Revision rhinoplasty, also referred to as secondary rhinoplasty, is a procedure to reshape or resize your nose following prior attempted surgery. This is often done for persistent cosmetic irregularities as well as breathing difficulties that can result from suboptimal surgical technique. Most revision cases involve excessive reduction of the nasal bridge, irregularities and asymmetry of the nasal tip, and poorly tolerated implant materials.
In many instances, the initial surgical result following rhinoplasty appears quite acceptable. Unfortunately, many surgeons achieve these early results at the expense of weakening the underlying structural support of the nose. Contrary to popular belief, your nose will continue to change shape long after the first few months of healing. If the structural support mechanisms were compromised during the original surgery, subsequent scar formation may begin to cause unwanted change as time goes on. Revision rhinoplasty patients often present several months to years after their first surgery, noting the development of unsightly irregularities.
Revision rhinoplasty is significantly more challenging than primary rhinoplasty, or those procedures performed for the first time. There is much more variation in terms of types of abnormalities encountered. In addition, prior scar formation makes the operation technically more difficult.
In some cases, revision surgery requires only minor recontouring of existing structures to achieve the desired refinement. However, most revision rhinoplasty cases are much more involved and typically demand an open approach. Many rely on the use of additional grafts to restrengthen and rebuild a structurally compromised nose. Whereas the septum (middle wall of the nose) is typically used for grafting material in primary cases, patients undergoing revision surgery usually have already had much of the septum removed. Therefore, revision rhinoplasty commonly involves harvesting cartilage from behind the ear (termed auricular cartilage harvesting) for grafting purposes. When done properly, the ear will look exactly as it did before the procedure with incisions that are essentially hidden behind the ear.
“I came to Dr. Hilinski after 3 botched nose jobs, leaving my nose thin, crooked, along with other issues. It was so ugly and difficult to work with that at that point, I wasn’t shooting for a pretty nose, I just wanted to look remotely normal/natural which I didn’t even think was possible. A year later, my nose looks like the best possible version of my original nose and fits my face perfectly.”
Dr. Hilinski is one of only a few facial plastic surgeons in California who has advanced, expert training specifically in revision rhinoplasty cases. He trained with internationally-renowned facial plastic surgeon Dean M. Toriumi, M.D., who is considered by many authorities to be one of the best revision rhinoplasty surgeons in the world. Dr. Hilinski utilizes the latest and most sophisticated surgical techniques in taking on some of the most challenging cases of revision rhinoplasty.
Revision Rhinoplasty Candidates
Good candidates for revision rhinoplasty include men and women with realistic expectations who desire refinement and reshaping of their nose following a prior rhinoplasty surgery. Patients should understand that revision procedures are significantly more complex and difficult than primary rhinoplasty procedures. Patients who are dissatisfied with the results of a previous rhinoplasty should wait a minimum of 10 to 12 months after the first surgery before proceeding with the revision procedure.
Revision Rhinoplasty Surgery and Recovery
In most instances, revision rhinoplasty can be performed on an outpatient basis in an outpatient surgery center. Surgery typically takes two and a half to four hours to complete, though surgery involving the use of a rib graft can take up to six hours. Deep sedation or general anesthesia is typically used.
The recovery period after revision rhinoplasty is similar to primary cases, with an initial recovery of about five to seven days. During this time, bruising and swelling may be most noticeable. Pain is usually not significant. Most patients look presentable in public and are able to return to work or school within seven to 10 days. While the majority of soft tissue swelling will disappear within several months, the nose will continue to undergo healing and remodeling of the shape for up to a year or more in some cases. Aerobic or reconditioning activity may be resumed within 10 to 14 days while more strenuous activities and resistance workouts may be resumed within three to four weeks.