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PROFILES Modern Rhinoplasty Textbook

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Revision Rhinoplasty

Written by Dr. Litner and Dr. Solieman

Correction of Unsatisfactory Results from Previous Surgery

Revision Rhinoplasty - female faceWhile most patients present wanting a smaller nose, the reduction rhinoplasty techniques employed by many well-intentioned plastic surgeons can result in numerous problems over time. These techniques include crushing, morselization, or aggressive resection of tip cartilages, and sacrifice of vital tip support structures. This achieves the goals of improved tip contour and definition in the short-term, sometimes at the expense of nasal breathing. The nose may look quite good for one or two years but, the value of a rhinoplasty is best measured not in years, but decades. Such procedures are akin to building a lovely bridge without proper supports. Predictably, it will not remain lovely for very long.

Often Drs. Solieman and Litner are asked to see patients who report having had a satisfactory rhinoplasty by another surgeon, only to find that, over time, they have become unhappy with the results. It is important to understand that with long term follow-up care extending several years after rhinoplasty, the weakened dorsal and tip cartilages are subject to contracture forces that cause distortion, buckling, malposition, and decreased tip projection. Inevitably, a good percentage of these patients present over time with scooped bridges, pollybeak deformities (fullness in the region above the tip), tip asymmetries, bossae or knuckling, and occasionally an overshortened nose.

Beverly Hills Profiles is one of very few practices that welcomes the challenge of helping correct the irregularities and problems that some patients experience after having had rhinoplasty elsewhere. While these problems can be improved with some difficulty in skilled hands, they are best prevented in the first place.

Young woman's face - before rhinoplasty treatment, front view, patient 1Young woman's face - after rhinoplasty treatment, front view, patient 1BeforeAfter
Young woman's face - before rhinoplasty treatment, right side view, patient 1Young woman's face - after rhinoplasty treatment, right side view, patient 1BeforeAfter

Any patient seeking a nasal revision should be aware that while a first-time rhinoplasty is difficult enough, every subsequent surgery has extra problems inherent in the fact that the previous surgery has altered the tissues of the nose. Because every nose is different, there is no one correct technique for every patient. Additionally, concepts of beauty differ greatly, and what is a beautiful nose to one person may not be to another. For that reason, it is very important that in consultation with Drs. Solieman and Litner, you honestly discuss your concerns and expectations. In return, they will do all they can to understand those expectations and, where possible, meet or exceed them. However, it must be understood that, unlike a piece of modeling clay, the nose cannot be shaped and revised into any form imaginable. Moreover, noses change in the post-operative period, and the final result may not be apparent for six months to two years after surgery, and it may continue to change even after that time. Revision rhinoplasty, in our hands, represents our very best efforts to render the vagaries of healing more predictable

If your nose is too small, too short, turned-up or pinched, your revision surgery will be more difficult. Natural structures and specially shaped tissues may have been removed and will now need to be replaced with grafts from elsewhere. These grafts must be molded to take on not only the shape but also the function of the previously removed structures. The types of grafts that are necessary depend upon what structures are missing, whether they are bone, cartilage, external skin or internal lining. When tissues are missing, what you will undergo is actually a nasal reconstruction rather than a revision rhinoplasty. For all these reasons, expectations for revision rhinoplasty must be tempered, and improvement, rather than perfection, is the goal.

Yet another area to be resolved in many cases of revision nasal surgery is dysfunction of the nasal airway. If you had difficulty breathing through your nose before your first surgery, or if the nasal airway was changed during your surgery, you may now be having trouble breathing through your nose, especially if your nose was made smaller or if you experienced a post-operative drooping of the tip. You may now need correction of a deviated or crooked septum (the partition between the nasal airways), and trimming of your turbinates may be required (turbinates are structures arising deep along the sidewalls of the nose that warm and humidify the air passing into your air passage). Furthermore, you may need a graft to re-support the tip of your nose. Your nasal airway could also be blocked if, at your first surgery, the tissue lining was roughened in two opposing or touching areas and then later healed together, causing the formation of a scar band or web. In such cases, this web has to be opened, and thin, soft plastic sheeting is placed in the nose to prevent this web from forming again. This sheeting will need to stay in place for at least three weeks after surgery.

Although revision nasal surgery is very difficult, there is good news: In the hands of Drs. Litner and Solieman, using assiduous care and judgment, predictably good results can be achieved. Modern techniques have made the operation more exacting, reaping better results than in the past. The open or external rhinoplasty approach allows Drs. Solieman and Litner to see the prior defects, and grafts can be sewn into place under direct visualization.

Despite the technical difficulty of the surgery and its length, we find that, in most cases, patients will benefit from revision surgery, especially those whose expectations are realistic. We will not operate unless we feel an improvement is highly probable, but we cannot promise perfection. So much of what we can do depends upon what we find at the time of surgery. We and our patients have been very happy with our results, and it is our sincere hope that we can help you with your individual concerns.


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