Revision Rhinoplasty

Answer: Without seeing you or some photos, I really cannot tell what you need. Revision rhinoplasty for what you describe, however, can be a more complex procedure than the original rhinoplasty. Surgical time would be 2-4 hours depending on the type of cartilage grafts needed to fix the pinching. I would not operate on you until 18 months after the original procedure. I would be happy to see you.

Answer : While artificial implants for the nose are widely used in the orient, they are less popular here because of the risk of infection.  They can be made out of silicone plastic, polyethylene, or PFFE (formerly marketed as Gore Tex).   In the US surgeons usually prefer to us the patient’s own tissue, usually cartilage from the nasal septum or an ear.  The use of your own tissues is safer and more customizable. 

Here is a link to look at: http://www.drbentkover.com/photogallery/rhinoplasty/patient-6

Answer :
It will be harder to get definition to the tip, and swelling will probably last longer.  You might not get the type of shaping of your nose that you envision.  You will need structural cartilage grafts, probably from your nasal septum, to get any sort of definition to your nose.  Here are three patients from my website with thick nasal skin.  All had significant cartilage grafts to achieve definition of the nasal tip:

http://www.drbentkover.com/photogallery/rhinoplasty/patient-9
http://www.drbentkover.com/photogallery/rhinoplasty/patient-10
http://www.drbentkover.com/photogallery/rhinoplasty/patient-11

Answer :
Actually it is 12-18 months.  I have seen post op noses at 1 year that still had some swelling and looked much better at 18 months.  In a rhinoplasty, open or endonasal (co-called closed), the skin is elevated enough off the underlying cartilage and bone to interrupt the flow of fluid through the skin in what is called the lymphatic system.  This causes fluid to accumulate in the skin.  As the nose heals, the lymphatic vessels re-establish themselves, and the fluid dissipates. Here are some photos of our rhinoplasty procedures:

http://www.drbentkover.com/procedures/rhinoplasty_photos-worcester-boston.shtml

Answer:
The best person to revise a rhinoplasty is most often the person who did the original operation.  He/she knows where the grafts are, how the cartilages were changed, what sort of shape the cartilages were in at the original procedure.  Of course, that assumes that the original surgeon does a lot of rhinoplasty.  If he/she is confident about what needs to be done, you should stay with the original surgeon.

Answer:
First, I would want to know how your breathing was pre op. Was this nostril a problem pre op also? If so, you may need some more work on you nasal septum or nasal valves. If it was not a problem pre op, you may need some work on your airway also. In any event, you should talk to your surgeon. Usually, revision work would not be done before a year post op or even at 18 months.

Answer:
Rarely. The scar under the skin around the cartilages needs to thin out as much as possible and the swelling gone in the tip.  That can actually take 18 months.  An exception would be if the bones are a bit off early on.  Osteotomies (cutting the bone) could be done earlier.

Answer:
You should not fear the scar of an open rhinoplasty. It is usually minimally noticeable and only from looking up from below. Major revisions are probably most often done open these days, but many surgeons still like the closed approach. Personally, I do an endonasal (closed) approach for minimal changes.