Top Revision Rhinoplasty Surgeons in San Diego
Rhinoplasty represents a common surgery for those who want to reshape the nose and improve their appearance and self confidence.
However, a second rhinoplasty may be necessary if the initial procedure fails to deliver the desired results. But with revision rhinoplasty from Changes Plastic Surgery & Spa, you can reap the benefits of a procedure performed by the top revision rhinoplasty surgeons in San Diego.
As San Diego’s premier revision rhinoplasty specialist, we will work with you to ensure all of your rhinoplasty needs are met. Thus, we serve as a proven revision rhinoplasty specialist, delivering exceptional support to patients day after day.
What Is Revision Rhinoplasty?
Revision rhinoplasty addresses both aesthetic and functional (breathing) problems that may arise after rhinoplasty. It is necessary in approximately 5 percent of cases and may be requested if the nose remains unbalanced due to healing issues or improper or incomplete rhinoplasty.
Why Should I Consider Revision Rhinoplasty?
There are many problems that may lead you to consider revision rhinoplasty after traditional rhinoplasty is performed, including:
- Nasal airway is obstructed, making it more difficult to breathe through the nose.
- Cartilage or nasal bones are damaged or collapsed.
- Internal and external nasal valve is damaged or collapsed.
- Nose asymmetry has become worse.
- Shaping is incomplete, resulting in insufficient cosmetic changes to the nose.
- Nose job appears “overdone” and does not match patient’s initial expectations.
- Dorsal height (bridge height or hump) has not been reduced to the ideal level for the patient.
- The nasal tip has been narrowed excessively.
- The nasal tip projection is excessive or inadequate for the patient.
- There is excessive internal and/or external thickened scar tissue.
When performing secondary or “revision” rhinoplasty, Dr. Lee and Dr. Reagan prefer the open approach. Given that a secondary rhinoplasty often is more challenging because of scar tissue from the previous surgery, the open approach will afford the necessary exposure to correct the issues at hand.
How Do I Know If I Need Revision Rhinoplasty
Common indications for rhinoplasty include:
Under Resection: The nose is still too big with residual dorsal hump, too long, or with overprojection. Sometimes there is a fullness above the tip call a poly-beak or supra-tip deformity.
Over Resection: The nose is collapsed with pinched or retracted nostrils, pointy tip, or “ski slope” dorsum. This can easily lead to nasal collapse upon inspiration.
Asymmetry: There exists asymmetry of the paired structures of the nose, deviation of the tip, upper lateral cartilages, or bony pyramid.
Difficulty Breathing: Often associated with over resection or residual septal deviation.
What Are Some of the Common Techniques for Performing Revision Rhinoplasty?
Common techniques used during revision rhinoplasty include:
Tips Grafts: a flattened piece of cartilage that is placed at the tip of the nose to render a more pleasing tip aesthetic. Usually derived from the septum.
Dorsal Grafts: Onlay grafts of cartilage or other tissue to correct ski slope deformity. Derived from septum, ear, or rib.
Spreader Grafts: thin strip-like grafts placed along dorsal septum to support internal nasal valve. Derived from septum or rib.
Ear Cartilage: Cartilage from the ear can be harvested using a posterior incision with a non-visible scar. The bowl of the ear is harvested so as not to change ear projection.
Rib Cartilage: Autologous rib cartilage is used when the patient needs significant amounts of cartilage for correction of a deformity, or there is insufficient septal cartilage. The preferred approach is using the 5th or 6th rib harvested through an infra-mammary crease incision.
What Are Some of the Common Revision Rhinoplasty Procedures?
Common revision rhinoplasty procedures include:
The nasal bones usually require narrowing at the time of Rhinoplasty. This is achieved by fracturing the bones in a controlled fashion with narrowing. Dr. Reagan and Dr. Lee perform percutaneous osteotomies using a small stab incision along the lateral nasal wall. A small (2mm) instrument is introduced to produce the controlled fracture.
The septum is a single, mid-line cartilaginous structure that supports the nasal tip and nasal vault. External trauma can cause septal deviation, which in turn, can lead to tip deviation and difficulty in breathing (nasal obstruction). A septoplasty usually involves removal of the deviated portion of the septum. Sometimes grafts are used to support repositioning of the septum.
Inferior Turbinate Resection
There exist three shelves on the lateral aspect of the nasal cavity that function to warm the air prior to entering the lungs. These shelves are lined with mucosa which is highly vascular and sensitive to external stimuli. The mucosa will swell to certain allergans, causing narrowing of the airway at the inferior aspect. Thus, inferior turbinate hypertrophy is the most common cause of airway obstruction. This turbinate is often reduced (submucosal turbinate resection) at the time of rhinoplasty.
Alar Wedge Excisions
It is not uncommon for the nostrils to flare at the time of shortening nasal tip. To correct this, a wedge of soft tissue is excised in the alar groove. This excision can be carried into the nasal sill if nostril reduction is desired.
What Does the Revision Rhinoplasty Process Involve?
For many patients, the same techniques that were used during the initial rhinoplasty will be leveraged during revision rhinoplasty.
Comparatively, the goals of revision rhinoplasty may differ from those of rhinoplasty, as revision rhinoplasty is used to fix problems that were not corrected during rhinoplasty or resulted from the initial surgery.
What Are the Long-Term Results of Revision Rhinoplasty?
You should notice the end results of revision rhinoplasty within one to two years. The long-term results of revision rhinoplasty may include an enhanced appearance and self confidence, along with improved breathing.
Revision Rhinoplasty FAQ
Does insurance cover the cost of revision rhinoplasty?
Typically, insurance will cover the cost of correcting problems that impair breathing. This means if revision rhinoplasty may be covered by your insurer if the surgery is considered reconstructive.
On the other hand, cosmetic surgery rarely, if ever, is covered by insurers. In this case, you may need to cover the cost of revision rhinoplasty.
How long does revision rhinoplasty usually take?
An average revision rhinoplasty surgery may take between 1.5 hours and 3 hours to finish. Additional time may be required if advanced surgery is required.
Am I asleep during the procedure?
There are three anesthesia options available that will determine whether you remain awake or asleep during revision rhinoplasty:
- Local – You may receive local anesthesia that is injected directly into the nose during revision rhinoplasty. This anesthesia will numb the pain but ensures you can stay awake during the procedure.
- Local with sedation – In addition to local anesthesia, you may receive a sedative that will put you to sleep during the surgery.
- General – This ensures you are fully sedated and breathing is done for you via an endotracheal tube. This is the most common anesthesia option for revision rhinoplasty.
Ultimately, your medical history may impact whether the surgeon recommends you remain awake or asleep during the procedure.
Are there restrictions on what I can do after revision rhinoplasty?
Revision rhinoplasty commonly is performed as an outpatient procedure. Thus, you’ll likely be able to return home after the procedure is finished with minimal restrictions.
It always is better to err on the side of caution after surgery. As such, you should plan to have a friend or family member drive you home from the surgical facility.
Furthermore, having someone stay with you the first night after surgery frequently is a good idea. By doing so, this individual will be able to help you with nasal care following revision rhinoplasty.
To learn more about revision rhinoplasty, please contact us today at 858-720-1440.
Rhinoplasty with Dr. Reagan