Rhinoplasty is rightfully considered by many to be one of the most difficult facial plastic procedures. The complex anatomy of the nose involving multiple tissues with various properties, such as skin, bone, cartilage and nasal mucosa, as well as the central location of the nose in the face make rhinoplasty surgery a very technically demanding task with variable final outcomes.
These factors undoubtedly account for a fairly high revision rate of rhinoplasty surgery compared to other surgical cosmetic procedures, which is known to be in the range from 10-15% nationwide. This high incidence of revision surgery is largely due to the intricacy and complexity of nasal anatomy requiring high surgical expertise to consistently achieve good results.
In cases of dissatisfaction after primary rhinoplasty for esthetic or functional (breathing) reasons, or both, revision rhinoplasty may be indicated to improve nasal appearance and/or function. Compared with primary rhinoplasty, revision rhinoplasty represents an even more challenging task since it is attempting to correct a previously unsuccessful surgery.
A poor rhinoplasty result is one of the hardest things for someone to deal with. You're reminded of it every time you look in the mirror. Often, you may feel some anger, guilt, and frustration over the change in your look. The important thing is to move past these feelings to determine what improvements can be made.
The following complaints/ problems frequently necessitate revision surgery
1. Persistent dorsal hump or nasal bridge irregularity
2. Low set or flat (saddle) dorsum
3. Persistent dorsal asymmetry and/or deviation.
4. Persistent septal deviation
5. Nasal tip asymmetry, poor definition, collapse, or droopiness
While some of the post-rhinoplasty deformities are purely cosmetic in nature, some however may result in significant functional problem of nasal airway obstruction. Low set (saddle) nasal dorsum and excessively thinned out mid-portion of the nose may result in difficulty breathing. Significant nasal tip irregularities and weakness commonly cause tip cartilage collapse, especially on inspiration, thus resulting in nasal obstruction as well. Excessive removal of the nasal septum during primary surgery may result in gradual loss of nasal support and progressive dorsal saddling. On the other hand, insufficient correction of the pre-existing septal deviation or total omission to perform septoplasty where indicated during primary rhinoplasty surgery leaves the patient with persistent nasal obstruction.
Dr. Ovchinsky routinely performs a thorough examination of the external and internal nasal anatomy, including nasal endoscopy, as a part of preoperative evaluation and planning for a revision surgery. This thorough exam allows for an accurate assessment of existing nasal problems and helps determine the optimal treatment plan.
Medical therapy has limited application in cases where the main problem is structural, i.e. loss of support, deviation, etc. However, there is a role for medical therapy in an attempt to decrease intranasal swelling and congestion and improve breathing. Intranasal as well as oral steroids and antihistamines may be used in various combinations for this purpose. Steroid injections into the areas of excessive skin thickening (most commonly mid-dorsal region) may assist in improving nasal appearance; injectable Kenalog is commonly used where three injections are usually delivered three weeks apart. Nasal implants placed during the primary surgery may become infected necessitating treatment with oral antibiotics which, although unlikely to salvage the implant, will diminish the infection thus optimizing the patient for a revision procedure.
Dr. Ovchinsky prides himself as a specialist in revision rhinoplasty surgery. He has a vast experience in nasal reconstructive surgery, which ranges from minor revisions to an extensive reconstructive rhinoplasty with multiple grafts (including rib cartilage and calvarial bone grafts) to bring a nose back to not only 'normal' but to attractive again. Whether your nasal problems come from previous surgery, trauma, or drug use, Dr. Ovchinsky can help you breathe again and give you a clear idea as to the degree of cosmetic improvement the surgery will be able to provide for you. While many plastic surgeons prefer avoiding the revision rhinoplasty procedure due to its difficulty, Dr. Ovchinsky has embraced it in his training and throughout his professional career. As a result, he frequently gets referrals for some of the most difficult revision rhinoplasty cases, and is almost always able to achieve highly satisfying results.
Come in for a consultation and together we can create a plan to give you the nose you always dreamed of!
See "before and after images" in our gallery