Revision Rhinoplasty FAQ

What is revision rhinoplasty?
Revision rhinoplasty, also referred to as secondary or tertiary rhinoplasty, is a surgical procedure performed to revise or correct the results of a previous rhinoplasty procedure that have been found to be unsatisfactory. Patients may be dissatisfied with their original rhinoplasty procedure due to functional problems that may hinder breathing or simply due to appearance. Rhinoplasty itself is one of the most complicated cosmetic surgery procedures, and revision rhinoplasty is an even more complex procedure. Because of this, it is essential that patients find a qualified surgeon who has extensive experience in revision rhinoplasty.

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Who is the best candidate for revision rhinoplasty?

A good candidate for revision rhinoplasty is a physically healthy man or woman who is realistic in their expectations and is dissatisfied with the appearance or function of the nose following a rhinoplasty procedure. It’s important that patients allow significant time for the nose to fully heal after their original rhinoplasty procedure given that post-surgical swelling can mask the end result for as much as six months to a full year. After this time, patients who are still dissatisfied with their results may be good candidates for a revisionary procedure.

What sort of problems occur that require revision rhinoplasty?
Complications resulting from rhinoplasty can be either aesthetic, meaning related to appearance, or functional, meaning related to breathing. Some patients may have problems with both. Some problems result from underresection, when not enough is taken off, while others result from overresection, when too much is taken off. Other problems include asymmetry and abnormal scarring. Problems with overresection typically require some sort of grafting material.

When a grafting material is needed to rebuild the nose, what is used? 
Various types of grafting materials may be used to rebuild the nose during revision rhinoplasty. Cartilage may be taken from the inside of the nose, the ear or, less commonly, the rib and be used. There are also synthetic materials that may be used.

Where is revision rhinoplasty performed?
Revision rhinoplasty procedures may be performed in a surgeon’s office-based facility, an outpatient surgical center or a hospital.

Is an overnight hospital stay required after a revision rhinoplasty procedure?
Revision rhinoplasty is typically performed as an outpatient procedure, thus requiring no overnight stay.

What type of anesthesia is used during revision rhinoplasty?
Revision rhinoplasty is often performed with either local anesthesia and sedation or with general anesthesia.

How long does a revision rhinoplasty procedure take to perform? 
The length of a particular revision rhinoplasty procedure will depend upon the amount of work required. Primary rhinoplasty procedures tend to take between two and three hours to complete and revision rhinoplasty procedures typically take between three and four hours.

Where are the incisions made for revision rhinoplasty? 
The incisions are often made on the inside of the nose, which is referred to as closed rhinoplasty and results in no visible scarring. In some cases, however, an additional small incision is made on the underside of the nose between the nostrils. This is known as open rhinoplasty and results in a well-concealed, fine-line scar that fades in time.

Rhinoplasty Age-Related Issues: 
Individual considerations are taken for elderly, teenagers and children.

The Elderly
There is no age restrictions for rhinoplasty surgery, that is assuming the individual is in good health and has reasonable expectations. Even so, the majority of patients receiving rhinoplasty are in their 20′s and 30′s. Individuals in their 40′s and 50′s request enhancement in their aging neck and eyelids rather than request rhinoplasty, however there are some in this age group that wanted to have it when they were younger but choose to have it later on as they got older.

Youths
Rhinoplasty can usually be performed in patients 15 years of age and older. If the operation is done before their ideal age, then the nose may grow in an erratic manner. The nasal growth can destroy the proportions that were made during surgery and create an unbalanced nose. Younger children may not be ready to face the emotional trauma of cosmetic surgery, so each individual needs to be reviewed alone.

What’s the difference between open and closed rhinoplasty? 
For closed rhinoplasty, the incisions are confined to the inside of the nose and result in no visible scarring. Open rhinoplasty procedures require an additional small incision made on the underside of the nose between the nostrils, resulting in a well-concealed, fine-line scar. Open rhinoplasty is preferred when doing tip work. The open procedure will produce excellent symmetry. Closed rhinoplasty is best suited for nasal hump reduction.

Are there scars after revision rhinoplasty? 
Closed rhinoplasty procedures, in which incisions are confined to the inside of the nose, result in no visible scarring. For open rhinoplasty procedures, an additional small incision is made on the underside of the nose between the nostrils resulting in a well-concealed, fine-line scar that will fade with time.

Is revision rhinoplasty a painful procedure? 
After surgery, patients may experience some discomfort though this can be controlled with prescription pain medication. Much of the discomfort that patients experience is a result of nasal packing, in which the nose is packed with gauze or cotton. Nasal packing is not always required and, when used, is typically removed within the first two days after surgery.

Will I be able to drive myself home after my revision rhinoplasty procedure? 
It’s best to arrange for someone to drive you home after your procedure

Will I need someone to help me out at home after my revision rhinoplasty procedure? 
It’s best to have someone stay with you during the first twenty-four hours after your revision rhinoplasty procedure.

What is the recovery like after revision rhinoplasty? 
Some swelling and light bruising can occur and begins to fade within a week’s time. A splint is usually worn during the first week. Any pain or discomfort can be controlled with prescription pain medication. If nasal packing is used, it is typically removed within the first two days after surgery. Though swelling is significantly reduced after the first week, it can take as much as a year for all of the swelling to disappear.

What is nasal packing? 
Nasal packing is when gauze or cotton is used to pack the nose after surgery. This is often done to prevent or control bleeding, though it is not always required. When used, nasal packing is typically removed within a day or two after surgery.

How much time will I need to take off from work after undergoing revision rhinoplasty? 
Most patients can return to work within a week after their procedure.

When can I exercise after my revision rhinoplasty procedure? 
You should not exercise (running, cycling, or aerobics) for at least four weeks. Also, you should avoid any contact sports for six weeks because it takes that long for the bones to completely heal.

When are the stitches removed after a revision rhinoplasty procedure? 
The stitches are typically removed or dissolve on their own within about a week after the procedure.

What are the risks or complications associated with revision rhinoplasty? 
Some of the potential complications associated with revision rhinoplasty include small burst blood vessels, excessive scarring, temporary loss of sense of smell, prolonged swelling, pulling of the nose to one side, adverse anesthesia reactions, and asymmetry.

Does insurance cover the cost of revision rhinoplasty? 
Revision rhinoplasty procedures performed solely for cosmetic purposes are typically not covered by insurance. However, coverage is usually available for revisionary procedure performed to correct functions of the nose, such as breathing problems. Patients should be sure to check with their own insurance company.

Is it possible to get a revision rhinoplasty procedure financed? 
Financing is available for many plastic surgery procedures.

What should I look for in a surgeon to perform my revision rhinoplasty procedure? 
Because rhinoplasty is one of the most complicated plastic surgery procedures and revisionary procedures are even more complex, it’s essential that you do your homework and carefully choose the surgeon to perform your revision rhinoplasty procedure. Your surgeon must have sufficient experience in revision rhinoplasty. Also make sure that the surgeon is certified by the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS). You should also be sure to ask the following questions:

  • Does the surgeon have privileges to perform surgery in an accredited hospital and, if so, which hospitals?
  • How many revision rhinoplasty procedures has the surgeon performed?
  • Where and how will the surgery be performed?
  • Is the surgical facility accredited by a nation or state-recognized accrediting organization?
  • What are the risks of your particular procedure?

What does it mean if my surgeon is certified by the ABFPRS? 
The ABFPRS credential signifies that a surgeon:

  • Has completed an approved residency in one of the two surgical specialties that include identifiable training in all aspects of facial plastic surgery (otolaryngology/head-and-neck surgery or plastic surgery, generally)
  • Is double boarded, having earned prior certification in one of those specialties through the American Board of Medical Specialties or the Royal College of Physicians and Surgeons in Canada
  • Has successfully completed a two-day examination
  • Has submitted for peer-review an acceptable record of at least two years’ clinical experience, including operative reports of a minimum 100 facial plastic surgeries
  • Holds proper licensure and subscribes to the ABFPRS Code of Ethics.

Should I have the same doctor who performed my original rhinoplasty perform my revision rhinoplasty? 
This depends. For starters, it’s important to remember that rhinoplasty itself is one of the most complicated plastic surgery procedures and, further, that revision rhinoplasty is an even more complex procedure. Whatever surgeon you choose to perform your revisionary procedure must have sufficient expertise in revision rhinoplasty. If you suspect that your original surgeon was not experienced enough in rhinoplasty and that this may have lead to your dissatisfaction, then you should not have that surgeon perform your revision. However, problems can result with even the most experienced surgeons. As such, if you know your original surgeon to be qualified and competent because you have thoroughly researched him, and if he has experience with revision rhinoplasty, then it may be safe to have him perform your revision.

 


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