Revision Rhinoplasty

Very early and still swollen 3 week post op views of a gentleman who underwent an extensive reconstructive open rhinopasty and septoplasty. Patient was operated in the past by two other plastic surgeons who left him with a severly deviated septum and obstructed breathing and an external twisted collapsed nose. Because all of his septal and ear cartilage was missing from previous surgeries cadaver rib cartilage was now used to reconstruct and support his twisted tip and dorsum.

Six week post views of a revision rhinoplasty that was originally done may years ago by another surgeon. In addition to refining the dorsum with some bony rasping the tip was completely reconstructed by removing distorted cartilage and rebuilding with her own custom shaped septal cartilage. Notice also the well healed open rhinoplasty scar in the basal view.

Most plastic surgeons agree one of the most demanding and technically difficult procedures in plastic surgery is the revision (redo) rhinoplasty. One week postop today after having her rhinoplasty done elsewhere in 1989. The tip was distorted/deformed from the previous surgical misadventure and corrected with complete tip reconstruction using ear and septal grafts.

Two-and-a-half months postoperative view of a lady who underwent repair of a rhinoplasty done five years earlier by another surgeon. She had a severely deviated septum to the right and was also complaining of nasal obstruction especially on that side. On preoperative lateral view, a pollybeak deformity can be clearly seen as a bulge in the lower third of her nose just superior to the tip. She also had some deformities and uneven profile in the upper half of her nasal dorsum.

Her tip was also rounded, unsupportive and bulky. She also had splaying of her medial crura, narrowing her nostrils and causing asymmetry in that area. This operation was extremely difficult as there was a significant amount of scar tissue and also the open rhinoplasty approach which was used this time was done through a nose that was previously dissected via an open rhinoplasty approach. The findings during surgery demonstrated a significant amount of fat, scar tissue and excessive dorsal septal cartilage and lower lateral cartilages, all contributing to the bulky protrusion pollybeak deformity of the tip. This was all corrected. The tip was then narrowed with spanning sutures. A tip graft was placed for support and definition. A septoplasty and turbinectomy were done to improve her breathing. She was a prior Afrin abuser to help her breathing. Postoperatively, she is breathing extremely well out of both nostrils without the use of Afrin.

As can be seen, her nose is more aesthetically pleasing on all views. Her nose will continue to thin, narrow and become more defined over the next few months.

Early five week postoperative result of celebrity reality star, Amy Fisher, who underwent a revision rhinoplasty. Amy had her original nasal surgery many years ago by another surgeon and was never happy with the appearance of her nose and breathing. It was determined that her nasal functional obstruction was due to a combination of enlarged hypertrophic turbinates and some collapse of her external nasal valve due to over-resection of her tip cartilages from the previous surgery. Because she did not have adequate septal cartilage available due to her prior surgery, her own ear cartilage was harvested so that it could be used in the reconstruction. An open rhinoplasty approach was used so that a more accurate assessment and treatment could be used. She was noted preoperatively, as can be seen on her frontal view, to have collapse and pinching of her alar tip, retraction of her nostril rims and a noticeable bossae of her right tip cartilage. This was causing asymmetry of her tip with an outward prominence and irregularity of her tip. This was corrected by correcting the distorted and abnormally shaped underlying tip cartilages and replacing them with strategically shaped ear cartilage grafts that were used both along the alar sidewall and as tip grafts. As can be seen in the postoperative view, the tip is now more symmetric and straight, although there is still some swelling which has subsided as can be seen in her one year professional picture above. On the three-quarter views, her preoperative depressions and irregularities of her tip are now corrected and replaced with a much smoother and natural contour. Postoperative views demonstrate a more symmetric and natural tip and nostrils with only slight evidence of the open rhinoplasty incisional scar which is all but invisible at this time.

Seven week postoperative result for a patient who underwent rhinoplasty by another surgeon several years ago and was unhappy with her appearance and breathing. As a result of the primary (initial) rhinoplasty, the patient developed a moderately crooked nose in the mid vault region, especially to the right with a depression of the left lateral nasal wall. She also had an amorphous non-supportive tip due to over-resection of tip cartilage. Her breathing was also impaired with a deviated septum and on the lateral view you can see she had somewhat of a pollybeak formation with excessive cartilage left just superior to the tip. Postoperatively we can see after performing an open rhinoplasty utilizing cartilaginous tip grafting and lateral onlay nasal sidewall grafting and osteotomies, that the nose was much straighter and elegant appearing. On lateral view, you can see that the pollybeak postrusion on the top of her nose is now gone and the nose is more streamline and feminine. She also has more structure and support to the tip. The nose will continue to improve over the next few months.

Two-month postoperative result of patient who underwent corrective rhinoplasty to improve multiple deformities left by a prior surgery elsewhere. Widened nasal bones were narrowed, mid-nose depression was improved, and cartilage graft was placed along dorsum to give more height to top portion of nose. Supratip fullness was also debulked. Airway notching and nostril size were normalized. Tip now more symmetric and triangular in shape. Open rhinoplasty approach was utilized and resulting scar as seen on “worm’s eye view” is barely viable even at this early stage of healing.

Three week post-op result of swimsuit model who had undergone initial rhinoplasty elsewhere leaving her with deformities of her nostrils and tip and also irregularities along the top of her nose. Utilizing open rhinoplasty approach with cartilage grafting, nose is now more harmonious with even nostrils, natural tip and smooth dorsum.

Two week post-op view of patient who underwent prior reconstruction by another surgeon one year ago, leaving her with deformities as seen in the before pictures. After extensive surgery using the “open rhinoplasty” technique and ear cartilage grafting to tip of nose a more natural and pleasing appearance is obtained. Note in post-op view almost absence of external incision used for surgery as seen on “worm’s-eye view,” nostrils now more symmetrical, crooked nose has been straightened, hanging tip of nose has been shortened, and hump on nose corrected. Also breathing is dramatically improved.

Three months post-op views of patient who had previously underwent two successful procedures by another surgeon. Multiple onlay ear cartilage grafts placed along top of nose and to tip to restructure normal anatomy. Also note on lateral view turned up tip was lengthened downward. Lower eyelid fat was also corrected at the same time by using “no scar technique.”

Patient had two previous nasal operations by another surgeon who left her with a widened bony bridge, distorted asymmetric tip and breathing problems. Post- op pictures demonstrate the result of successful narrowing of nasal bones and recontouring of tip with cartilage and fascia grafts. Breathing also improved with septoplasty and turbinectomies. Nose should continue to narrow and define as swelling subsides over the next year.

Nose initially done elsewhere and subsequently corrected at our center with ear cartilage grafts. Sinus surgery done at same time. Full description can be found in Dr. Scaccia’s book chapter which is published in the text “Surgical Reconstruction of the Face and Anterior Skull Base.” Copies available upon request.

Six week post-op views of nose previoiusly operated on by another surgeon 10 years ago. Frontal view demonstrates improvement in “inverted V” deformity of nose which gave the appearance of almost two separate disconnected noses. Lateral view demonstrates improvement in polly beak deformity by correcting extra cartilage along the top of the nose with placement of double tip graft for correction of blunted/rounded tip deformity. Top of nose maintained strong and natural because of patient’s preference and her tall height.