Surgeons use various techniques to improve the both the function and the look of the nose with rhinoplasty. Functional improvements center on breathing issues.
A common functional improvement is to correct a crooked or deviated septum. The septum separates the two nostrils, when the septum is deviated one of the nostrils is blocked, which can lead to breathing problems.
Here are some basic questions to ask your surgeon regarding your revision rhinoplasty during your consult.
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Do you regularly perform revision rhinoplasty?
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How many procedures do you do a month?
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Will the procedure be an open or closed rhinoplasty?
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Will the function of the nose improve after surgery?
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What are the complications and side effects associates with revision surgery?
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How long will healing take and when will results be final?
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Will any grafts be used? If so, what types will be used?
There are a lot of reasons to consider having Rhinoplasty:
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Do you feel self conscious about your nose
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Maybe you think your nose is too large for your face
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You have a bump on the bridge of your nose
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Your nose is crooked or asymmetric
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Maybe your tip is droopy or your nostrils are too wide
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You suffer from breathing issues
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Your nostrils are too wide
Taking Arnica can help some of the bruising that happens following rhinoplasty. This homeopathic treatment helps to address the bruising along the eyes. Arnica can be taken up to 10 days or so after the surgery.
Another treatment for bruising is Intense Pulsed Light Therapy. An IPL treatment of the black and blue marks helps them resolve quickly. Patients are also given vitamin K starting five or six days before surgery and continue to use it four days after surgery. Vitamin K helps with the clotting that can form around the rhinoplasty area. It helps the patients so they will not bleed as much.
Patients often ask questions about how long they should wait or when it is ok get pregnant following a rhinoplasty surgery.
Usually, a patient can become pregnant a month after rhinoplasty. There is no contraindications in getting pregnant.
However, if there is some reason the patient needs a revision rhinoplasty, then one has to wait for a year following the initial surgery.
It is particularly important to stay out of the sun for approximately three months after rhinoplasty surgery. Both the sun’s rays and heat can increase swelling in the nose. We recommend wearing hats and sunscreen on your nose if you have to be out in the sun or the heat.
Many patients want to know when they can start exercising again. Patients can resume physical activity about four weeks after surgery.
One important note, smoking is not recommended at any time after surgery. Nicotine causes decreased blood circulation to the region, which can decrease healing and cause post operative complications.
In the normal younger patient, the fat that causes these little bulges under the eye are back inside near the eye protecting the eyeball. As we age a tissue called septum that holds in the fat starts to relax and loosens up until the fat becomes pushed out or herniates out. That is when you can see the puffy, bags appear.
In addition, the muscle and soft tissue inside the lower eyelid that also typically hides any type of protruding fat descends. The cheek fat pad strikes to descend, and then you see the outline of the lower orbital rim. When you see this outline of the orbital rim that is from where you get hollow look and then you will see that fat herniate. This has to be addressed surgically.
According to Dr. Nassif, sometimes, I will look at the nose and decide to use alar rim grafts in a primary rhinoplasty. This is because when I do nasal tip work, the nostrils will start to collapse in more after surgery.
I can look at the nose beforehand and tell that this might occur. The alar graft is used versus lateral crura strut grafts, especially in patients were there is vertically oriented lower lateral cartilage and where the tip cartilage is going in a more vertical direction.
In very select, simple, small cases, I will do a closed rhinoplasty. In most cases I will do an open rhinoplasty procedure.
When we do an open rhinoplasty, we are losing some of the natural support of the nose. Therefore, we have to reconstruct the nose so it won’t droop and the tip won’t drop in the future. So in many of my primary rhinoplasties, we add spreader grafts. I’d say about 90 percent of the time, I will put in a columellar strut to keep the nasal tip support up and projected.
That is what looks nice in a nose, when you can set the nasal tip projection so it looks supported. Then no one can complain that it has fallen after a couple of years. Often this is what happens with a patient looking to have a revision rhinoplaty. They will come in and say, “Well, it looked good for the first year. Then my nose started to collapse and fall.
A lot of patients will ask “Why do you need to make my tip bigger?” Or, some patients may come in with collapsed nostrils. They can’t breathe because they have had too much cartilage removed from the nasal tip.
According to Dr. Nassif, even in situations when he removed a conservative amount of cartilage and leave the magic number of 7 mm of lower lateral crura, you still could have collapse of the cartilage. The patient will get these deep alar grooves in the nose. What also occurs is a pinch in the airway, when we place binding sutures to make the tip smaller.
“With some patients, I notice that they have the pre operative signs of weak rims. Sometimes, when I look inside the airways after I put in dome binding sutures, I’ll notice that the lower lateral crura are impinging into the airway. So, I’ll reconstruct that area,” said Dr. Nassif.
“I’ll take a piece of cartilage, most likely septo cartilage, and make it thin so that it will curve and give us a nice convex type of a graft. We will place that on the under surface or the posterior surface of the existing small remnants of lower lateral cartilage. This will prevent the cartilage from collapsing inwards. Hopefully, it also will prevent you from needing a secondary revision rhinoplasty in the future.”
