About 10 percent of nasal reshaping surgeries will eventually require a revision. This procedure is known as a revision rhinoplasty. A patient may want or need a revision rhinoplasty because they have had difficulty healing, as the result of unplanned anatomical complications encountered during surgery, or simply because they are dissatisfied with the results of their previous rhinoplasty.
This article will briefly discuss the most common reasons patients have a revision rhinoplasty: their previous rhinoplasty has created an undesirable change in appearances such as a hump or depression on the bridge of the nose, an asymmetrical tip, a twisted nose, wide nostrils, or a wide middle third of the nose; or their previous rhinoplasty created or uncovered a functional problem that must be corrected, like a deviated nasal septum or collapsed nasal valve. The doctor can often perform the revision rhinoplasty through the nostrils with a closed rhinoplasty (minimal scarring), although sometimes an open rhinoplasty is required for more complex corrections.
There are several different conditions for which a revision rhinoplasty may be an appropriate treatment option:
After a rhinoplasty, the nasal bones will sometimes form a bump. This can be a result of inadequate removal, a slight collapse of the connected septal cartilage after removal, or growth occurring after surgery. Humps are treatable by removing the bone and cartilage extending from the bridge of the nose. The doctor may need to bring the nasal bones together to recreate the natural shape of the nose.
The nose tip is primarily soft tissue and cartilage, which will heal and change in shape for many years after surgery and as the patient ages. The doctor can correct a bulbous or irregular tip with conservative removal of the top edge of the lower lateral cartilage, and by bringing the left and right lower lateral cartilages together.
A nasal bone fracture may make the nose appear twisted. A deviated septum may change the outside shape of the nose. Correcting the deviated septum or an osteotomy of the nasal bone can straighten a twisted nose.
Over time, an operated nose may form excessive scar tissue. This excess scarring is usually a result of poor healing, surgical technique or grafting, or improper follow-up care. The doctor may need to administer steroid injections or surgically remove some scar tissue in order to reshape the nose.
If too much dorsum cartilage or nasal bone has been removed, the nose may drop too much when viewed from the side. If the middle of the nose is depressed, it can be elevated by building it up with cartilage or a synthetic graft.
The nostrils can be narrowed by removing small wedges of skin at the nostril base. It is very straightforward to remove nostril tissue, but very difficult to add tissue to this area. Nostril narrowing should therefore be done with caution. Nostril reduction (alar base reduction) is done at the end of surgery, and can be done in the office if necessary.
Rhinoplasties are the primary cause of nasal valve collapse. If the doctor detaches the nose’s upper lateral cartilage when removing nasal bone, this will result in an internal valve collapse and/or an ‘inverted-V deformity’. Removal of too much lower lateral cartilage can collapse the sides of the nose causing external valve collapse. Treatment of an external nasal valve collapse in generally treated with an alar batten graft. The doctor may use grafts from ear or nasal septum cartilage to restore the strength and symmetry of the nose.
A patient’s ability to breathe may suffer if the outside of the nose is reduced without regard to an already existing deviated nasal septum. A deviated septum itself can change the external shape of the nose. Deviated septum surgery can be performed during a rhinoplasty procedure. Insurance will generally pay for a deviated septum repair.
Occasionally, the use of additional tissue is necessary to achieve the patient’s desired results. Often, the doctor can use cartilage from the septum or non-structural area of the ear for this purpose.
The ability to breathe comfortably can promote a better night’s sleep and is an important part of a healthy lifestyle. Dr. Harounian treats many patients referred by other surgeons with complex breathing issues or whose previous surgery uncovered or created breathing concerns. He is well-known for his revision rhinoplasty method, which restores the patients’ ability to breathe and improves the nose’s appearance by rebuilding previously removed cartilage or bone.
Dr. Harounian will individualize your revision rhinoplasty plan and care. A minimum of half an hour is needed to fully understand your expectations and to get a complete history and evaluation of the inside and outside of your nose. Knowing what to expect will make the entire experience more pleasant and increase your satisfaction with the surgical results. Dr. Harounian will discuss the cosmetic and functional expectations of your revision rhinoplasty in detail to make sure all of your questions are answered. Your photo will be reviewed with you and a projected computer image will be shown to you to make sure we are on the same page.
Knowing what to expect will make for a smoother and more enjoyable experience. Dr. Harounian performs the revision rhinoplasty at Lenox Hill Hospital or at a state-of-the-art Upper East Side ambulatory facility.
You will need to arrive one hour before your procedure is scheduled to begin.
You will speak with the nurse and anesthesiologist about your medical history and what to expect during the procedure.
Dr. Harounian will discuss your treatment and goals before you receive any medications. You will then receive some medicine to relax you, followed most times by a general anesthetic.
Dr. Harounian will come to speak with you again after you have awakened from the procedure. He will have already spoken to the person taking you home.
You are given the supplies needed to take care of your healing nose. You will leave the ambulatory center with your chaperone about an hour after surgery.
You are given the supplies needed to take care of your healing nose. You will leave the ambulatory center with your chaperone about an hour after surgery.
Dr. Harounian’s techniques minimize the recovery period and allow most patients to return to a normal routine the week after surgery.
Dr. Harounian employs both the advanced closed (endonasal) and open (external) surgical techniques to sculpt an attractive and natural-looking nose with minimal incisions and rapid recovery time. Most often no excisions are required on the outside of the nose. When performing a revision rhinoplasty, Dr. Harounian emphasizes preservation or recreation of nasal breathing and structural support. A natural-looking nose is also very important. These concepts are the basis for an excellent long-term outcome.
Dr. Harounian places a small plastic splint over the healing nose for protection (he rarely finds it necessary to pack the nose).
It is normal to have a mild headache for a day or two. You will be given some prescription pain medicine, although most patients take only a couple of doses and then switch to Tylenol.
You should keep a dressing under the nostrils to avoid sniffling when you have any nasal discharge.
You will probably feel a lot of congestion, although some people can breathe very well immediately after surgery.
You may have bruising and swelling around the nose and eyes. This will start to resolve within a few days. Most swelling will go down after a couple of weeks, but changes in the nose can continue for a year or more.
Avoid strenuous exercise for three weeks.
Avoid wearing glasses for six weeks (If your nasal bones were broken during surgery).
You will return to the office one week after surgery to have the bandage removed and then return as needed to have the nose checked.
Anyone who has had a previous septoplasty or rhinoplasty may, especially before 2020, may not have much grafting material left in their nose. This is important as many revision nasal surgeries will need grafts to adequately support the nose. Rhinoplasty is a cosmetic surgery procedure for reshaping the nose. Also referred to as a “nose job” or “nasal reshaping surgery”. If you need additional grafts in your nasal reconstruction then you could use a donated graft from a cadaver, or use a portion of your own rib (autologous rib). Dr. Harounian uses the most advanced surgical techniques, using either type of graft, to give you the breathing and aesthetic changes you are looking for.
Rib is strong but flexible and can be shaped to support any area inside of the nose. Dr. Harounian can use cadaveric or your own rib if you don’t have adequate grafting material for your procedure. Cadaveric ribs are tested and it is highly likely that they are free of disease. Using your own rib guarantees the safely of using your own tissue which is comforting to many patients. Using your own rib heals and feels better in most cases and cadaveric grafts have been shown in some studies to have a higher rate of resorption.
Organ donors provide cadaveric rib. The specimens are harvested from the organ donors and radiated and purified to insure that they are as safe as possible. They are stored in saline.
Your own rib can be grafted during your nasal surgery. A 2-3 cm incsion is made along your 7th or 6th rib, usually on the right side. Either the top of the rib is removed or 3-4 cm of the entire rib in this area is harvested. The surgeon will decide how much material is needed. The incision is closed and the nasal surgery completed.
Dr. Harounian performs the procedure at Lenox Hill Hospital, Midtown Surgery Center or at the Grammercy Surgery Center, both state-of-the-art East Side ambulatory facilities. You arrive an hour before your procedure is scheduled to begin. You will speak with the nurse about your medical history and what to expect during the procedure and then change into a surgical gown. Dr. Harounian will discuss your treatment and goals before you receive any medications. You will then receive some medicine to relax you, followed most times by a general anesthetic. Dr. Harounian will come to speak with you again after you have awakened. He will have already spoken to the person taking you home. You will leave the ambulatory center with your chaperone about an hour after surgery. Dr. Harounian places a small plastic splint over the healing nose for protection but rarely finds it necessary to pack the nose. Dr. Harounian’s techniques minimize the recovery period and allow most patients to return to a normal routine the week after surgery.
The area of harvest may feel like you had a hard abdominal workout for a week or so. The area has a sealant that keeps it dry and will start peeling off about 10 days after surgery. You will be given some pain medicine, although most patients take only one or two doses and then switch to an over the counter pain medication. You will return to the office one week after surgery to have the nasal dressing removed and the graft site inspected, then return as needed to have the nose checked.
Usually. If the surgery is for functional improvement of the nose then harvesting the graft and placement is usually covered by insurance. In our experience, insurances do not allow cadaveric rib and the patient will need to cover the cost. Our staff will take a look at your insurance and let you know what to expect so there are no surprises.
