Revision Rhinoplasty

Revision Rhinoplasty Procedure in MA

For Dr. Bentkover, Rhinoplasty is a Passion.Operating in Worcester and Boston, Dr. Bentkover has dedicated his career of over 28 years to the art and science of rhinoplasty. Because Dr. Bentkover is so committed to this specialty, he accepts difficult and challenging revision rhinoplasty cases (also known as secondary rhinoplasty) and commonly sees patients from all over New England.

You should make a careful list of the cosmetic features and functional problems with your nose.
The marriage of form and function is just as important here as it is with primary rhinoplasty. The difference is that with a revision operation, especially if it is one a series of operations, there are limiting factors that may make it impossible to achieve all your goals. The most common limiting factors are the amount of scar tissue under the skin (which increases with each operation) and large amounts of missing cartilage in the nasal tip and nasal septum. It may not be reasonable to expect any surgeon to achieve all of your goals. Therefore, before coming for your consultation, you should prioritize your surgical objectives. It will be very helpful for Dr. Bentkover to know what really bothers you about your nose.

At your initial consultation Dr. Bentkover will carefully and realistically evaluate your nose. If he thinks he can help you, he will work with you to come up with a realistic plan. If you come to Dr. Bentkover for an opinion on a revision rhinoplasty, you must bring a copy of the operative note (s) from your previous operation (s). These notes are essential in determining what specific changes have been made to your nose and where to start to discuss and plan a revision operation.

Rhinoplasty is the most technically challenging of the facial plastic surgical operations, and the surgeon cannot always control all the changes that occur in a nose after surgery. Your nose actually continues to heal for about 18 months after surgery and may show some further changes as you age. An outcome that you may consider unsatisfactory is not necessarily a reflection on your surgeon. Even the most expertly performed operation, by the most experienced surgeon, can never be perfect. Many experienced rhinoplasty surgeons agree that the outcome of the initial operation is about 80%-90% predictable. Despite the fact that there is no such thing as a “perfect rhinoplasty”, most patients find there noses much im proved and are very pleased with the results.

The best chance to correct cosmetic or functional problems with your nose is at the first procedure. However, much can still be corrected by an expertly performed revision operation. You may have changes after a rhinoplasty that you think make your nose look distorted or interfere with your breathing so much that you might consider having a revision rhinoplasty. Nationally, About 10-20% of patients may choose to have some secondary surgery. This may range from just filing down or trimming some degree of a persistent bump on your profile (secondary hump removal) under local anesthesia to a major revision of your nasal tip and profile. Repair of these problems may require a revision rhinoplasty along with a septoplasty (to straighten the nasal septum – the cartilaginous and bony wall in the middle of your nose that separates the air passages) and a repair of your nasal valve system. The nasal valve system does much to control the amount of air that flows through your nose and may have been weakened by the removal of cartilage at the time of the original procedure. The repair of the nasal septum and nasal valve system may require cartilage grafts from the nasal septum or from the ears.

Dr. Bentkover will carefully discus all the details of his recommended procedures with you so that you can understand the reasons for his recommendations and the likely outcome of the surgery. He will draw sketches of the proposed procedure for you and “morph” your images on the computer to try to simulate the outcome.

In the Before and After section we have posted just a few of our patients. We have more to show you in our office. Some of our patients prefer not to have their photos posted on our website.

For a general discussion of our philosophy of rhinoplasty and the consultation process please also see our general discussion under Rhinoplasty elsewhere on this web site.


YOUR PROCEDURE

Before Surgery

It is important to tell Dr. Bentkover just what is bothering you with relation to your original surgery. Some of your issues may be more ‘fixable” than others. Digital photographs and computer imaging help Dr. Bentkover evaluate your nose and recommend the appropriate changes needed to achieve the desired results. He will ask for your active participation while he evaluates and “morphs” your digital images.

A fact of the matter is that the best chance to get the nose you want is at the first operation. A revision rhinoplasty can often improve the appearance and function of your nose significantly, but still may not achieve exactly what you want. The scar that forms under the skin and potentially distorts the underlying cartilage increases with each procedure and can be a limiting factor in what can and cannot be accomplished with a revision operation.

Method of Surgery

Because it affords better visualization of the nasal architecture and a better evaluation of the problems in a previously operated nose, Dr. Bentkover performs most of his revision rhinoplasties through an “open” approach. As much as he likes to avoid “surprises” at the time of a primary rhinoplasty, in a revision case it is even more important to be prepared for anticipated problems in the nose. The operative report from your previous surgery is an important element in preparing for the surgery, but nothing beats the ability to clearly see all the problems.

He may use a closed approach for small touch up revision procedures. This might be just some filing of the profile or a small graft. Some of these cases can even be done under local anesthesia in our office. However, most of the revision procedures he does are full rhinoplasties that require the open approach and cartilage grafts from the nose and/or ears. These are usually done with general anesthesia in the Day Surgery Unit at Saint Vincent Hospital, Worcester Medical Center, Worcester, MA. We are confident you will find all of these facilities to be state-of-the-art, comfortable and very patient friendly There is a bit more extensive discussion of the pros and cons of open vs. closed rhinoplasty in the Rhinoplasty section of this website.

Recovery: What to Expect

The recovery takes one to two weeks. Most people resume most of their normal activities and return to work within 10 days. At surgery, a lightweight splint is applied to protect the nose. The splint is removed in a week. Soft silicone plastic splints may be inserted on either side of the nasal septum at the time of surgery to protect the septum. These are also removed in a week. There is always some stuffiness of the nose for a week or two, especially when work has been done on the nasal septum. Pain is generally moderate and is usually well controlled with medication. Bruising occurs around the eyes, but begins to fade within a few days. Discoloration usually disappears within 10 days to two weeks.

Insurance

Your insurance company may cover part of the costs associated with your surgery if part of the surgery is done to correct breathing problems secondary to the original operation. It never covers the cost of the cosmetic part of the procedure. We recommend that you check with your carrier to determine if there is coverage.


FAQ

What per cent of rhinoplasties require secondary operations?

An outcome that you may consider unsatisfactory is not necessarily a reflection on your surgeon. Even the most expertly performed operation, by the most experienced surgeon, can never be perfect. Many experienced rhinoplasty surgeons agree that the outcome of the initial operation is about 80%-90% predictable. About 10-20% of patients nationally, may choose to have some secondary surgery.

Isn’t the revision surgery really easier than the original surgery?

A minor revision to a scar, filing down a bit of bone to even out the profile, or injecting a filler like Radiesse into a small depression may be easier than the original procedure. However, if there are major cosmetic or functional issues that need to be addressed, the revision operation is frequently more difficult and challenging than the original operation. Every time you have nasal surgery, scar forms under the skin and around the cartilages of the nose. This scar can make the surgery more difficult. In addition, you may require cartilage grafts from you ears or elsewhere to properly revise your nose.

Is revision surgery worth doing, or should I just leave it alone?

Ultimately only you can make that decision. However, Dr. Bentkover usually can give you a realistic prediction with regard to his ability to correct the functional and cosmetic problems in your nose. He will not operate on you unless he really thinks he can improve you nose and that the surgery is “worth doing”.

How do I know whether I will need a minor or major procedure on my nose?

Dr. Bentkover will carefully examine your nose and review your operative notes from the previous surgery. (That is why it is important to bring the notes to the consultation.) He will listen to you to determine what exactly is bothering you about your nose. Based on all this information, he generally can tell how complex a procedure you may need. Revision surgery, however, can have its surprises. Sometimes he may not know exactly what needs to be done until he is in the operation.

If my breathing is worse as a result of my previous surgery, will my insurance company cover the cost of the revision surgery?

Most insurance companies will cover functional surgery on your nose, whether or not it is a result of previous surgery. However, depending on your deductibles and the exact language in your policy, they may not cover the entire cost. They generally will not cover fees related to changing the appearance of your nose. Polices regarding nasal surgery vary from insurance company to insurance company. We will apply for approval for procedures related to nasal function, but we cannot guarantee they will provide coverage.

Will the revision surgery be more painful than the original surgery?

Nasal pain should be about the same as the original surgery. If Dr. Bentkover needs to use cartilage grafts from your ears, that often is more tender than the nose after surgery. Our patients usually complain of little pain, but everyone has their own, personal pain threshold. We will provide appropriate amounts of pain medication.

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