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Revision Rhinoplasty

Revision rhinoplasty, performed at our suburban Augusta, GA, practice by rhinoplasty specialist Dr. Achih H. Chen, is arguably one of the most complex procedures in cosmetic surgery because it is a procedure performed to correct problems from a previous rhinoplasty — more commonly known as a nose job. Revision rhinoplasty is not a cookie-cutter procedure. It is customized to each individual to address issues that may have developed from previous nasal surgery. Problems that may have developed from previous nasal surgery may be cosmetic in nature, such as an “operated” appearance, or they may be functional in nature, such as collapse of the nasal structure with breathing troubles, or a combination of cosmetic and functional problems.

Dr. Chen works with you, discussing your individual problems, needs, and goals to address problems that may have developed as a result of your previous nasal surgery. The goal is to leave the patient with a natural appearance, alleviating the “post-operative,” or “done” appearance and bring about harmony and balance to a patient’s natural features.

To discuss your options, request a consultation with Dr. Chen using the online form, or call The Georgia Center for Facial Plastic Surgery at (706) 210-2625. Dr. Chen works with revision rhinoplasty patients from Columbia and Charleston, S.C., in addition to women and men from the Atlanta metro area and beyond.

What Is Revision Rhinoplasty?

There is no single perfect or ideal nose. Instead, the nose depends on an individual’s facial features. The ideal nose is one that is in harmony with the other facial features and allows areas such as the eyes to be the focal point of attention. The goal of rhinoplasty, or a nose job, is to shape an individual’s nose so that it is no longer the focus of visual contact, creating better facial balance to allow other facial features to become more visually noticed. Although reshaping the nose may seem simple, rhinoplasty is one of the most complex cosmetic procedures. The nose is more than just a central facial feature, it also serves an important functional role.

Rhinoplasty is primarily thought of as a procedure to reshape the nose, but it must reshape the nose in a way that allows an adequate pathway for air passage and in a way that allows enough support so that the nose does not collapse with time. That could result in pinching or buckling of the underlying cartilage. Additionally, as a central facial feature, even subtle asymmetry may be noticeable. As a result, rhinoplasty, unfortunately, may not always be successful in meeting the goals of patient and the initial surgeon, alike.

While rhinoplasty is a complex procedure, with scarring and surgically altered nasal anatomy, revision rhinoplasty is an even more complex procedure. Revision rhinoplasty specialist, Dr. Achih H. Chen, will work with you to address the problems that may have developed from previous rhinoplasty surgery to help you achieve a natural-appearing, functional nose that is in balance with your facial features at our cosmetic surgery facility in Evans, Georgia.

Problems to be Addressed with Revision Rhinoplasty

The goal of the revision rhinoplasty is to leave each patient with a balanced and natural look and to correct problems caused by a previous rhinoplasty procedure. A previous procedure may have resulted in problems due to poor wound healing, an unanticipated healing process, a miscalculation of technique, or some other cause. Dr. Chen will be able to assess the cause and discuss the options, limitations, and how to proceed to best address your goals. In the past, prior to the current understanding of nasal anatomy and physiology, aggressive alteration of the nasal anatomy has led to a common reason for revision rhinoplasty, the “operated” appearance. Some of the phrases that describe, and have become synonymous with, signs of a rhinoplasty procedure, include “scooped-out,” “turned-up,” or “pinched-in.”

These problems may have occurred due to accumulation of scar tissue within the nose and disturbances to the soft and skeletal tissue for a variety of reasons, including unexpected challenges with the healing process or surgical technique. Revision rhinoplasty uses state-of-the-art techniques and cartilage grafting (when necessary) to address these problems to re-shape a previously operated nose to create one that is harmonious with the other facial features for a natural, unoperated appearance. Additionally, maintaining or improving nasal function is often as important as achieving the cosmetic goals.

The list of problems that may require revision rhinoplasty as a result of a previous rhinoplasty procedure is long and extends beyond an “operated” appearance. Dr. Chen will work with you to address other problems beyond the simple external appearance of your nose, including asymmetry, twisting, and projection, and more troublesome problems from breathing troubles to a collapse of the nasal bridge. Dr. Chen will provide a detailed examination to assess your individual situation to help you fully understand your options in revision rhinoplasty at the Georgia Center.

Revision Rhinoplasty Timing

As a revision rhinoplasty specialist and cosmetic facial plastic surgeon, Dr. Achih H. Chen will work to serve patients to meet their needs. It is generally accepted that before undergoing a revision rhinoplasty, the previous operation be given at least 1 year, during which time local swelling decreases, and the scar tissue is given time to soften and heal. There are circumstances, however, when revision rhinoplasty be completed sooner to address significant structural support and deformity concerns.

Revision Rhinoplasty Procedure

Similar to rhinoplasty, depending upon the individual anatomy and goals, in revision rhinoplasty there are two possible surgical approaches: an “internal” — or endonasal — approach, and an external approach. The endonasal method uses only incisions hidden within the nose (intranasal incisions), while the external or open approach uses incisions hidden within the nose as well as an incision hidden under the base of the nose. As a general rule, the external approach allows more extensive assessment and surgical correction of the nose. Once the underlying nasal structures are accessed, correction of the resulting problems from a previous rhinoplasty can be completed. A consultation with Dr. Chen with a comprehensive internal and external nasal examination will help determine the best approach for your revision rhinoplasty.

Revision Rhinoplasty Recovery

At our facility, revision rhinoplasty is generally performed under deep intravenous (IV) sedation. Deep IV sedation affords the patient the avoidance of the uncomfortable nausea and sore throat that often follows general anesthesia, while still being unaware of the surrounding surgical environment. Post-operative discomfort from the revision rhinoplasty should be relatively minimal. Some bruising and swelling may occur, but this varies depending on the individual and the extent of revision surgery required. If these symptoms do occur, they will likely be limited to the areas around the lower eyelids, and should resolve over the course of 1 to 2 weeks, although individual recovery time may vary.  The postoperative dressing may include a nasal splint placed over the nose and generally is removed on the fifth to seventh day following the operation. Return to light activities is allowed within a few days of surgery, while vigorous activities should be avoided for at least 1 week, with contact sports reserved for after 4 weeks. Return to the public eye should be possible in as little as one week, although recovery time will vary from individual to individual.

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