Rhinoplasty is my passion.
I have dedicated much of my career of over 35 years to the art and science of rhinoplasty. Because I am so committed to this specialty, I accept difficult and challenging revision rhinoplasty cases (also known as secondary rhinoplasty) from all over New England, Boston, Worcester, and other parts of the country.
It is important to realize that an outcome that you may consider unsatisfactory is not necessarily a reflection on your previous 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 only about 80%-90% predictable. Despite the fact that there is no such thing as a “perfect rhinoplasty”, most patients find their noses much improved and are very pleased with the results.
Revision Rhinoplasty Procedure
The best chance to correct cosmetic or functional problems with your nose is at the first operation. 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 in your profile 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. I will carefully discus all the details of the recommended procedures with you so that you can understand the reasons for my recommendations. I will draw sketches of the proposed procedure for you and “morph” your images on the computer to try to simulate the outcome.
You should make a careful list of the cosmetic features and functional problems with your nose. It is also very important that you bring copies of you operative notes to the consult. I need to know what was done and how. I also need to evaluate how much cartilage and bone was removed from your nose. Your nose continues to heal for from 18 months to even 4 years, so patience is important.
In the Before and After gallery, 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.
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 what really bothers you about your nose.
Revision Rhinoplasty Consultation
At your initial consultation, I will carefully and realistically evaluate your nose. If I think I can help you, I will work with you to come up with a realistic surgical plan.
When you come 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. You will be with us for about 90 minutes. Please fill out your history forms before you come.
Preparing for Revision Rhinoplasty Surgery
It is important to tell me 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 me evaluate your nose and recommend the appropriate changes needed to achieve the desired results. I will ask for your active participation while I evaluate and “morph” your digital images.
Recovering from Surgery
The recovery can take one to two weeks, but most people resume most of their normal activities and return to work within 8 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 the discoloration usually disappears within 10 days to two weeks. Ice is your friend for the first 2-3 days.
Revision Rhinoplasty and 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.
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 can increase with each procedure and can be a limiting factor in what can and cannot be accomplished with a revision operation. We must set realistic goals.
Because it affords better visualization of the nasal architecture and a better evaluation of the problems in a previously operated nose, I perform most of my revision rhinoplasties through an “open” approach. As much as I like 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. I may use a closed approach for small touch up revision procedures. This might be just some filing of the profile or a small graft. However, most of the revision procedures I do are full rhinoplasties that require the open approach.
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.
A minor revision to a scar or filing down a bit of bone to even out the profile can be easier that the original procedure. However, if there are major cosmetic or functional issues that need to be addressed, the revision operation is frequently more difficult, longer and more 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 your ears or elsewhere to properly revise your nose.
Ultimately only you can make that decision. However, I usually can help give you a realistic prediction with regard to the likely outcome. I will not operate on you unless I really think I can improve your nose.
I will carefully examine your nose and review your operative notes from the previous surgery. I will listen to you to determine what exactly is bothering you about your nose. Based on all this information, I generally can tell how complex a procedure you may need. Revision surgery, however, can have its surprises. Sometimes I may not know exactly what needs to be done until I am at surgery.
Nasal pain should be about the same or less than the original procedure, depending on the extent of the surgery. If I need to use cartilage grafts from your ear, the ear is often more tender than the nose after surgery. Our patients usually complain of little pain, but everyone has his/her own, personal pain threshold. We will provide a prescription for an appropriate amount of pain medication.