FAQ: Revision Rhinoplasty

FREQUENTLY ASKED QUESTIONS

Beverly Hills Facial Plastic Surgeon Dr. Babak Azizzadeh frequently answers questions from patients on realself.com. They are separated into categories below. If you do not find an answer to your question here, please contact us or call us at 310-657-2203.



 

REVISION RHINOPLASTY

Q: Is Scar Tissue Removal and Columella Reduction Possible?

I had revision rhinoplasty done in 2004. I have a larger nose now, including scar tissue where the incision was made in my columella. My columella is extremely thick and my nostrils are large and wide. Is there any way to fix my tip so that it is smaller and thin out my columella to make my nostrils smaller?

A: Many patients with prior rhinoplasty complain of similar issues.

Those are common reasons that we revise noses, but until we see you it is difficult to know. Outcomes will depend on your surgeon, your anatomy, and the healing process

Q: Bump on dorsum?

Is it normal to feel a bump on the left dorsum after a revision rhinoplasty?

A: Swelling normal.

Even though your revision procedure wasn’t extremely intricate, you can still experience swelling for up to two years post your procedure. During this time, it’s best to be patient until the final results can be appreciated. If you’re very unhappy with your results, you can always seek a second opinion from an expert facial plastic surgeon who specializes in rhinoplasty procedures.

Q: Planning 2nd Nose Job?

I broke my nose 15 years ago and had a nose job 2 years ago. Now I breathe better while asleep, the nose is thinner and the profile looks better but the top of the septum USED to be crooked and now its the bottom. When I inhale fast, the sides of my nose collapse a little.

A: Most likely need spreader

From what you are describing, it sounds like you may most likely need spreader grafts and nasal middle vault reconstruction to improve the collapse. You need to figure out if your doctor has experience in revision surgery or not and then decide. I suggest visiting an expert facial plastic surgeon with an extreme knowledge in the performance of rhinoplasty to make sure you receive excellent results.

Q: How Long Must I Wait After Broken Nose/closed Reduction to Have Repair Rhinoplasty?

I want to have a revision rhinoplasty but need to know when I can.

A: 3-6 months

The most common time frame for a procedure like this would need to take place 3-6 months following your initial surgery. This is the safest time period to ensure that the problems your experiencing will be corrected. I suggest visiting an expert rhinoplasty surgeon who can examine you in person.

Q: Can the shape of your eyes change after several revision rhinoplasty procedures?

I had a rhinoplasty in August 2011 which I was not happy with. Since then, I have had 3 more surgeries that I am not happy with. I noticed the shape of my eyes have changed, also my cheeks look kind of distended. On the overall, my face seems swelled up and I cannot properly smile.

A: It’s difficult to know what is going on without examining you.

You may want to get a CT scan of your face and visit an experienced otolaryngologist to figure out the proper course of action going forward.

Q: Should you get a revision rhinoplasty if you’re unhappy with initial results?

If you don’t like your nose but others say it is fine, should you undergo surgery to correct your nose?

A: It is a personal preference.

If you are truly unhappy with the results of your primary rhinoplasty, it’s best to see an expert who agrees and can provide you with a successful surgery. On the other hand, if you accept the changes to your nose, an additional surgery isn’t necessary.

Q: What can I do to help decrease swelling at 7 weeks post-op?

I am 7 weeks post op and experiencing a lot of swelling. Is there anything that I can do to help it go away quicker?

A: With time, your swelling will diminish.

It’s best to follow the post operative instructions as set by your plastic surgeon. Swelling can take some time to completely go away and is still common during your stages of healing. Try to be patient and all will heal in time.

Q: Revision Doctor Found Septal Perforation Post Rhino, Is It Ok To Proceed?

I had my initial rhino 2/2010 and am currently in search of a revision due to undesirable/unexpected results. In a recent examination with a new ENT/PS it was brought to my attention that I had a septal perforation. I have noticed some of the symptoms in the past year or so but attributed them to other causes. Is it safe to proceed w cosmetic Sx and leave the perf alone? Shouldn’t my initial surgeon told me about the perforation? Will this implicate my aesthetic results?

A: A post-op perforation may be OK but dependent on the size of the perforation

It might be ok to perform another procedure if the perforation is not significant. A small perforation does not have to be repaired. If it is a large perforation, the surgeon may need to get cartilage from other areas such as rib or ear to repair the perforation. It is best to discuss this with your surgeon to see if the perforation needs to be repaired.

Q: Open Rhinoplasty 3 Months Ago, when Can I Get Revision to Refine the Tip and Breathing Difficulties?

I had a deviated septum and a hump on the bridge of my nose. The physician was supposed to break my nose but said that it wasn’t necessary. After the cast was removed I noticed my nose had bones stick out where my hump was originally. I asked for tip refinement and my tip is extremely bulbous, a sloped profile but its straight w/ a slight hump, but most of all I can’t breathe at all through my nose anymore. When would be an appropriate time to inform my physician he needs to redo the surgery?

A: Wait at least 12 months before another surgery

The swelling takes at least a year to go down completely and return to normal. Therefore, it is best to wait 12-18 months to see how the nose turns out before returning to your surgeon. I would also recommend that you seek out the advice of the best revision rhinoplasty surgeon you can find.

Q: Can a Long Surgery Affect Swelling and the Final Results of a Revision Rhinoplasty?

I was wondering if a longer rhinoplasty surgery would lead to more swelling as opposed to a short one.

A: Surgery length does not affect swelling after revision rhinoplasty

No, swelling after revision rhinoplasty is not related to the surgery length. Every surgeon takes a different amount of time to perform the surgery. The swelling experienced is actually caused by how extensive the surgery was. An experienced surgeon can take a longer amount of time depending on the complexity of the procedure.

Q: Dented Nose Bridge, Deformed Side Profile and Bottom Bigger then Top After Third Surgery, What Now?

I’ve gone through my third nose job and don’t know what to do at this point I have no idea if my PS is doing things wrong or not. Basically 1st one my nose looked larger then before because nothing was taken off the bottom half, 2nd I noticed a dent on bridge and people kept asking if I was bruised. The bottom half is still bigger. He injected kenalog didn’t work. 3rd now more dented still bigger on bottom half what do I do ?!?!

A: Seek a consultation from a revision rhinoplasty surgeon

It sounds like the revision surgery was not done properly. Rhinoplasty is a very complicated surgery, and it can be done improperly. It is recommended that you seek a consultation with a surgeon that specializes in revision rhinoplasty surgeries. I specialize in revision rhinoplasty and would offer you to contact me for a consultation. Visit the Institute for Rhinoplasty and Revision Rhinoplasty for more information about revision rhinoplasty. Good luck!

Q: Nasal implant or bone graft? 2nd rhinoplasty.

I had surgery and I’m extremely unhappy with it. I’m booked to have a revision rhinoplasty in February. They have told me that I will either need a bone graft or an implant. Please can any one tell me which they have had and any complications or advice you could give. I know there are pros and cons with both…

A: Rib graft for revision rhinoplasty

In this situation, I prefer using a rib graft as it has a softer consistency than bone and lower risk of infection than an implant. Best of luck with your revision rhinoplasty procedure.

Q: Can I have a fascia graft on top of a fascia graft?

I had a bad nose job where the bridge was scooped out. I had a decent revision where a fascia graft was used to build it up, yet it is still a bit flat and undefined. Can I get a graft placed on top of the graft or does the first graft have to be removed for another to be placed. What are my options?

A: Second revision rhinoplasty fascia graft

Yes. During a revision rhinoplasty surgery, your surgeon will be able to place another graft on top of your existing graft in order to improve the appearance of your nose.

Q: What medical conditions increase the risk of revision rhinoplasty complications?

What prescription drugs are known to contribute to revision rhinoplasty complications more frequently?

A: Revision rhinoplasty complications

There are not any prescription drugs that I am aware of that can increase the risk of revision rhinoplasty complications. However, be sure to discuss all of the medications you are taking with your surgeon.

Q: Nose tip too narrow and uneven and bone bump grew back. What can I do?

Over 10 years ago I had my bump filed down from bridge of nose. I woke up and the dr mentioned he narrowed the tip and put plastic things I’n tip for definition. I never asked for this and loved the tip of my nose before. I tried for many years to live with it but the truth is, it bothers me everyday. My nose looks long and narrow and the bump somehow grew back. The most annoying part is that my nose runs constantly! So embarrassing. What can I do to fix this?

A: Revision rhinoplasty for narrow nose tip and bump

Revision rhinoplasty to reverse the cartilage narrowing and rebuilding the framework is commonly performed. Just be certain that your surgeon has extensive experience and expertise in revising noses.

Q: How does grafting procedure work in revision rhinoplasty?

From what part (or parts) of the body can the tissue be taken for a nose job revision?

A: Grafting for revision rhinoplasty

Usually the septum. If that area has been exhausted or lacks sufficient cartilage, then ear or rib cartilage. I also like camouflaging grafts with temporal is fascia or perichondrium.

Q: Deciding on a Doctor from Overseas

I’m an Australian resident. I wish to have revision rhinoplasty and cheek augmentation. I prefer to have the operations in the USA because it’s cheaper (average cost of rhinoplasty alone is a minimum of $10,000 in Australia) and I believe the general quality of the work is higher in the USA. Can anyone offer any advice about how to decide on the right surgeon for me from abroad? I prefer a Californian surgeon.

A: Come to Beverly Hills – Center for Advanced Facial Plastic Surgery

My center in Beverly Hills would be a great fit for you. I have just published my second textbook on rhinoplasty, and am also double board-certified as an ENT so would be ideal for your revision rhinoplasty and cheek augmentation. My office and surgery center are also next door to the hotel montage, a great place to stay and recover after your surgery. We are very accustomed to out-of-town patients and can accommodate your needs. Please check out my website facialplastics.info for pictures and more information.

Q: Is It Possible to Get a Photograph?

I am going for a revision rhinoplasty and chin augmentation. I would like a picture showing me what I may look like is this possible? I am scared to have something done without me knowing what I might look like.

A: Yes with 3D Imaging

At my office in Beverly Hills we offer Vectra 3D imaging, which takes a picture of your face and we can morph it so you can see results before agreeing to the surgery. It sounds like the solution you are looking for!

Q: What is the Price Difference Between Regions?

I live in Kenosha, WI right between Milwaukee, WI & Chicago, IL. What is the price difference between these areas? I have concerns with who I go through for my next rhino since my original surgeon did a hack job 14yrs ago and my nose is still a mess from a break. Help?

A: Don’t worry about price, find the most experienced surgeon you feel comfortable with

You should not be worried about the price, especially if this is a revision rhinoplasty. Find the most experienced surgeon you feel comfortable with. Revisino rhinoplasty is often a complicated procedure and in most cases you do get what you pay for.

Q: Seeking Top Revision Rhinoplasty Surgeon in US for Ethnic Style/type Nose (But Not Ethnic)

This will be my second surgery after having had the first one well over a decade ago. I am looking for a mature (in age) surgeon that has performed thousands of revision surgeries and ideally only focuses on rhinoplasties. My nose has afro-Caribbean features – wide nose, slightly bulbous tip and large nostrils. I am not however of Africean origin – my family from India! I have inherited this nose from my father and desperately seek to find the right Dr.

A: Beverly Hills is your place

There are tremendous differences among ethnic groups, and significant variations within ethnic groups. We strive to maintain your ethnic look while improving outstanding features.
Many plastic surgeons have limited experience working with patients of African, Asian, Middle Eastern, or Hispanic descent. This lack of experience with diverse ethnicities can often result in rhinoplasty procedures that produce incongruous results.
I also only perform procedures on the face, which gives me more expertise than a regular plastic surgeon. Furthermore I am also a board certified ENT to ensure breathing issues are not an issue, and have written 2 medical textbooks focused on rhinoplasty.
I would be happy to review your case if you are interested, please send me an email.

Q: How Long Before I Can Pursue a Bone Graft Removal Post-Revision?

After my primary, my surgeon suggested I need to build my bridge up and that he could do that by using freeze dried cadaver bone. Everything he said sounded fine. It’s been 4 weeks since the surgery and I very much so regret having the revision. The contours of the bone are very evident and the nose like it almost projects out again. I would like to remove the bone graft. It is physically painful and I always feel the pressure on my bridge, which is distracting throughout the day.

A: At least 12 months

You have to speak to your surgeon about this…I think that it is always prudent to wait at least six months to remove any grafts…most surgeons would recommend at least 12 months.

Q: Would Revision Rhinoplasty Be Easier if I Stick to the Same Surgeon?

I am thinking of having a revision rhinoplasty, and I liked the first result but wish to have some minor touch ups done. Should I stick to the same surgeon? Is it easier/better because she knows what she did the first time, or is it all the same if I just go to another plastic surgeon? What’s more advisable and most likely to get the best results?

A: Stick with same surgeon

I would suggest to stick with the same surgeon as they are familiar what was done during the 1st surgery.

Q: Where does the cartilage come from for a rhinoplasty revision for a pinched tip?

My wife wants a rhinoplasty revision for a pinched tip; how is it possible to add back what was once taken away? Where does the extra cartilage come from?

A: Usually from the ear but may require rib cartilage if issue is significant

Yes, i call it “reverse rhinoplasty” we usually use ear cartilage but may require rib cartilage if the issue is significant.

Q: Post-rhinoplasty in Office Scraping?

I had a septorhinoplasty done in Dec 2010. During my last post op (July 2011) my surgeon told me that he would like to do some more scraping to remove a bump on the bridge of my nose and to shave down some more of the lower part of my nose (top of tip)He told me that he would only administer anesthesia similar to that given when removing wisdom teeth. What i would like to know, is what is the recovery like for a procedure like this? How long until I am healed & do i have to wear bandages?

A: Depends on the amount of surgery.

It is possible, it really depends on the amount of surgery. Be sure to speak with your surgeon about your concerns.

Q: How Long Do I Need to Wait for Revision Tip Plasty?

Hey. I had tip plasty performed nearly a month ago. It was to raise the tip of my nose slightly because it was too long for me face and dipped a lot when I smiled which made me incredible self-conscious. I’d always put my hand over my face when I smiled. Now it has been done, he has not raised the tip at all. It is just a bit swollen. How long to I have to wait to get it done again? Thanks X

A: Must wait at least 12 months to assess issues at hand

You really should wait at least 12 months to assess the true issues at hand once you are 100% done healing.

Q: Used Q-Tips Post Rhinoplasty And Nose is Constantly Worsening- Do I Need A Revision?

i had a rhinoplasty a year ago and it was perfect but the result has been constantly worsening or scar tissue accumulating and losing its original bony shape…i never touched it but i used q-tips for a prolonged period and i once hit the sidewall mildly hard with a cottonless q-tips stick ( i had forgot i removed the cotton and so it was plastic) when i was 8 months post-op. now that side of my nose is lumpier and the nostril is little bigger, will this heal with time or do i need a tip revision

A: Likely won’t get better. Should get evaluated by a revision rhinoplasty expert

Unfortunately it is likely your nose won’t get better. Should get evaluated by a revision rhinoplasty expert.

Q: Should I Be Concerned w/Post Revision Rhino Bleeding, 5 Days After

This was my second revision. From my right nostril, which is the one with the most work, I find traces of fresh blood when I clean it with a q tip. Seems like it’s still bleeding slightly where the stitches are because I can see dry blood around them. Should I be concerned? Please advise. Thanks.

A: No this is normal

No. Normal. Only of you have bright red blood that requires changing of gauze every 20 min or more is concerning.

Q: 4 Weeks Post Op, Hate my Nose

I am 4 weeks out from revisional (10 years ago) closed rhino to reduce bump on bridge and narrow the tip, no bones were broken. When I had my cast off it looked good, I had a slight curve and tip was raised a bit. Now it looks like a swollen blob on the left side and on the same side it looks like my hump is there. On my right it looks decent but not great, and my tip has dropped too. I am wondering if this is what happens and it will go back to looking like it did after cast removal?

A: Need to wait, still very early

You need to wait. There is still a lot of swelling and your nose should continue to improve. Make sure to continue following up with your surgeon.

Q: Bad Nose Job- Seeking Revision.

Hello, I had a nose job about a year ago and I’m unhappy with my results. Should I seek revision? Also, what exactly is wrong with my nose? Why is there a depression at the junction between the tip and the bridge? What did my surgeon do wrong?

A: Yes, if you are unhappy I would find a revision rhinoplasty specialist and go in for a consult

Yes, if you are still unhappy with your results i would find the best revision rhinoplasty specialist in your area and schedule a consultation. It is hard to tell from the photos what is ‘wrong’ but about 20% of people need revisional surgery so this is not uncommon.

Q: Can Nasal Tip Surgery Be Reversed?

I recently had nasal tip surgery, and am on my 10th day of recovery. I had a lot of cartilage in my nasal tip pushing downwards. I know its very early to judge, but I am so disappointed with the results. Where my surgeon has removed the cartilage slightly it exposes my nostrils a lot and I hate it. I want to know weather this is to with swelling? And once that goes down so will my nostrils. I want to know if it possible to reverse this procedure slightly,

A: Be patient, you are still healing

You need to be patient as you are still healing. Your nose will continue to improve, and currently still has a lot of swelling. Make sure to continue seeing your surgeon regularly for follow-ups.

Q: Is revision rhinoplasty my only option to remove cartilage at the tip of my nose?

I had a rhinoplasty at 18 for cosmetic reasons. I was always happy with my results, until recently, which is now 8 years later, that I noticed what appears to be a piece of cartilage at the tip of my nose. It seems to only be getting bigger and more sensitive. The tip of my nose since surgery has never softened, but the spot where the possible cartilage is, is even harder. I’m nervous that a surgeon will suggest surgery, but am afraid it could be my only option.

A: It sounds like you have “bossae” formation, which is very common after first time rhinoplasty—especially in thin-skinned individuals or those who have had excessive cartilage removed.

Revision rhinoplasty is the best treatment, but I recommend you see an expert who specializes in revision surgery. Also, discuss the use of temporalis fascia during the surgery to soften the region.

Q: What procedures, if any, can be done to help my nose?

10 years ago, I had surgery on my sinuses. Since I had a deformed tip from an accident, my ENT dr offered to fix that while he was in there. The tip was improved somewhat, but the surgery left me with an extra problem. I have, what I am guessing is, scar tissue in my right nostril. It sticks out when I laugh, yawn, etc. For 10 years I have tried to hide it, but it has done damage to my self esteem. Is there anything else that can be done?

A: Sinus surgery should not cause any issues with your tip unless the Doctor performed septorhinoplasty at the same time.

If so, please see a revision rhinoplasty expert.

Q: How to get rid of nasal tip bossae?

I had rhinoplasty in 2009. Since then, my nose developed a bossae near the tip on the left side. It makes my nose look deviated to the left and longer in side view. Is there any way to get rid of it with applying pressure or massaging it? If surgery is required can it be done with a quick fix like just shaving the cartilage down? Or does a full blown revision rhinoplasty have to be done?

A: Yes, you need full revision rhinoplasty and reconstruction of tip cartilages.

Make sure you see a rhinoplasty expert who can address all of the issues you want to change during your revision surgery to achieve the best possible outcome.

Q: Can scar tissue be removed after Rhinoplasty surgery?

I had my op in Nov 2012. My surgeon made my nose thinner over the bridge, didn’t touch the tip but there is a bulge above my nostrils, he said that this was swelling from the internal stitches and it would go so I went back after a year & he told me to come back in 6m & if it hadn’t gone he’d give me steroid injections. Is that safe? Also there’s a little ball of bone on one side of the bridge of my nose. It wasn’t there when I first had my cast off, it makes my nose look bent. What should I do?

A: You need a complete analysis to evaluate the underlying issues.

Scar tissue does occasionally form after rhinoplasty, however the majority of issues are usually a result of cartilage or bony factors reflecting through the skin. These factors do not get better with steroid injections. I think enough time has passed for you to be evaluated for revision rhinoplasty.

Q: What graft is needed after rhinoplasty to mimic breathe right strip?

I did not have any breathing problems at all before rhinoplasty. I now have a handful of problems, one of them being not being able to breathe properly. I now wear breathe right strips when at home.

A: There are a number of different grafts that can be used depending on your individual circumstance.

Spreader grafts, alar batten grafts, lateral crural strut grafts, and/or butterfly grafts are some of your options. Where the strips will be used depends on the area of narrowing/collapse.

Q: High nose bridge, overprojected tip, thick skin and already had a primary: Is improvement possible?

I had my primary done in 2011 and while my nose looks nice and straight from the front, the side-view is not to my satisfaction at all. The shape is fine, but it’s just too big. My surgeon told me that he can’t fix it and if I would try to fix it somewhere else, it would end up looking worse or weird. Doctors, even though the picture is missing, is my type of nose really difficult to reduce in size, while maintaining the proportions (i.e. not just a lower bridge or too much tip rotation).

A: In order to determine the potential options for your individual case, you need a comprehensive revision rhinoplasty consultation.

Look for a revision rhinoplasty expert who has extensive experience performing revision surgery.