Revision Rhinoplasty

The nose is a complicated three dimensional structure that plays pivotal roles in both its form and function. As a result, there are times that additional surgery is necessary to improve aspects of the nose which have not been addressed or have failed to meet expectations. This surgery, called revision rhinoplasty, is usually performed only after at least one year has passed from the time of the original surgery, which is commonly referred to as the "primary" rhinoplasty.

Revision rhinoplasty is more challenging than primary rhinoplasty for several reasons. The natural "geography" of the nose has been altered during the original surgery, requiring exploration of the new and artificial anatomy. Cartilage may have been harvested and moved in order to straighten the nose or provide support during the original surgery, necessitating alternative sources of structural support should it be needed during revision. Fortunately, at the Chow Center for Facial Plastic Surgery, Dr. Jen Chow is fully knowledgeable in a wide variety of techniques to provide for this and other difficulties in revision rhinoplasty. In addition, Dr. Chow also performs reconstructive surgery for the nose, and therefore is familiar with not only the cosmetic form of the nose, but its functions as well.

Clearly, there are many special considerations unique to revision rhinoplasty. But it can also be especially rewarding. If you are considering revision rhinoplasty (regardless of where you elect to have the surgery performed), you should always find a board certified surgeon who specialized in facial plastic surgery. Please refer to the frequently asked questions below for more details about revision rhinoplasty.


REVISION RHINOPLASTY FREQUENTLY ASKED QUESTIONS (FAQs)

1. What are the reasons for having revision rhinoplasty?
There are multiple reasons for revising previous surgery on the nose. First and foremost among these is the fact that you are dissatisfied with the results of a prior nasal (nose) surgery. When this dissatisfaction is linked to an identifiable, correctable problem, revision rhinoplasty is the best solution. Some experience poor nasal breathing after their surgery. Others are displeased with prior results, with a nose that can be any of the following and many more:
too large,
too flat,
too humped,
too wide or flat,
too thin,
too long,
saddled or scooped in appearance from the side,
has a "poly-beak" deformity,
has a saddle-nose deformity,
has developed an "inverted V" deformity,
contains a hanging columella (outer middle wall separating the two nostrils),
obstructed or impaired breathing,
too short, or
over rotated.

At the Chow Center for Facial Plastic Surgery, Dr. Jen Chow will work with you to review exactly what factors led to your present disappointment and use computer imaging with your present nose in order to come to a shared agreement on how the nose should look after surgery.

2. Why is revision rhinoplasty more challenging than primary rhinoplasty?
A second surgery on any part of the body is always more difficult than the first, due to altered anatomy, scar tissue (even if imperceptible at the level of the skin), altered lymphatic drainage, and possible inflammation from the healing process. Third or fourth surgeries are successively more challenging, as is each one thereafter.

In the case of the nose, revision surgery requires a thorough exploration to determine exactly what was done in the past (past medical records and photos are helpful), why it did not successfully address the problems that persist, and then correction of that problem. Therefore, revision rhinoplasty may take longer and require extra implant material which is often harvested from other areas of the face or body. Examples include cartilage from the ear or rib and calvarial bone grafts. These are discussed in greater detail below.

3. Does Dr. Chow perform rhinoplasty surgery on my particular ethnic group?
Each ethnicity has unique physical and cultural characteristics which affects the ideal shape and contours of the nose. Dr. Chow has operated on numerous noses on patients of Eastern and Western European, East Asian, South Asian, African-American, Latino, American Indian, and Middle-Eastern descent. He has experience with other ethnic groups (particularly more specific cultural and ethnic groups within these broad categories) as well. The ability to recognize particular characteristics related to ethnicity and address them in order to produce an attactive nose without infringing on your sense of self is an important skill in revision rhinoplasty. At the Chow Center for Facial Plastic Surgery in Arcadia, California, you will always feel comfortable discussing these subtle, yet vitally important, details with your surgeon.

4. Ever since my rhinoplasty, I can't breathe well through my nose. Can you fix this?
Yes. Dr. Chow is also a board certified head and neck surgeon, which means he spent five years training on functional and reconstructive nose surgery. He is not only trained to evaluate and shape the outer part of the nose, but also understands and treats the entire nose, taking into account allergies, sinusitis, deviated nasal septum, turbinate hypertrophy, empty nose syndrome, and a host of other factors. By scheduling an appointment today, you will be able to consult with Dr. Chow regarding the underlying cause of your breathing difficulty and have your nose cared for both inside and out.

5. Will insurance cover my revision rhinoplasty?
In some cases, your insurance will help cover the costs of revision rhinoplasty. When the function of the nose is impaired, correction is usually covered by your medical insurance. Examples include nasal obstruction, nasal collapse, septal deviation or collapse, as well as injury or chronic infection of the tear ducts. However, undesirable cosmetic features are rarely, if ever, covered by insurance.

6. The skin over my nose is very thin. Is this important?
The thickness of your nasal skin affects its final appearance. Subtle changes in the underlying framework are often easily seen and felt through thin skin. Therefore, any changes in your nose must be done carefully and gently to avoid any bumps or unnatural corners. Occasionally, a layer of tissue such as fascia or morselized cartilage is placed between the rigid inner structure and the thin outer skin to provide smooth contours and create an attractice nasal shape.

Thin skin is also more easily damaged in the period after surgery. Smoking can seriously impair blood flow, especially to the tip of the nose, causing skin break down. Therefore, pressure to the nose after the cast has been removed should be minimized and all smoking stopped for as long as possible starting in the weeks prior to surgery.

7. I have thick skin over my nose, and the last doctor I consulted said I wouldn't able to see any details with a revision rhinoplasty. Is this true?
This is not true in the overwhelming majority of cases. While thicker skin can clearly obscure subtle changes in the cartilage and nasal bones, refinement is still possible. Sometimes, the skin can also safely be made thinner to provide better definition to the nose. As with any cosmetic procedure, however, there are limits to what can safely be done. As an extremely obvious example, a request to have the nose of an elephant could never be fulfilled through cosmetic surgery. By discussing your concerns with Dr. Chow, you can participate in a computer-assisted image enhancement session and see how changes made to your nose might improve its appearance.

8. A doctor told me there is too much scar tissue in my nose, and that he/she can't do anything more for me. Is this true?
The ability to revise a nose despite a significant amount of scar tissue is often surgeon dependent. However, there are cases when additional surgery is unlikely to help. Depending on the amount of previous surgery, existing original cartilage in your nose, skin thickness, and the problem areas to be addressed, additional surgery may or may not be beneficial. In addition, there are often alternative, less invasive, treatments that can be used when a revision rhinoplasty is unlikely to help. Call Dr. Jen Chow today to schedule an appointment to discuss these complex issues on an individual basis. You will have ample time to address all of your concerns.

9. Does Dr. Chow use computer imaging? What are its benefits?
Yes, Dr. Chow always uses computer imaging to allow you to share your specific thoughts about your nose. Since the nose is a very difficult part of your face to describe in great detail (and yet so easy to see!), having your nose altered to your liking allows Dr. Chow to understand your needs. Computer imaging also helps Dr. Chow to show you what is possible with surgery after revision, and what is not. As always, such images are not a guarantee of your eventual outcome. They provide an excellent visual aid to discussion before revision rhinoplasty. At the Chow Center for Facial Plastic Surgery in Arcadia, California, you can always ask for computer imaging prior to your nasal reshaping surgery.

10. Can I still have revision rhinoplasty if I don't have enough cartilage left in my nose?
Yes, you can. Dr. Jen Chow has a number of techniques to obtain your own cartilage to use in your nose. Depending on the amount of cartilage you may need, cartilage from the ear or rib may be used. A number of other sources for structural support also exist, including bone grafts that can be harvested without any significant long term impact to donor sites.

11. If cartilage is harvested from my ear, how is it affected?
Dr. Chow harvests cartilage through a small incision behind your ear near the crease the ear makes at the point where your it is connected to the rest of the head. As it heals, the incision line will move toward the natural crease, further disguising it and making it all but invisible in most patients.The cartilage is harvested from an area called the concha, which is the bowl of your ear next to the auditory canal. When done appropriately, this cartilage harvest almost never affects the appearance, support, or function of the outer ear. You may be able to feel the difference when you touch the concha, or bowl of the outer ear, with your finger. The natural curve of this cartilage makes it a useful surrogate for cartilage harvested directly from the nose.

12. If cartilage is harvested from my rib, how is it affected?
The purpose of ribs is to protect the lungs and heart while allowing mobility (which is especially important for breathing!). Early in life, ribs are comprised of significant portions of cartilage. As we get older, this cartilage gradually calcifies to become bone. Therefore, the use of rib as source of cartilage for the nose is moderately dependent on age. Techniques may vary slightly, but in women, the incision, which runs at the length of a several centimeters, is usually placed in the inframammary crease, which is the fold below the breast. In men, the incision is also placed in a similar position. At the Chow Center for Facial Plastic Surgery, you can go over each step of the surgery, including rib harvest and reshaping for the nose, with Dr. Chow in order to fully understand your decision. We understand that the decision to undergo revision rhinoplasty is not one to be taken lightly, and you should always be provided with every bit of information that you need in order to make the right choice for you.

LEARN MORE ABOUT REVISION RHINOPLASTY 

Request a Consultation by filling out the form below or by calling 626-447-3223 to speak with Dr. Chow.