Behind the Scenes Exclusive: Revision Rhinoplasty to Fix Nasal Problems

Rhinoplasty, or nose surgery, is a procedure designed to enhance both the aesthetic appearance and functional aspects of the nose. However, in some cases, patients may not be entirely satisfied with the initial results. This is where revision rhinoplasty comes into play.

Revision Rhinoplasty is a surgical procedure performed to address issues that may have arisen from a previous Rhinoplasty. Just as a renovation project might be necessary to correct flaws in an initial construction, Revision Rhinoplasty aims to refine and improve upon the initial surgical outcome. At Tannan Plastic Surgery, we specialize in closed (or endonasal) Rhinoplasty where all the incisions are located inside the nose.

Several factors can necessitate a Revision Rhinoplasty, including:

Functional Issues: Breathing difficulties, such as nasal airway obstruction or difficulty breathing through the nose, may persist or develop after the initial surgery.

Aesthetic Concerns: Sometimes in trying to fix one aesthetic problem, another one is created. Dorsal hump reduction can result in saddle nose, inverted V deformity, loss of nasal support and can make the tip look different. It may cause irregularities visible on the nasal dorsum or an unsatisfactory bridge height.

Internal Structural Issues: Internal nasal structures such as the nasal septum may have collapsed or become distorted, leading to functional breathing problems or aesthetic problems with changes to the nasal appearance.

Revision rhinoplasty often involves significantly more complex surgical techniques than the initial procedure. Common approaches include:

Septal Correction: Addressing deviations of the nasal septum, the wall of cartilage that divides the nasal passages, to improve airflow and breathing.

Grafting Techniques: Utilizing cartilage grafts to refine the nasal shape and appearance while improving nasal airway support.

• Spreader grafts: These cartilage grafts are placed next to the septum along the most dorsal aspect of the septum to open up the nasal passages and improve breathing. These grafts open up the internal nasal valve responsible at least half of the nasal airflow. Spreader grafts add rigid structure and support to a nasal dorsum that is weakened after dorsal hump reduction.
• Dorsal grafts: These are used to augment the bridge of the nose, correcting a flattened or depressed appearance. They can additionally improve nasal airflow and add support after dorsal hump overresection.
• Alar Batten grafts: These support the external nasal valve, or the outside of the nostrils, helping prevent collapse. They additionally enhance the tip structure and support and help maintain and natural, pyramidal shape to the nose from narrow at the bridge to wider at the nasal base. They address a common problem of loss of support that comes with an aggressive cephalic trim of the lower lateral cartilages, which is done to rotate the nasal tip upward.
• Tip Grafts: These grafts refine the nasal tip, and add support to a drooping tip. They can improve nasal rotation, or the angle from the nasal base to the upper lip skin.
• Columella Grafts: These grafts support the nasal tip, improve nasal facial angle and improve tip definition.

This lovely patient is generously sharing her experience. She originally underwent Rhinoplasty to remove a dorsal bump and straighten her crooked septum in 2008. She felt like her nose was wobbly, unsupported and the tip looked droopy like it was falling off.

On exam, she had collapse of her internal and external nasal valve and total loss of nasal support of her dorsum and her columella. We made a plan to do a major revision using cadaveric (from deceased donors) costal (rib) cartilage. We custom carved and sculpted multiple grafts to improve her nasal airflow and appearance.

(ABOVE): Check out the side profile in the before images – notice how her nasal dorsum looks scooped out. See how small her nostrils appear and how it’s almost as if her nasal creases, which are deep are making her nostrils flare out to the sides. When she had her original Rhinoplasty years ago somewhere else, they removed too much cartilage from her nasal dorsum and from her nasal creases. That gave her nasal airway obstruction and a nose that was very floppy and not stable.

SURGERY VIDEO:

(Caution: graphic content!) Watch us rebuild the nose, carve and sculpt cartilage grafts custom-fit to her needs, and insert them in these videos. The photos illustrate the intended location of the various grafts. The videos show how we place these grafts through internal (endonasal) incisions.

Notice that in her afters, her nose is not completely new and different. That is the point. Our goal is to make her look like herself, no one else. We believe in staying true to your nose, while restoring support and aesthetics at the same time.

BEHIND THE SCENES:

This is the Rhinoplasty Worksheet that I make during every consultation when we look at the aesthetic and functional problems together and I describe my proposed solution.

Selecting an experienced and qualified plastic surgeon with expertise in Revision Rhinoplasty is crucial. A thorough consultation will allow the surgeon to carefully assess your concerns, evaluate the previous surgical outcome, and develop a personalized treatment plan to address your individual needs.

Important Note: Revision Rhinoplasty is a more complex procedure than primary Rhinoplasty. It requires meticulous surgical planning and a high level of expertise. If you are considering Revision Rhinoplasty, it is essential to consult with a board-certified plastic surgeon to discuss your concerns and explore the best treatment options for your specific situation.

Considering Revision Rhinoplasty surgery? Contact us today to schedule a consultation with board-certified plastic surgeon, Dr. Shruti Tannan in our Raleigh, NC office.