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Houston Cranio Facial

Revision Rhinoplasty (Nasal Reconstruction)

Revision rhinoplasty is a surgery that is performed to enhance the form and function of the nose after an initial operation. Also referred to as secondary and tertiary nasal reconstruction, revision rhinoplasty is performed for a multitude of reasons. Some reconstructive procedures require staggered stages of surgery to achieve the desired result. In other cases, patients may be dissatisfied with the outcome of a cosmetic or functional rhinoplasty and receive an additional operation to address these concerns. Dr. Eric Payne, our experienced craniofacial plastic surgeon, is extensively trained in the complexities of nasal reconstruction and can help you or your child correct a wide range of issues, whether associated with a disease, defect, injury, or other cause.

Secondary nasal reconstruction is a complex procedure, and we believe you should be as well-informed as possible before making a decision about your healthcare. Talk to us today to learn more and to schedule a consultation.

What Issues Can Revision Rhinoplasty Correct?

If revision rhinoplasty is performed primarily for cosmetic reasons, the procedure can address a wide range of concerns, including enhancing the appearance of the bridge width, addressing asymmetry, modifying the size and shape of the nasal tip and nostrils, and much more. Functional issues can also be corrected, such as a deviated septum; a missing, flattened, or asymmetrical bridge; a misshapen nasal tip; or other internal structural problems. Dr. Payne will discuss the best treatment plan prior to your operation and identify the purpose of surgery as well as the techniques he plans to use to achieve the desired outcome.

When is Revision Rhinoplasty Necessary?

Patients who are dissatisfied with the result of a previous nose surgery performed by another surgeon for cosmetic or functional purposes may choose to undergo revision rhinoplasty. In that case, this procedure is typically designed to correct the problems of the initial operation or to achieve more comprehensive improvement. Rhinoplasty is considered to be one of the most complex facial surgeries, and revision rhinoplasty even more so. It’s very important to select a highly trained and skilled surgeon like Dr. Payne to complete this operation.

Injury and disease are two of the most common reasons a person may require multiple nose surgeries. Birth defects and congenital abnormalities can also play a role in the need for multi-stage operations. Treatment of skin cancer, for instance, can leave patients with significant changes to their facial landscape, including missing or deformed nasal structures. Dr. Payne is trained in reconstruction of Mohs surgery (or micrographic surgery) defects, considered to be one of the most effective techniques for skin cancer treatment. While this is a tissue-sparing approach, patients can still require facial and nasal reconstruction to address areas of removed tissue.

How is Revision Rhinoplasty Performed?

Nasal reconstruction can be completed a number of ways and the techniques used will depend on the type of repair being performed. In the event that additional tissue is needed to restore the shape of the nose, cartilage can be harvested from the ribs or ear to form the nasal bridge and septum. Skin flaps can also be created, and the location from which this tissue is harvested will vary depending on your needs. Dr. Payne seeks to create results that look as aesthetically appealing as possible, and your treatment plan will be customized based on your anatomy and desired outcome.

Open Rhinoplasty vs. Closed Rhinoplasty

Generally speaking, open and closed rhinoplasty are the most common approaches utilized to address nasal concerns. A closed rhinoplasty means all incisions will be placed inside the nose (endonasal), typically leaving no visible scarring. An open rhinoplasty is the more common of the two, as it allows the surgeon to have greater access to all internal structures of the nose. The incision in this case is often located on columella, the soft piece of tissue that separates the nostrils. Two more incisions, inside each nostril, are also placed to allow more extensive access to the deep nasal structures. These scars should be relatively inconspicuous once healed.

What is the Revision Rhinoplasty Recovery Process Like?

Recovery following revision rhinoplasty will vary based on the techniques used and each patient’s unique response to healing. A simpler revision rhinoplasty is typically an outpatient procedure (meaning you can return home the same day as the operation); however, the age of the person (and other considerations) can affect how much time is spent in the hospital. Time off from regular activities may be anywhere from one week to one month, depending on these same factors. If tissue is harvested from other areas of the body, this can sometimes extend the recovery period and Dr. Payne will let you know if this applies to your situation. Additionally, if nasal reconstruction is only one of several techniques performed, healing time can also be longer when compared to a single procedure.

After the operation, it’s normal to experience swelling, bruising, and tenderness in the treated area(s), as well as nasal congestion; these effects should gradually subside as the structures heal. We will prescribe medication to manage your pain, and keeping your head elevated can also help expedite the healing process. Dr. Payne and our extensively trained medical team will monitor your progress and provide exceptional care for the best possible outcome. It’s important to note, swelling can last several months and up to a year or more before the results are finalized. Most patients, however, no longer notice signs of inflammation after a few months.

How Much Does Revision Rhinoplasty Cost?

Due to the complicated nature of revision rhinoplasty, this procedure typically costs more than a primary nasal reconstruction. That said, every patient’s treatment plan will be unique and so, too, will be the cost. Dr. Payne will review the details of your program so you have a good idea of what to expect. On average, the price of revision rhinoplasty can vary between $10,000 and $15,000 or more. This number reflects the surgeon’s fee alone, and individuals should know that there will also be a hospital facility fee, anesthesiology fee, and potentially other expenses. Health insurance may or may not cover part of the cost of the procedure. Our skilled medical team can help you better understand the total cost and discuss your financing options with you.

What Will My Revision Rhinoplasty Scars Look Like?

For patients whose procedure was performed using the closed technique, there may be no visible external scarring. In many cases of open rhinoplasty, the scar from revision nose surgery should blend into the natural crease where the nose meets the upper lip. Dr. Payne takes great care to make all incisions as discreet as possible so any scarring is not immediately noticeable to outside observers. Patients can further camouflage their scars by closely following Dr. Payne’s instructions on taking care of their incisions. Proper healing of these wounds can increase the likelihood that residual scars will fade over time.

How Do I Find the Best Revision Rhinoplasty Surgeon For Me?

The most important step in identifying the right surgeon for you is selecting one who is board certified. You should also ask your potential surgeon about his educational background and experience, as well as how many procedures of this type he has performed. Dr. Payne is extensively trained in general, plastic, and craniofacial surgery for patients of all ages, from infancy through adulthood. His care and compassion combined with his artistic eye lend him the ability to provide unparalleled results. Your well-being is his primary concern.

Additional Revision Rhinoplasty FAQs

What is the revision rhinoplasty success rate?

The rate of success after revision rhinoplasty varies depending on your surgeon, the nature of your previous surgery, and the problem(s) to be corrected. Primary rhinoplasty is a significantly complicated procedure on its own, with revision rhinoplasty proving even more difficult due to the challenge of working on cartilage and nasal tissues that have already been operated on. Given the presence of existing scar tissue and the intricacy required to perform secondary rhinoplasty, selecting a qualified surgeon who specializes in craniofacial or facial plastic surgery is essential to receiving an optimal outcome. These medical professionals focus exclusively on improving the appearance and function of the craniofacial framework, and their specialized experience often maximizes the chances of successful surgery without the need for future procedures.

How long should I wait before revision rhinoplasty?

It’s necessary to wait until all or most swelling in the nasal structure has resolved before considering revision rhinoplasty, which can take from six months to one year depending on your unique rate of healing. This can allow you time to fully realize the final results of your original procedure before making a decision about revisionary surgery. Additionally, this waiting period can give your reconstructive surgeon the opportunity to better visualize the cartilage and bone of the nose and identify goals for improving the outcome.

Can you explain the revision rhinoplasty swelling timeline?

After surgery, you can expect the nose to look fairly swollen for the first week or two. This inflammation decreases as the healing process progresses, and the majority of swelling should resolve within six to eight weeks. As swelling subsides, you should notice your nose becoming more refined and be able to see your results more clearly. Some minor swelling may linger for as long as one year before the full outcome is realized.

When can I blow my nose after revision rhinoplasty?

While the nose may feel stuffy and/or congested after surgery, patients should avoid blowing their nose for approximately two weeks after revision rhinoplasty to protect the delicate nasal structure while its healing. This may vary from patient to patient depending on their surgical plan and progress during recovery. During this period, you can clean your nose by gently rinsing the nostrils with saline solution and/or using a cotton-tipped swab.

When can I wear glasses after revision rhinoplasty?

Any unnecessary force on the nasal bridge should be avoided, so Dr. Payne advises that patients refrain from wearing eyeglasses and sunglasses for 10 to 14 days after surgery—or until he instructs otherwise. He recommends switching to contact lenses until the nose has adequately healed to the point wherein the nasal bridge can safely handle the pressure placed by glasses. Some may use tape to the forehead holding the glasses off the nasal bridge.

For additional information about revision rhinoplasty and nasal reconstruction, or to schedule a consultation with Dr. Payne, please reach out to our medical team today.