Having a Nose Job Done for the Second Time

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More and more rhinoplasty patients from the 80’s and early 90’s have requested revision rhinoplasty to meet today’s trend for a prominent nose profile and defining nose tip. Alternatively, rhinoplasty patients of the past may wish to otherwise improve the aesthetic appearance of the nose or increase functionality that has been compromised years after surgery.

Functional complications that have arisen from rhinoplasty procedures of the 80’s to the early 90’s include: ill-defined cartilage, unbalanced sidewalls of the nose, reduction in nose tip protrusion, and breathing impediments.

Today’s Options

There are often several reasons for a previous rhinoplasty patient to request a second revision procedure. This makes revision rhinoplasty surgery more complex than the initial surgery. By the same token, the advantage of secondary rhinoplasty today is that there are improved techniques available for patients to benefit from, including:

Grafting Techniques: There are several grafting techniques to improve functional and aesthetic concerns. Cartilage from the ears or ribs may be grafted to recreate a supportive structure for the bone and cartilage of the nose. The procedure requires up to 3 times the amount of time required for an initial rhinoplasty. In addition, recovery is much longer. Yet, the results can be quite complimentary from both an aesthetic and functional point of view.

Injectibles: Aesthetic issues can be improved through artistic techniques utilized through injectibles. Hyaluronics (Restylane and Hylaform) as well as calcium hydroxyapatite (Radiesse or Radiance) help to create a smooth profile and can improve depressed cartilage areas on the nose. Botox may be used to curve the lip upward, bringing balance to the features of the nose and face. Injectibles can be appealing because of the lack of downtime, immediate results that last 6 months to a year, and nominal fees when compared to grafting techniques.

Both grafting and injectible approaches are highly technique driven. They require the skill of a plastic surgeon with great expertise. It is important to select a plastic surgeon that has extensive experience in the procedure of choice for secondary rhinoplasty procedures.

Because of the special nature of the blood supply to the nose and surrounding area, it is possible for retrograde infections from the nasal area to spread to the brain. To reduce the risks follow the doctor's advice both before and after the surgery.

Surgical procedure:

Surgery can be performed under general anesthesia with local anesthesia depending on patient or doctor's preference. Incisions are made inside the nostrils sometimes; tiny incisions are also made on the columella, the bit of skin that separates the nostrils. The surgeon first separates soft tissues of the nose from the underlying structures, then reshapes the cartilage and bone which causes the deformity.

In some cases the surgeon may shape a small piece of the patients own cartilage or bone to strengthen or increase the structure of the nose. This is done for cosmetic reasons or to improve breathing and function of the nose. In rarer cases a synthetic implant may be used to reconstruct the nose if the normal structure of the bone and cartilage is badly damaged or weakened. Alloplastic synthetic are often associated with long term complications alternatively, cartilage from the septum, ear on rib may be used.

Recovery:

A tape dressing will cover the nose for one week, there may be some discoloration and swelling around the eyes which will improve over 5-7 days. One week is usually enough time for returning to work and social activities.

Dave Stringham

Dave Stringham is the President of LookingYourBest.com - an online resource for plastic surgery and offers a list of top plastic surgeons.

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