What is revision Rhinoplasty?

Revision rhinoplasty occurs after someone has had a first surgery on their nose and following the surgery the appearance or the function of the nose is not the result the patient desired. Revision rhinoplasty can change the appearance of the nose to make it look more pleasing or revision rhinoplasty can be designed to improve the function of the nose. In all cases of revision rhinoplasty the results should be a nose which functions properly and allows the patient to be able to breathe through the nose without obstruction. Additionally, it is essential that the nose match the face, be in harmony with the rest of the facial features, not draw attention to itself, and not distract from the other features of the face.

When is a revision Rhinoplasty needed?

If you do not like the appearance or function of your nose following a primary rhinoplasty procedure you should consider a revision rhinoplasty. Revision rhinoplasty allows the surgeon to correct those issues that occurred as a result of the first rhinoplasty. These issues can be related to the appearance of the nose such as an uneven tip, a subtle asymmetry, a scar from the incision or a failure of the tissue to heal properly. Or a revision rhinoplasty can be related to the function of the nose such as an inability to breathe or smell following a primary rhinoplasty. Most commonly however it is a mixture of both appearance and function that brings a patient to see Dr. Eugene Alford for a revision rhinoplasty.

When can revision Rhinoplasty be performed?

Patients frequently ask me how long after a first nasal surgery must one wait until a revision rhinoplasty can be performed. The best answer is: to wait as long as possible after the first surgery to allow all of the swelling, edema, bruising and scar tissue from the first surgery to have resolved as much as possible. If wound healing, scar formation, and edema are still present then the results of the revision rhinoplasty (the second nasal surgery) can still be impacted by the effects of the first surgery. By waiting at least a year all of the negative effects of the first surgical procedure will have gone away and the operating surgeon performing the revision procedure has more control over the tissues and the ultimate outcome.

How is revision Rhinoplasty performed?

Revision rhinoplasty usually involves reshaping the cartilaginous and bony structures of the nose to achieve a more pleasing appearance as well as improved function of the nose following a previous nasal surgical procedure. The shape of the nose is determined by the cartilages that provide the overall structure and shape to the nose. These cartilages are covered by the skin and it is the draping of this skin over the nose that gives its shape. The only way to change the appearance and the function of the nose is to alter the shape and interrelationships of the nasal cartilages and then allowing the skin to re-drape over this cartilaginous framework. Commonly revision rhinoplasty requires taking cartilage from other parts of the body such as the ear or the rib and transferring them to the nose in order to re-create the proper shape, appearance, and function of the nose. In those cases in which too much mucous membrane lining of the nose have been removed, there can be an entity called "empty nose syndrome" which is a devastating malady for which there is currently no cure or way to improve the nasal function.

What is "empty nose syndrome"

Empty nose syndrome occurs when too much mucosal membrane lining of the nose has been removed leading to a dry, crusty, nonfunctioning internal lining of the nasal cavity. Even though the nose is wide open and without obstruction, patients with this disorder feel as if they have no air flow through the nose because the mucous membrane lining has been destroyed and they cannot feel the air passing through their nose. This is most commonly the result of removal of too much of the inferior and/or middle turbinates of the nose. Symptomatic treatment with the use of nasal saline spray and topical treatments with over-the-counter medications, such as Ponaris, and nasal irrigations are the only options available for the improvement of quality of life in patients with this disorder.

Why is revision Rhinoplasty more difficult to perform?

Several factors make revision rhinoplasty much more difficult to perform than a primary, or first time, rhinoplasty procedure. As a result of the first surgery tissue such as cartilage bone and/or internal nasal lining have been removed; therefore, the second surgery has lost some of the important material necessary to create the appearance and function of the new nose. This material must be replaced with donor material from somewhere else in the body or from donor tissue taken from a cadaver. Commonly when cartilage is needed to rebuild the nose we can take it from the backside of the ear or cartilage from a rib. Newer technology has allowed us to use cartilage harvested from a cadaver which is then rendered acellular such that it does not transmit disease and that tissue can be used to reconstruct the nose without having to make another incision on the patient's body. My personal preference is to use tissue from the patient, either the ear or the rib, as we know that this tissue will have no adverse effects on the patient and the risk of rejection is the lowest risk possible. Cartilage grafts from the ear and the rib can be harvested with no visible scars, without changing the appearance of the ear, very little pain and very low risk. Cadaver cartilage grafts have no extra pain associated with them and a very low risk of rejection but still slightly higher than that of donor tissue taken from the patient themselves.

Will insurance pay for a revision Rhinoplasty?

If revision rhinoplasty is being performed purely for aesthetic appearance concerns then insurance will not pay for the surgery. If however there is a functional concern, i.e. difficulty breathing through the nose, insurance might pay for a portion of a revision rhinoplasty. In all cases of any type of revision surgery, a letter of medical necessity for predetermination of benefits must be sent to the insurance carrier seeking their approval for coverage of the surgery prior to surgery being performed. In general rhinoplasty whether primary, secondary, or revision surgery are very often specifically excluded from the vast majority of insurance policies. Therefore, the general answer is that insurance does not pay for rhinoplasty.

Why is revision Rhinoplasty more expensive than a primary Rhinoplasty.

Revision Rhinoplasty is more expensive than primary Rhinoplasty because the amount of work is much more with a revision Rhinoplasty then it is with a primary Rhinoplasty. Revision Rhinoplasty almost always requires a more difficult preparation of the nose because of dissection through scar tissue. Also a revision Rhinoplasty almost always requires tissue from somewhere else in the body such as the ear or the rib to be harvested, carved, prepared and then sutured into place in such a way as to re-create both a pleasing appearance and a nose which operates properly. A primary Rhinoplasty usually takes only 2-3 hours in the operating room under anesthesia while a revision Rhinoplasty y may take as many as 4-6 hours of surgery time depending on the degree of tissue that is being replaced.

What is the recovery time for Revision Rhinoplasty?

Generally, we encourage you to take at least 2 weeks for your recovery before returning to normal activities. Your first post-operative visit will be 1 week after surgery, during that first week you will have a small cast on the outside of your nose. For some patients, they prefer to wait until that cast is removed before returning to work, school and social activities. During the second week of your recovery you are welcome to ease back into your normal schedule being mindful that you are still in the early recovery phase. Two weeks after surgery you will be able to resume all of your normal activities including full exercise. However, wearing glasses of any kind is prohibited for the first 4 weeks following surgery. In an effort to meet the needs of our patients who wear eyeglasses, we have a special device that is available at Alford Facial Plastic Surgery that will allow you to wear your glasses during your post-operative recovery without affecting your surgical results.

How can I prepare for my Revision Rhinoplasty procedure?

During your Rhinoplasty Consultation, you will meet with Lindsay, Dr. Alford’s Nurse, who will share in detail how to best prepare for your surgery. She will also share with you the Alford Facial Plastic Surgery Recovery Plan that we have formulated and found to be very successful in expediting healing, resolving bruising, and get you feeling and looking your best after surgery!

Steps you can take to support your best outcome:

1. Discontinue the use of any aspirin, ibuprofen, vitamin E, and certain herbal supplements two weeks before and for the two weeks after your Rhinoplasty surgery. This is for your safety; we will review your current medications and discuss any adjustments that will need to be made in the recovery period.

2. Stop smoking for at least four weeks before surgery. Nicotine slows healing and can compromise the needed blood flow for healing tissues.

3. Stock up on frozen peas and nasal saline spray before surgery as these will be very important components of your recovery!

4. Enlist the help of a relative or friend to assist for at least the first 48hours after surgery. It's great to have support, someone to fetch your beverages and soft foods, and a person to keep track of when you've taken your meds and when you'll need your next dose. Also, to transport you to and from the hospital for the day of surgery as you will not be able to drive yourself home after your rhinoplasty.

5. Wear comfortable clothes the day of surgery. Front-buttoning tops are better than shirts that pull over your head.

6. For your comfort you may use a humidifier at night and use throat lozenges throughout the first few days. This is to soothe dry mouth/throat as breathing through your mouth is common in your initial recovery period when your nose is initially congested.

7. Rest! Allow ample time for your body to heal. While we encourage you to walk and stay vertical as much as possible, knowing your own limits and not over-doing-it too soon is best!

Ask Questions! If you are feeling anxious, we understand! The decision to have any surgery is one made with thoughtful consideration, so feel free to ask any and all questions!