Revision Rhinoplasty

Most revision rhinoplasty cases are done under general anesthesia. Less complicated nose reshaping surgery cases limited to a given nasal region may be done with a regional nerve block, and sedation.

Each physician you see will have their own style of communication. I prefer to identify what particular features of the nose bother my patient most. Since everyone’s idea of the perfect nose varies widely, I like to hear what my patient would change about their nose. This gives me an idea as whether their expectation is realistic, and what features I would need to address. Most alterations are possible, but a patient’s nose must fit their face. If I believe a patient’s desires may leave them with a nose that does not fit their face I will explain this to the patient, and emphasize what I think would be an appropriate course of action. The patient is then evaluated for airflow problems, general medical problems, and undergoes a physical examination of the nose and associated structures. I explain the revision rhinoplasty surgery plan, all of the possible risks and complications, and also talk about what I think the outcome would be. If there are adjunctive procedures that would improve the patient’s appearance I discuss such measures.

Anyone with real concerns about the function or appearance of their nose makes a good candidate. Unrealistic expectations, deficits that only the patient can see, psycho-emotional instability, the belief that one’s entire life rests on undergoing the procedure are all red flags.

My patients are typically seen twenty four to forty eight hours after revision rhinoplasty. Packing is removed at this visit. Weekly visits follow for the next two weeks. The patient is then seen at three, six, and 12 months after surgery. This regimen varies from surgeon to surgeon.

If bone repositioning was not done, glasses may be worn as usual. For all other revision rhinoplasty cases, glasses my rest on top of the external nasal splint while it is in place. After the splint is removed, glasses should not be allowed to rest directly on the nose for one month, or a total of six weeks from the time of revision rhinoplasty.

Many people mistakenly believe that nose reshaping is done for cosmetic reasons only. In fact, many people who would benefit from a functional revision rhinoplasty would also get the side effect of a more balanced nose. This is because the septum, which lies at the root of many upper airway breathing difficulties also happens to form a very important structural component of the nose that impacts enormously on the external appearance of the nose. Deviation of the septum can cause significant breathing difficulties – a problem of much more import than the external appearance of the nose. Addressing this lopsided culprit, which by the way is often covered by most insurance carriers, will greatly aid nasal airflow, and fortunately, also improve nasal shape. In addition, in some cases of trauma, where the nasal bones have been misplaced, nasal airflow is also significantly compromised. Resetting the displaced bones will usually take care of the problem, and again, improve nasal shape. How is this done? Depending on the complexity of the problem, and the surgeon’s preference, the surgery may be performed through an open or closed approach. From a simplified perspective the only thing that separates the two approaches with respect to the final appearance is the presence of a small, usually imperceptible (except to the dog or the lover of the patient) scar at the top of cupid’s bow. From the surgeon’s standpoint, however, the addition of that small opening can greatly facilitate exposure, and help precise matching of one side to the other in the more involved case. To conclude, form is function and function is also form when it comes to nose surgery, fix your breathing, fix your nose.