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Revision Rhinoplasty (Nose Job)

What is a revision rhinoplasty (nose job)?

Rhinoplasty is a procedure in which a surgeon repairs or reshapes the external nose. Common motivations for a patient to seek rhinoplasty are to improve medical (e.g. respiratory) problems, or the esthetic appearance of the nose. In either case, the patient may be dissatisfied with the cosmetic results of their surgery, and opt for a repeat procedure to correct them. This is known as secondary or revision rhinoplasty (nose job). Other patients may need to undergo revision rhinoplasty due to post-operative complications, such as newly-acquired breathing difficulties and infections that develop after surgery.

Video: Dr. Klausner explains a revision rhinoplasty (nose job)

Video Transcription

A revision rhinoplasty is an operation performed to reshape the nose and a patient who has had at least one prior operation performed to reshape the nose and generally, patients who consider revision rhinoplasty are patients who are dissatisfied with their previous operation, perhaps because not enough was done in the first operation. In some cases, too much was taken away in the first operation and in other cases there is nasal dysfunction as a result of the prior operation. The greatest challenge with revision rhinoplasty has to do with the fact that because of the prior surgery there’s scar tissues um there are layers in the nose and this becomes more difficult to um identify the layers um in your surgical dissection and open the nose. There’s greatest risk of traumatizing the layers because of the presence of scar tissue. The other feature that makes revision rhinoplasty more challenging has to do with what might’ve been done in a prior operation. Maybe the cartilage and the natural curves on the cartilage and other structures in the nose have been altered  with the prior operation and being able to recreate those nice, natural-looking contours can be more challenging the second time around. The general rule of thumb is to allow about a year following the previous surgery um to pass and the reason for that is to give the nose an opportnity to heal, to give the scar tissue um an opportunity to remodel and mature and to allow for a lot of the swelling to go away. Operations, minor revisions to nasal surgery, if they occur earlier than that, the tissue is a lot tougher and more difficult to um to dissect.  A revision rhinoplasty can take longer to heal. The presence of scar tissue can also impede the resolution of the swelling. So, a nose that has had more than one operation um and in some cases multiple operations uh can hold on to the swelling for much longer.

How does a primary rhinoplasty lead to revision?

The nose is made of a number of tissue types and structures, and has many functions. Nasal damage may result in adverse consequences such as nasal bleeding, deformities (e.g. loss of normal nasal symmetry) or an impaired sense of smell. The psychological effects of a cosmetically undesirable nose can also affect life quality and functional status. Therefore, a surgeon may take on patients seeking ‘elective’ primary rhinoplasty (nose job) in addition to patients whose symptoms are of a purely medical nature. However, the rate at which patients require revision rhinoplasty (nose job) is relatively high (approximately 21%). The reasons for this include failure to correct the deformity (which may be objective or subjective in nature) and adverse events in the post-operative period. Patients with unacceptable levels of dissatisfaction on these grounds may request a revision rhinoplasty (nose job) to correct these problems.   

Before and after revision rhinoplasty. Results may vary.

female before after revision rhinoplasty nyc

What does the timeline look like for a revision rhinoplasty (nose job)?

A surgeon has many points to consider when approaching any (primary or revision) rhinoplasty. These include the initial shape of the nose, and the ideal shape required by the patient. Nasal reshaping is an often complex piece of surgical ‘engineering’ that may require grafts to achieve the desired result and support the structure of the ‘new’ nose. These grafts may be cartilage harvested from the patient in question, or be made of sterile surgical-grade silicone. In cases of revision rhinoplasty, the surgeon may need to take additional problems into account. These include scar tissue resulting from the primary procedure, which may prove an obstacle or prevent adequate manipulation of the nose during surgery.

Revision rhinoplasty (nose job) may also require several new grafts in order to fully correct nasal shape. A second procedure may also be a more ‘open’ surgery, in which the surgeon must ‘dissect’ the nose to a greater extent compared to the primary rhinoplasty. This may address the need for improved access to some parts of the nose due to the actions of the surgeon who performed the first procedure. A surgeon may also find that they need to work on the tip of the nose (a procedure also known as ‘tip plasty’). This may involve its partial dissection, re-suturing and yet more grafts. These are placed in the part of the nose immediately ‘above’ the tip, for structural support.

Before and after revision rhinoplasty. Results may vary.

male revision rhinoplasty before and after

What else should you consider before getting a revision rhinoplasty?

Revision rhinoplasty (nose job) may be associated with post-operative risks. Prominent examples include those of infection (which may be intensified if the revision involves more open surgery) and deformity. An example of deformity related to revision rhinoplasty is the characteristic ‘polly beak’, which occurs if the nasal tip loses support and slips somewhat below the level of the rest of the nose. On the other hand, revision rhinoplasty can result in positive outcomes for many patients. A recent study reported that 90% of patients receiving this procedure exhibited good or very good subjective results, with significant improvements in many aspects of nasal appearance. Full recovery from rhinoplasty may take up to six weeks. However, it is important to note that post-operative swelling and/or fluid build-up in the length and tip of the nose, which may distort patient or surgeon impressions of the eventual results, may require up to 12 weeks for total resolution.

Contact a Revision Rhinoplasty (Nose Job) Specialist

Lee Ann Klausner, MD is a revision rhinoplasty specialist. Please contact our office with any questions regarding your medical needs or to make an immediate appointment.

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