Revision Rhinoplasty and Nose Job Repair by Dr. Jose Barrera IN SAN ANTONIO, TX
When rhinoplasty doesn’t work out as expected, men and women from across the state turn to the Texas Center for Facial Plastic and Laser Surgery. Our Stanford Fellowship Trained and board-certified facial plastic surgeon Dr. Jose Barrera is one of the area’s top rhinoplasty experts. Using the latest techniques in nasal surgery, he can repair the damage to your nose and improve your rhinoplasty outcome.
Revision rhinoplasty is highly complex. Scar tissue and structural changes from previous surgeries complicate nasal surgery, already a difficult procedure. You need a surgeon with extensive rhinoplasty experience to ensure a good outcome.
Learn more about revision rhinoplasty in Texas by calling (210) 468-5426 for a consultation.
What Is Revision Rhinoplasty?
Revision rhinoplasty is a nasal surgery performed on patients that have received previous rhinoplasties. Revision surgery is considered one of the difficult types of rhinoplasty. When surgery is performed on the nose, scar tissue can develop and the underlying structure of the nose is changed. Revision rhinoplasty must repair damage and work with scarring and previously altered tissues to create a nose that is both aesthetically pleasing and structurally sound.
Revision rhinoplasty is performed for many reasons including:
- Breathing difficulties
- Rhinoplasty results that aren’t as expected
- Further refinement to the nose after nasal surgery
- Facial trauma or injury after a previous rhinoplasty
If you’ve had a previous rhinoplasty and are considering additional nasal surgery, contact our office to learn more about revision rhinoplasty in San Antonio.
What Happens During Revision Rhinoplasty in San Antonio?
From breathing problems to aesthetic changes, revision rhinoplasty is performed for many reasons. As such, the procedure varies considerably. Dr. Barrera will create a customized plan for your surgery, designed to address your specific concerns. For detailed information about what to expect, talk with Dr. Barrera.
Revision rhinoplasty is often performed using an open technique. Open rhinoplasty provides better visualization and access to your nose. An incision will be created along the columella, the tissue that divides the nostrils, and the skin is lifted. Dr. Barrera will shape and refine the nose. Cartilage grafting is often needed in revision rhinoplasty.
Patients undergoing revision rhinoplasty may have dorsal irregularities which correspond to nasal bone asymmetry and residual boney humps, inverted V deformity from loss of support to the upper lateral cartilages, or pollybeak deformity from excessive scar tissue in the lower portion of the nose. Reconstruction using septal cartilage, ear grafts, and costal cartilage or rib grafts may be necessary. After surgery, the nose is placed in a protective splint to hold refinements in position until they have healed. Patients spend a few hours in recovery with careful monitoring by our skilled nursing team before heading home.
Recovery: What to Expect
After rhinoplasty, your nose may feel bruised, swollen, and tender. Swelling is very common after revision surgery and tends to be more pronounced than after a first-time rhinoplasty. Plan on taking about a week off from work.
Our patients recover quickly. After the first day, many can resume basic daily activities. Take it slowly and reintroduce activity as you’re comfortable and able.
To ensure comfort, we’ll provide prescriptions for analgesic pain medications and antibiotics. We ask patients to irrigate the nose with saline during recovery.
Dr. Barrera will provide detailed recovery instructions and is available if you have questions or concerns. We’ll schedule several follow-up visits. These visits allow us to assess your healing. They are an essential part of the recovery process. Make every effort to attend your follow-up visits.
- Sutures and splints are typically removed five to eight days after surgery.
- Avoid strenuous exercise, heavy lifting, and blowing your nose until you’re cleared by Dr. Barrera.
- The nose is highly sensitive to the sun after rhinoplasty. Avoid sun exposure.
Careful attention to our recovery instructions is essential to achieving your desired result after this procedure.
There are many common rhinoplasty concerns. These concerns may be due to over-resection of the underlying nasal cartilages or abnormal healing with scar. Other patients present with complications after their rhinoplasty surgery.
Revision rhinoplasty can treat:
Septal perforations can be caused by trauma, infection, autoimmune, inhalant drugs, malignancy or prior rhinoplasty surgery. When indicated a biopsy may be needed to evaluate the cause of the perforation. Dr. Barrera will perform a nasal endoscopy to evaluate the extent of the perforation.
Patients often present with crusting and bleeding from the nose as well obstruction and whistling noises. Surgical correction is indicated when failed medical management cannot decrease these symptoms. An interpositional graft made from ear or costal cartilage and mucosal flaps are often necessary.
Treating the Crooked Nose
Crooked noses can be caused by trauma, facial asymmetries or prior rhinoplasty. Correction of the crooked nose requires complete dissection of the nose often through an open approach. Correcting the deviated septum is the first step, followed by osteotomies and spreader grafts for the middle area of the nose. Nasal tip deviations can be addressed using caudal extension grafts and reshaping the nasal tip cartilages.
Lengthening the short nose
The shortened nose can be caused by concavity of the dorsum or overresection of a boney hump, over-rotation of the nasal tip, deep nasion, and an obtuse nasolabial angle. Treatment requires open rhinoplasty with complete release of the supporting structures, caudal extension grafts, extended spreader grafts, radix grafts, and possibly tip grafts to lengthen the nose. All of these cartilage grafts can be fashioned from septum, ear, or costal cartilage (rib) grafts.
The Tension Nose and Treating the Long Nose
Patients with an extremely long caudal septum with overprojection of the nasal tip and weak tip cartilages often have a tension nose. Patients present long noses where the nasal tip descends below the dorsum of the nose. Treatment involves reducing the dorsal septum to deproject the nose while supporting the remaining septum with spreader grafts and a caudal extension graft. The long columella can be treated with a tongue in groove technique of the columella cartilage or caudal extension graft. Alar base flairing can be treated with base reduction of the nose with a Weir or combined Sill excision.
Pollybreak Deformity treatment
Patients with a pollybeak deformity present with overprojection of the lower nasal dorsum due to loss of tip support, scar building, or inadequate cartilage reduction of the dorsum. Treatment is directed to remove excessive scar and provide lower nasal support using spreader grafts and caudal extension graft. Sometimes defatting the SMAS layer is necessary. Taping and steroid injections are often necessary.
Saddle Nose Deformity
The saddle nose deformity is caused by over-resection of the nasal dorsum with loss of the natural height of the nose from prior rhinoplasty. Other causes include autoimmune diseases like Wegeners granulomatosis, relapsing polychondritis, or cocaine abuse. Overuse of topical nasal decongestants can also cause saddle nose deformity. Treatment includes spreader grafting, onlay grafts to restablish dorsal height, and nasal tip support using costal cartilage grafting.
Inverted V Deformity
The inverted V deformity is often seen in revision rhinoplasty. Patients present with collapse of the upper lateral cartilages leading to depression in the mid vault of the nose from over-resection after hump removal. Spreader grafts are often necessary. Increase risk of inverted V deformity occurs in patients with short nasal bones and long upper lateral cartilages.
Over-resection of the Lateral Crura
The lateral crura are the nasal tip cartilages that offer support to the nasal valve of the nose. Patients who receive cosmetic rhinoplasty with resultant over-resection of the lateral crura can have atypical pinched nasal tips, supraalar collapse, asymmetry, bossae formation, and alar retraction. Dr. Barrera typically preserves 7 – 8 mm of the lateral crura when performing cephalic trim in order to avoid alar retraction. In alar retraction, alar batten grafts, lateral crural strut grafts, and alar rim grafts may be using to redefine and support the nasal tip.
In bossae deformity, knuckling of the lower lateral cartilage results in visible and palpable nasal tip asymmetry. Patients with thin skin, strong alar carilages, and tip bifidity as predisposed to bossae deformity. Treatment involves trimming the bossae, obtaining good nasal tip structure and symmetry, and onlay camouflaging using crushed cartilage techniques.
A hanging columella is due to failed correction at the time of previous rhinoplasty surgery. Patients with a hanging columella benefit from tongue in groove technique using the native septum or a septal extension graft for support. Removal of the membranous septum may also be helpful.
Open Roof Deformity and Rocker Deformity
The open roof deformity is caused by inadequate lateral osteotomies or failure to perform osteotomies after dorsal hump reduction. Irregularity of the bridge of the nose and dorsum can result with indentations. Spreader grafting and osteotomies are necessary. Similarly, rocker deformity results from carrying the osteotomy too high resulting in lateral displacement of the superior fracture. A transverse percutaneous osteotomy can alleviate this problem.
Nasal Valve Obstruction
Nasal valve obstruction may be caused by previous rhinoplasty surgery or by inadequate cartilage of the external valve. Patients may also present with airflow limitations due to a narrow internal valve.
Patients often say that pulling the nasal ala with their fingers, called the Cottle maneuver, improves nasal breathing. Using cotton tip applicators, the modified cottle maneuver can help to further identify whether internal or external valve compromise exists.
Treating the External Valve and Caudal Septal Deviation
Patients with external valve collapse present with either collapse of the lower alar cartilages, narrowing of the base of the nose or nasal sill, a columella asymmetry, or a caudal deviation of the nasal septum. The caudal septal deviation is a common finding in sports injuries, trauma, and previous unsuccessful septoplasty. Dr. Barrera utilizes additional grafting in the form of septal extension grafts, alar batton grafts, and / or lateral crural strut grafts to treat the external valve.
A common presenting complaint by patients to otolaryngologists is trouble breathing through the nose. While etiologies are numerous, nasal valve stenosis is commonly implicated in these patients. Patients worry about their ability to obtain appropriate oxygen, especially during times of exertion, as well as quality of sleep. In particular, this type of nasal deformity may worsen a patient’s obstructive sleep apnea and contribute to excessive daytime sleepiness. Nasal valve incompetence is commonly a quality of life problem for patients. Surgeries have been developed to address such issues and are aimed at correcting internal and external nasal valve structure as well as creating space in the nasal passage. These techniques involve grafting cartilage from the existing nasal septum or from other parts of the body, such as rib or ear. Current literature often uses the umbrella term functional rhinoplasty to describe these operations.
Nasal Valve Obstruction and Internal valve correction
Nasal Valve obstruction is common in patients with previous rhinoplasty surgery. At the time of revision rhinoplasty, care must be taken to ensure the internal valve is improved by proper placement of spreader grafts and a thorough septoplasty to treat a high septal deviation. The middle vault must be supported to ensure that ongoing collapse does not recur.
Surgeries to correct nasal valve insufficiency that follows septoplasty with rhinoplasty using alar batton grafting or lateral crural strut grafts, and turbinate outfracture are very common. While these techniques have shown promise for patients seeking relief for nasal obstruction, they are invasive, and depending on the patient’s past surgical history, may be complicated.
An alternative approach has been introduced by Spirox with its novel nasal device, Latera. This absorbable implant serves to support the nasal cartilage in a way that does not require cartilage harvest and reshaping as does traditional methods. Spirox Latera is an innovative device that is FDA approved for support of the lateral nasal wall in patients with nasal valve incompetence. Of important note, the implant does not alter the patient’s normal nasal architecture, and thus the aesthetics of the nose may be preserved.
Patients often seek ways to improve their health in ways that least disrupts their daily lives. Latera implant may offer a solution for people seeking minimally invasive correction of nasal valve stenosis and collapse. In this study, we aim to investigate the effect of Latera implant versus traditional functional rhinoplasty on nasal airway obstruction through subjective scales and polysomnogram data. This research may be of importance to clinicians seeking to offer their patient’s the best options for treatment.
Non-Surgical Revision Rhinoplasty
Many patients don’t want additional surgery but wish they could improve their rhinoplasty results. You may be a candidate for non-surgical correction of depressions and humps on the nasal bridge. Non-surgical correction is also used to refine the tip of the nose.
Non-surgical rhinoplasty uses dermal fillers such as Restylane to change the appearance of the nose and create a more attractive shape. Fillers aren’t permanent, but they are long-lasting. Results last from three months to two years, depending on the filler used and the area treated.
If you have breathing obstructions or structural issues with your nose, surgery is needed. Non-surgical rhinoplasty is limited in what it can achieve, but it does help many of our patients to avoid revision surgery while improving their rhinoplasty results.
Revision Rhinoplasty in Texas: Frequently Asked Questions
Few plastic surgeons in Texas have the training and experience that Dr. Barrera does, especially when it comes to nasal surgery. Dr. Barrera is board-certified in otolaryngology, a medical specialty that focuses on the ears, nose, and throat. He is also a board-certified facial plastic surgeon. He is highly experienced in nasal surgery and has performed many complicated revision procedures with excellent results.
If you’re unhappy with the results of your previous rhinoplasty, you may be a candidate for revision surgery. We recommend that patients wait at least a year before revision surgery. Ideal candidates are in good health and have realistic expectations for the procedure. To find out if you’re a candidate, contact Dr. Barrera for a consultation.
Revision rhinoplasty typically takes more time than a first-time rhinoplasty. Procedures can take four hours or more, compared with one to two hours for a first-time rhinoplasty.
Revision rhinoplasty is often performed using an open technique. A small incision is created outside of the nostrils on the columella. Most patients don’t notice the scar after healing.
Come to your consultation with a firm idea of what you hope to achieve. Be prepared to discuss with Dr. Barrera what went wrong on your previous rhinoplasty. Bring along a list of questions. We look forward to meeting with you and helping you achieve your rhinoplasty goals.