Revision Rhinoplasty Newport Beach

The general rule is one year from the primary surgery. Two categories of patients ask this question.

Some patients think their nose still looks too large or not refined enough after the initial surgery. They should wait the entire year because it is usually in the second half of the year that refinement takes place. If, after one year, the concerns persist, revision rhinoplasty may be warranted.

The other group has a specific abnormality (dent, collapsed tip, narrowed nostrils, etc.) that will likely not improve with time. For these patients, Dr. Reinstadler suggests waiting at least 6-9 months before undergoing revision surgery to let most swelling resolve.

The general rule is one year from the primary surgery. There are two categories of patients who ask this question. Some patients think their nose still looks too large or not refined enough after the initial surgery. These patients should wait the entire year because it is usually in the second half of the year that refinement takes place. If after one year the concerns persist, revision rhinoplasty may be warranted. The other group of patients has a specific abnormality (dent, collapsed tip, narrowed nostrils, etc.) that will likely not improve if given more time. For these patients, I suggest waiting at least 6-9 months before undergoing revision surgery just to let the majority of the swelling resolve.

Cartilage is used during rhinoplasty for either structural grafts or to achieve cosmetic changes. The cartilage in the septum is very well suited for these purposes. 

Many times during revision surgery, the cartilage available in the septum has been taken or damaged in the initial rhinoplasty, and there are limited other sites to obtain strong and straight cartilage. The ears may be used, but the cartilage is soft and curved; this is not a good idea if you need structural support.

A rib graft is obtained from the cartilage portion of the ribcage, where the rib bones join the breastplate or sternum. In women, an incision is made in the crease below the breast, so it will ultimately not be visible. The cartilage is removed, and there is ample supply for use in any grafting purpose.

The main risk of this procedure is pain. Initially, it will hurt more than the nasal surgery portion, and you will feel twinges of discomfort for a few weeks, which will improve day by day. The other risk is that a small tear can occur on the undersurface of the cartilage. This can let air into the chest cavity. We manage this in several ways but usually require one or two X-rays to confirm that the air collection is resolving normally.

Each case is handled individually. In general, a strong piece of cartilage can be used to lengthen and counter-rotate the tip of the nose. The normal tip cartilages are then sutured to the extended graft, providing a stable platform for the new shape.

Spreader grafts are used when there is a narrowing effect of the nose, or when a collapse of the middle portion is causing either a cosmetic or functional defect. These are small rectangular pieces of cartilage that are placed alongside the septum.

Spreader grafts physically increase the space between the septum and the cartilage that supports the side of the nose. This will widen the middle of the nose slightly, but it is usually a positive cosmetic change.

A poly beak deformity is when the nose tip remains full after all the swelling has resolved. Early in the healing process, the swelling in the supra-tip can mimic this finding, but this will resolve.

This deformity can result when the dorsum is lowered too much and the cartilage at the tip is not enough. From the profile view, it looks very rounded with an ill-defined tip. It can also result from the tip cartilages that are very curved and give the illusion of fullness to the tip — though they are just tenting it up.

Another problem that can arise from primary rhinoplasty is the collapse of the middle portion of the nose. The cartilage support for the side of the nose can fall in from its natural attachment. This shows up like an upside-down “V” on photographs.

There is a shadow below the nasal bones and above where these cartilages should be attached. This can be corrected with the placement of spreader grafts or other combinations of maneuvers with a revision rhinoplasty.