If you have undergone a previous rhinoplasty and are not completely satisfied with the results, undergoing a revision may be the next step in achieving a natural and balanced nose. Many people interested in a revision rhinoplasty cite either an undesirable cosmetic appearance or difficultly breathing as the motivation for undergoing additional surgery. The ultimate goal of repeat surgery is to create a natural and aesthetically pleasing nose that fits the patient’s face.
The 2 Philosophies I Take During a Revision Rhinoplasty
There are 2 approaches I take in considering the best surgical approach during a second procedure. They are:
1) Camouflage Revision Rhinoplasty
2) Structural Revision Rhinoplasty
A camouflage revision rhinoplasty is ideal for a patient that has good structural foundation of both cartilage and bone in the nose. These patients typically have good nasal breathing but have some aesthetic concerns. In this situation, I will take a surgical approach to correct the aesthetic concerns without major manipulation of the foundation of the nose.
A structural revision is ideal for a patient that has a poor foundation of the nose. The nose may be collapsed, over-resected from previous surgery, or has weak support. These patients typically have problems breathing through the nose. In this situation, the foundation of the nose has to be rebuilt in order to improve both the appearance and function of the nose.
When patients come to my office for a second surgery or broken nose surgery, I will explain my reasoning for the surgical plan. Through my extensive training in facial plastic and reconstructive surgery, I can help my patients restore a balanced and natural profile — leaving them pleased with their results.
Who Is a Good Candidate?
A revision rhinoplasty has unique challenges. A good candidate for a revision is someone that wants to improve the appearance and breathing in the nose. There are several reasons why patients seek revision rhinoplasty surgery, including but not limited to:
- Twisted nose
- Persistent nasal hump
- Unbalanced chin aesthetics
- Pinched nose deformity
- Short or overturned nose
- Unnatural nasal tip
- Asymmetric nostrils
- Persistent breathing difficulty
- Nasal valve collapse
- Nasal tip bossae
- Over-resected nose
- “Pinched nose deformity”
Primary Rhinoplasty VS. Revision Rhinoplasty
Revision rhinoplasty can be a more complex than primary rhinoplasty. From the start, revision surgery requires increased attention to the subtle nuances of the nose during the initial examination and more comprehensive evaluation and planning. As a board-certified head and neck surgeon with fellowship training in facial plastic and reconstructive surgery, I will examine your previous surgical records, closely looking at the structure of your nose allowing me to outline a realistic treatment plan. Typically, the revision procedure is carried out at least 1 year after the initial surgery. In order to improve and achieve the aesthetic and breathing function of the nose, precise techniques must be used.
Many times when performing a second rhinoplasty or broken nose surgery, the nose needs to be rebuilt secondary to over-resection of bone and cartilage from the previous surgery. The nose is rebuilt from cartilage from your own body. Cartilage is obtained from either inside the nose, the septum, the ear, or the rib. Additionally, after each surgery, the skin on the nose will become increasingly thinner. If the skin needs to be thickened, then tissue can be obtained from behind the hairline, temporalis fascia. This tissue is placed in the nose to thicken the skin
Recovery After Revision Rhinoplasty
In general, recovery from revision rhinoplasty lasts about 1-2 weeks. I rarely place packing in the nose, however a cast will be placed on the outside of your nose and is removed 1 week later. Follow-up appointments are critical to the healing process and ultimate success of your surgery. You will visit my office the first day after surgery and then every week for 2 weeks. During this time, I may inject the nose with medications to modulate the healing and get the best results. Revision requires a long-term commitment to your overall health, so we will work together to ensure the best healing during your recovery.
The slowest aspect to resolve after a revision rhinoplasty is the swelling in the nose. It can take up to 1.5 years for all of the swelling to resolve in the nose during a structural revision. At 4-5 weeks after surgery, you will able to see a decrease in the swelling and then it will slowly go down over time.
It is my goal that you achieve natural, aesthetically pleasing results, as well as improved function, when undergoing revision.
To see before and after photos of a revision rhinoplasty procedure, please visit our photo gallery.
Revision Rhinoplasty FAQs
Q: What type of anesthesia is used for revision rhinoplasty?
A: Deep sedation or general anesthesia can be used in most revision procedures.
Q: How long does it take to see the final results of revision rhinoplasty or broken nose surgery?
A: The nose typically heals more slowly after a revision compared to the first surgery. After a few months, a patient is able to get a good estimate on the final result. The final result is best appreciated about one to 1.5 years after the revision surgery once the swelling has resolved.
Q: When can I return to work after revision rhinoplasty?
A: Patients can return to work, or their daily activities, in approximately 10-14 days.
Q: When can I wear glasses after a revision rhinoplasty surgery?
A: Glasses cannot be worn normally on the nose for some time, as it may cause indentation or cause the nose to be crooked. Glasses can be worn during the first week if they are resting on the cast. After the cast is removed, patients have several options for their glasses:
- Glasses can be lightly taped to the forehead to prevent pressure on the nose
- Glasses can be placed on a small head wrap that keeps the glasses from touching the nose
- The patient may keep the nasal cast and use it to rest their glasses
Glasses can be worn six weeks after surgery.
Q: How should I sleep after a revision rhinoplasty?
A: There will be some swelling in the nose, which causes the patient to feel congested. Keeping the head elevated above the heart for the first week after surgery will help keep the swelling down. While sleeping, you can put a few pillows underneath your back and neck or sleep in a recliner chair.
Schedule Your Revision Rhinoplasty Consultation Today
Undergoing a revision can initially be a scary thought, which is why it’s always my goal to make my patients feel as relaxed and comfortable about their pending procedure as possible. If you’ve been considering a second or third procedure but aren’t quite sure about what to do next, I encourage you to contact me today to learn about how I can help you attain a natural, balanced, and functional nose.
To discuss options for a revision rhinoplasty in Charlotte, schedule a consultation with Dr. Kulbersh today by calling 704.323.5090.