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.
What Can You Expect During Revision Rhinoplasty Recovery?
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.
What Conditions Can Revision Rhinoplasty Treat?
Septal Perforation
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.