most rhinoplasty surgeons discuss valve collapse they are talking about internal valve collapse. This occurs when the upper lateral cartilages in the middle of the nose have been too narrowed. Take a look at the attached diagram to see where these are. This problem happens when a nasal bump is taken down too much and when the cartilages themselves are shortened or not reattached during a rhinoplasty.

Nasal valve collapse issues seem to occur more often after a closed rhinoplasty because most surgeons detach these cartilages without repairing and reattaching them at the end of the procedure. When the natural cartilage supports have been lost, they simply fall inwards and collapse. The result is poor breathing and two visible cosmetic deformities. One is called an ‘inverted V deformity’. That is because the collapsed area where these cartilages attach to the nasal bones looks like an upside-down letter V. Take a look at the photos below to see an ‘inverted V deformity’.

Patient nose, before and after Rhinoplasty Mistakes treatment, front view
The second visible cosmetic deformity is when the middle part of the bridge starts to look very pinched. This issue is common after primary rhinoplasty. The revision rhinoplasty experts at Beverly Hills PROFILES fix a pinched bridge using extended spreader grafts among other techniques. Click here to see our blog on the use of spreader grafts.

Moreover, we took care of the following patient’s tip abnormalities. Below we turn our attention to the upper two-thirds of the nose to correct her remaining concerns.

Rhinoplasty Mistake #9: Open Roof Deformity

Patient nose, before and after Rhinoplasty Mistakes treatment - front view
The nasal bones are not so much like a pyramid but more like an arched covered bridge or tunnel. When a bump is made smaller, the top of the bones is shaved or cut shorter to reduce the bump. This leaves an opening in the roof of the bridge. That’s one of the reasons why we have to cut the base of the bones during rhinoplasty surgery (called osteotomies). We perform osteotomies in order to push the bones inward towards each other so that this opening can be closed.

If the opening is not closed properly, we call the resulting problem an ‘open roof’ deformity. The photos to the left give you a sense of what this rhinoplasty problem looks like. When you have an open roof deformity, the middle part of the bridge will look and feel unnaturally flat. The edges of the bones are separated and can be seen and felt as a prominent bump at the side edge of the bridge.

Los Angeles and Beverly Hills rhinoplasty and revision rhinoplasty surgeons Dr. Solieman and Dr. Litner have extensive experience correcting these and many other rhinoplasty deformities. To repair an ‘open roof’ deformity, the bones need to be brought back together. However, sometimes the bones have been so shortened and whittled away that it is impossible to bring them together without pinching the top of the nose completely. In this situation, it is necessary to rebuild the roof with grafts. Whatever the extent of your rhinoplasty concerns, the PROFILES surgeons are well-versed at tailoring your procedure to address your individual issues.

Rhinoplasty Mistakes #10: Twisted Nose

The final rhinoplasty surgery mistake and problem we discuss is the twisted nose. A twist in the nose can happen anywhere from the nasal bones to the middle third of the nose and down to the tip. Getting a nose completely and perfectly straight is one of the hardest things to do in rhinoplasty and is especially hard in revision rhinoplasty. That is why you need to see an experienced rhinoplasty specialist like the Los Angeles rhinoplasty surgeons at Beverly Hills PROFILES.

A frequent cause for a twisted nose is crooked nasal bones. This can result when a pre-existing crooked bridge simply was not corrected properly or when poorly performed osteotomies caused the bones to shift. If the cartilage of the mid-nose or tip is twisted, sometimes it can be corrected by re-suspending or stabilizing the cartilage with sutures. This includes repairing the normal connections between anatomical parts that are often lost during prior surgery. It is important to note that careful planning and execution of each maneuver goes a long way in preventing these problems.

Male face nose - before and after Rhinoplasty Mistakes treatment - front view
Furthermore, more often than not, we find that during revision rhinoplasty many of these normal structures have been damaged or removed, causing the lower part of the nose to buckle and warp. Sadly, this is often beyond simple repair. In these cases, grafts of cartilage taken from your septum (if available), your ear, or rib (which is rarely done), are needed to rebuild the lost tissues and reconfigure their normal connections and supports.

In conclusion, we have illustrated a handful of the most common rhinoplasty mistakes and how we can fix them. There are a lot of delicate details that go into this, and cases such as these can take us many hours to perform. However, we dedicate the time necessary to get the best results possible in each case because our ultimate goal is that your first rhinoplasty with PROFILES is also your last.

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FAQs

  • When Can I Have Revision Rhinoplasty?

    Because it takes six to twelve months for all the swelling to recede, you may have to wait up to a year to have revision rhinoplasty. However, if you are uncomfortable with your nose or have functional problems, Drs. Solieman and Litner can assess your case to determine the best course of action.

  • Is Revision Rhinoplasty Common?

    At PROFILES, Drs. Litner and Solieman conduct revision rhinoplasty surgeries regularly. Patients come from different states and all over the world after having problems with their previous rhinoplasty work. However, once they work with our double-board certified plastic surgeons they often achieve their cosmetic goals. Dr. Solieman and Litner want your revision rhinoplasty with them to be your last.

  • Can I Have Revision Rhinoplasty After 6 Months?

    Swelling may take up to twelve months to completely recede. However, there are many cases where a bad rhinoplasty may result in breathing problems, other functional issues, and visible deformities. These patients may be candidates for surgery after six months. It is best to consult with Drs. Litner and Solieman to find the best alternative.

  • Is Revision Rhinoplasty More Expensive?

    The price of revision rhinoplasty depends on your location and the plastic surgeon’s experience. If you want to get an accurate estimate, the best thing to do is consult with a double board-certified plastic surgeon in your area.

  • How Long Does It Take for Swelling to Go Down After Nose Surgery?

    Inflammation is a normal part of the healing process after revision rhinoplasty. Although most swelling recedes in the first few weeks, it may take up to 12 months for it to go down completely. In order to see the final outcome of your first rhinoplasty, you may have to wait up to a year.

Written by Dr. Litner and Dr. Solieman 11/28/19

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