Revision rhinoplasty is commonly referred to as a surgical procedure that revises or corrects a previous surgery. The revision procedure is much more complicated than the primary rhinoplasty. It requires a sophisticated understanding of the nasal structure and expert surgical technique, which the best-in-class plastic surgeon in New York City Dr. Linkov possesses.
City Facial Plastics, located in Manhattan, NYC, has an enormous history of performing rhinoplasty with phenomenal results. When needed, we can also repair a previous nose job through a rhinoplasty revision to help our patients finally enjoy the benefits of a beautiful, functional nose.
What Is Revision Rhinoplasty?
Revision rhinoplasty technically refers to a surgeon repeating a rhinoplasty procedure on his own patient. In contrast, secondary rhinoplasty is performed by a surgeon on a patient with a history of rhinoplasty, whose nose he had not operated on. Revision rhinoplasty NYC is performed using the same general principles and techniques as primary rhinoplasty. Attention is often paid to correcting the bridge of the nose or to tip revision rhinoplasty.
People seek out rhinoplasty surgery to improve their nose, assuming it will be a one and done procedure. But sometimes a person might find that the results of the rhinoplasty do not meet their cosmetic needs or that they still have breathing problems afterward, or even new breathing problems. Often the reason for these problems is an overly reductive initial rhinoplasty that took too much supportive tissue away leaving the potential for many problems behind. People who are unhappy with the results of their first rhinoplasty will sometimes seek out rhinoplasty tip revision, either with the same surgeon or with a different surgeon. Revision rhinoplasty rates generally range from 5-15%.
What Are the Common Rhinoplasty Problems?
A successful nose job should look natural and blend with the rest of the facial features. When rhinoplasty is overdone, poor techniques are used or healing does not go as planned, the results are often noticeable. Some of the common complaints from poor nose job recipients include:
- A pinched appearance
- Collapsed or saddle nose
- Upturned or twisted nose tip
- Bumpy, deviated or twisted bridge
- Nasal valve collapse
Who Is a Good Candidate for Revision Rhinoplasty?
The overlying skin must be in good condition before revision procedure takes place. A reliable donor source of grafting material must be identified before undergoing a revision rhinoplasty.
This cosmetic procedure can address many nasal complaints that are similar to primary rhinoplasty, including:
- Difficulty breathing through the nose – Collapsed cartilage or cartilage that warps or returns to its original form may lead to nasal obstruction.
- The nasal hump on the bridge – At times the bony or cartilaginous portions of the hump were not removed adequately and need to be redone. Bony callus may also form and might need to be removed.
- Saddle nose deformity – If too much cartilage was removed from the septum then the nose might collapse with the need for an augmentation procedure to restore the nose.
- Crooked nose – Often a deviated nose is corrected with the primary rhinoplasty but certain forces acting on the repositioned cartilage and bone can lead to a recurrence of the deviation. More aggressive maneuvers may need to be taken to ensure that it does not happen again.
- Wide nose – A common indication for primary rhinoplasty, this appearance may remain if the bony osteotomies (cuts) are not properly designed or if the tip is not properly refined.
- Tip asymmetry – As the nasal tip heals and the swelling resolves, tip asymmetries may become evident.
- Droopy tip – Sometimes the nasal tip cartilages are poorly secured during the primary rhinoplasty which can result in the nasal tip drooping.
- Overly rotated tip – Many rhinoplasty maneuvers can lead to an upturned, overly rotated tip. It may need to be derotated during revision rhinoplasty.
- Overprojected tip – The tip may be left over projected which makes it appear larger and further out from the face than desired. This can be corrected with various tip cartilage techniques and the bridge height might need to be adjusted.
- Weak or under projected tip – If the front of the septum (caudal) is weak then the tip will be weak and may cause cosmetic and functional problems. Strengthening the caudal septum and attaching the tip cartilages properly is helpful.
When to Do Revision Rhinoplasty in Manhattan, NY?
After your primary rhinoplasty, it is best to wait a full year before planning for revision rhinoplasty. Sometimes a decision can be made a few months earlier, such as at 10 months, but that is on a case by case basis. The reason to wait this long before having a tip revision rhinoplasty is that the swelling, especially at the nasal tip, can take many months to improve.
Surgery done too soon may be unnecessary. Also, it is best to allow the tissue to heal before retraumatizing it and tissue planes may be more difficult to find and dissect if revision surgery is done sooner. Board-certified plastic surgeon in Midtown, Manhattan Dr.Linkov will walk you through the most appropriate timing for your revision rhinoplasty in NYC.
What Makes Revision Rhinoplasty More Complicated Than Primary Rhinoplasty?
There are several reasons that revision rhinoplasty is more complicated, including:
- Scar tissue: Significant scar tissue can make it difficult to find important structures and dissect tissues. It can also sometimes make the surgery more bloody.
- Lack of grafting material: Often the usable septum is fully consumed during the first rhinoplasty and therefore another grafting material is needed (such as ear or rib cartilage) to create the proper support and aesthetics in a revision case.
- Emotional scarring: Patients are often upset and frustrated while looking for a revision rhinoplasty specialist. Many feel that their primary rhinoplasty surgeon did not fully listen to their requests. Helping patients feel confident in their decision making is very important in cosmetic surgery.
What Is the Recovery From Revision Rhinoplasty?
Recovery from a revision rhinoplasty can be divided into time from surgery, such as:
- First 48 hours – Oozing from the nose is possible. Wear a drip pad under the nose to catch the spots of blood. Pain is usually mild to moderate and can usually be managed without narcotics.
- 1-2 weeks – Primary swelling and most bruising resolve in the first two weeks. Splints, casts, and sutures are removed typically at one week. Nasal stuffiness slowly improves.
- 8-12 weeks – The redness of the external incision, if used, diminishes. Tip swelling improves and can be aided by steroid injections.
- 3mo – 1 yr – Tip swelling continues to improve and eventually resolves to leave you with a final revision rhinoplasty result.
It is important to avoid strenuous activity such as exercise or heavy lifting for at least 1 week. Avoid contact sports for at least 6 weeks.
What Are the Risks and Complications of Revision Rhinoplasty?
Similar to a primary rhinoplasty, the risks and complications of revision rhinoplasty surgery, include:
- Bleeding – Major bleeding is rare but oozing in the first few days after surgery is common.
- Infection – Rare if the body’s own tissues are used, but the rate increases if foreign substances are used during the procedure (other than suture).
- Poor scarring – Primarily refers to the external incision if performed. If closed in an inverted-V or stair-step fashion poor healing is rare.
- The undesirable aesthetic result – It is always possible that the patient will be unhappy with the cosmetic appearance of the revision nose job. This risk can be mitigated with careful planning and superb communication between the best revision rhinoplasty surgeon and the patient.
- Upper dental numbness – Extensive dissection or cautery at the nasal spine or along the nasal base may result in temporary upper dental numbness which usually resolves in weeks to months.
- Asymmetry – The nose often has asymmetric features that rhinoplasty may fail to address.
- Bossae (tip irregularities) – With swelling the nasal tip may appear symmetric and uniform in the early months but eventually various pressures on the nasal tip can result in certain tip irregularities and prominences.
- Overrotated tip – Failure to control the rotation of the tip will result in a “piggy” appearance with an increased nostril show from a frontal view.
- Alar retraction – Nasal tip maneuvers need to be balanced or else alar retraction can occur which is most visible from a profile view.
- Septal perforation – This can occur from the septoplasty portion of the procedure if there is an improper dissection of the tissue around the septal cartilage.
- Saddle nose (bridge collapse) – Overaggressive removal of septal cartilage can result in the bridge collapsing in.
- Pollybeak – This can result from an under-resection of cartilage or from a droopy tip.
- Nasal valve collapse – Both the internal and external nasal valves which are critical for proper nasal airflow need to be well supported to avoid collapse and airflow obstruction.
- Inverted -V deformity – If the midvault of the nose, or the middle third, is collapsed, the nasal bones can become more prominent, giving the appearance of an upside-down V. This is usually from lack of support in the middle third of the nose and a reduction of the nasal bones.
- Deviated nose – The nose may appear straight in the early period of healing but can sometimes deviate over time since cartilage tends to have “memory” and may try to return to its original shape.
- Rocker deformity – Inaccurate bony osteotomies (cuts) may lead to the upper part of the nose still appearing wide.
- Open roof deformity – If a nasal hump is removed additional grafts or bony cuts need to be made “to close the roof” and limit the chance of the bridge of the nose appearing “open” with visible shadows of underlying structures.
- Dorsal irregularities – As bone and cartilage are manipulated at the bridge, edges and contours must be smoothed or else they may show through, especially in thin-skinned individuals.
- Damaged skin – Each time the nasal skin and soft tissue are dissected off of the underlying structures, blood supply may be altered and result in changes to the skin integrity.
Compared to a primary rhinoplasty, the risk of many of these events is higher with a revision nose job.
Is a Revision Rhinoplasty Worth It?
Whether a revision nose is worth the added downtime, risk, and expense depends on many factors. The revision rhinoplasty specialist should be able to explain to you what may have gone wrong during the first surgery and have a concrete plan on how to fix these issues. The patient, on the other hand, needs to have a specific idea of what they want to have corrected and understand the challenges of, and the extended recovery for, a revision rhinoplasty.
Is revision rhinoplasty in NYC free?
There are two scenarios to consider. The first is that a surgeon performs rhinoplasty and the patient is unhappy with the result. If that surgeon and patient decide to pursue a revision rhinoplasty then they must decide the cost. Often, for these types of cases, the surgeon’s fee is waived but anesthesia and facility costs may apply.
Another factor to consider for the first scenario is how long after the primary rhinoplasty is the revision requested. If a patient returns after five years requesting a revision nose job it may be a different financial situation compared to stating disappointment and requesting a revision after a few months.
The second scenario is if a patient, who has previously had a rhinoplasty elsewhere, comes to a surgeon seeking a revision procedure (secondary rhinoplasty). Often, in this scenario, the surgery will cost more than primary rhinoplasty because of the complexities described above. Keep in mind that every surgeon approaches his or her own revision rhinoplasty fees differently.
Who Is the Best Revision Rhinoplasty Surgeon in NYC?
Patients often search for the best nose plastic surgeon. Dr. Gary Linkov is proud to be among the top-rated NYC revision rhinoplasty surgeons specializing in revision nose job surgery. Dr. Linkov is a specialist with extensive experience treating all conditions of the nose, especially those that have been previously operated.
He is the Chief of Otolaryngology and Facial Plastic Surgery for the Veterans Hospital in Brooklyn, NY, where he operates on complex nasal deformities on our country’s veterans. Dr. Linkov’s private practice in Manhattan’s Upper East Side focuses on cosmetic and functional rhinoplasty. You can view before and after photos of Dr. Linkov’s patients below.
Revision Rhinoplasty Before and After
While rhinoplasty revision is complicated, Dr. Linkov, as a top-rated facial plastic surgeon in New York, has the experience and skills to help patients who are unhappy with their previous nose job results. If you want to explore rhinoplasty revision, contact City Facial Plastics in UES, Manhattan to schedule an appointment with Dr. Linkov.