What is a revision rhinoplasty?
A revision rhinoplasty is a plastic surgery procedure designed to rectify undesirable outcomes or complications that have surfaced following an initial rhinoplasty or nose job. The primary objective, in most instances, is to amend any nasal irregularities that were a result of the original rhinoplasty, such as reshaping the nose tip or bridge. This surgery can also alleviate breathing problems and enhance nasal function by clearing blocked nose airways and repairing valve collapses with cartilage grafts.
Getting two rhinoplasties is not as uncommon as you may think. It is projected that about 5 to 15% of all rhinoplasty patients undergo revision surgery, even those initially done by a qualified and seasoned plastic surgeon.
The complexity of revision surgery is often greater than that of the first operation due to the presence of scar tissue, unpredictable healing, and missing natural tissue.
During a consultation, the surgeon is expected to discuss the risks and establish realistic goals around the possible outcome. To align expectations, many surgeons use computer imaging to understand the patient's vision for the desired results.
Open communication with your surgeon performing the revision is crucial to clarify the aspects you're unsatisfied with and to understand what is feasible. Remember, even the most skilled surgeon cannot promise a flawless nose.
Often, it's suggested that you allow a full year for your nose to recover from the initial surgery before considering a revision rhinoplasty operation.
Melon Hint: It might be worth considering a return to your original surgeon for the revision rhinoplasty, provided they have the necessary skills to execute the operation, which is typically more challenging than the initial surgery. Many surgeons offer revisions without charge, barring a small surgical facility and anesthesia fee. However, if you have reservations about their competency, it would be wise to find a specialist in revision rhinoplasty.
What are the pros & cons of revision rhinoplasty surgery?
- Another surgery can enhance your nasal aesthetics by fixing issues like a pinched or bulbous nose tip, slender bridge, crooked septum, or a bump. It can also address functional problems such as breathing difficulties.
- The procedure is on an outpatient basis, and postoperative discomfort is typically mild.
- Achieving a satisfactory result from a subsequent procedure can bring more symmetry to your facial proportions and elevate your self-esteem.
- Scars from the operation will gradually fade and become less noticeable over time.
- The technical difficulty of a revision rhinoplasty is well-documented, making it one of the most challenging facial plastic surgery procedures. It calls for precise surgical methods and a sharp eye for detail. In some instances, a revision rhinoplasty could do more harm than good, hence the importance of choosing a proficient, board-certified plastic surgeon who can guide you on your journey.
- Post-surgery, you should anticipate a recovery period of 1 to 2 weeks for the bruising and swelling to heal.
- Just like your first rhinoplasty, it could take up to 2 years for all swelling to subside before you can see your final result.
- The outcome might not meet your expectations.
- As it is highly complex, the cost of a revision rhinoplasty is typically higher than the first operation, particularly if you choose not to return to your original surgeon or if they do not offer a discount for the revision.
Melon Hint: A study in Aesthetic Plastic Surgery found that nearly a third of rhinoplasty candidates were diagnosed with Body Dysmorphic Disorder (BDD). It also highlighted that these patients usually have lofty expectations about the surgical outcome and are frequently disappointed post-operation. Therefore, your surgeon should watch for indications of BDD to help evaluate your suitability for a follow-up procedure. If they suspect severe BDD, they might even refuse to operate.
How much does revision rhinoplasty cost?
Average Cost: $19,700
Range: $8,500 - $38,000
If your revision rhinoplasty is only small adjustments, like dealing with a lingering nasal bump, it may be less expensive than the first surgery, especially if done by the original surgeon. Some surgeons may even provide their initial rhinoplasty patients with complimentary revision, charging only a minor fee for the operating theatre and anesthesia.
However, if your nose presents several significant concerns, like noticeable deviation and a downward nasal tip, this would likely necessitate comprehensive nasal reconstruction surgery. The cost of nasal reconstruction is considerably higher than an initial rhinoplasty due to the intricate technicality and time required. In this situation, it's advisable to seek the most proficient revision rhinoplasty surgeon within your budget to lessen the chance of needing another revision in the future.
In most cases, revision rhinoplasty is deemed a cosmetic procedure and is not typically covered by Medicare or private health insurance. However, if your breathing is impaired due to issues like valve collapse or a deviated septum, Medicare or your insurance might offset a portion of the expenses.
Still, it's important to note that not all surgeons specializing in revision rhinoplasty accept insurance payments. Given the complexity of these operations and the often negligible insurance compensation, many highly skilled surgeons may not bother with the paperwork. Even those who do may still leave you with considerable out-of-pocket expenses.
Financing your treatment through a personal loan can be a viable option.
How long should I wait before getting a revision rhinoplasty?
Many plastic surgeons endorse a waiting period of 1 year to allow the swelling to recede and for slight asymmetries to settle before undergoing a subsequent surgery. This is usually the time frame required for complete recovery from the original procedure.
The most severe complications encountered during revision rhinoplasty have arisen when a revision surgery was prematurely attempted.
That being said, doctors have reported performing earlier revisions for suitable candidates under exceptional circumstances.
While you are waiting, be cautious about getting a 'liquid' or non-surgical rhinoplasty using filler as a temporary solution. A non-surgical nose job can alter your anatomy, increasing the difficulty for your revision surgeon. Moreover, non-surgical rhinoplasties are not sanctioned by the TGA and could result in serious complications.
What happens during revision rhinoplasty?
The procedure is typically conducted under general anesthesia, which means you'll be unconscious. The duration varies between 2 to 5 hours, contingent on the intricacies of your case.
Most surgeons specializing in rhinoplasty opt for the open approach, granting them superior visibility to evaluate the nasal tissue and simplified access for nasal reconstruction.
The operation begins with a minor incision in the columella, the area between the nostrils, along with another incision inside the nostril bases. This enables the surgeon to detach the skin from the bone and cartilage.
Next, the surgeon will begin modifying the shape of your nose. This might involve severing and repositioning bone (commonly known as 'breaking the nose') or extracting bone and cartilage. More often than not, it will be necessary to incorporate cartilage grafts to provide enhanced structure for your reshaped nose.
The additional cartilage is typically sourced from the nasal septum, ear, or rib. A revision rhinoplasty involves careful handling when reducing surplus tissues and augmenting areas where tissues might have been excessively removed during the initial surgery.
Once the underlying design of your nose is completed, the skin is delicately repositioned, and the nasal tip is precisely aligned and secured with tiny stitches.
After you have recovered from the anesthesia, you will be ready to head home. As you may still feel drowsy, it's recommended to have a trusted individual accompany you to ensure a safe journey home.
Can revision rhinoplasty be done with a closed technique?
For simpler cases of corrective surgery, the less invasive endonasal or closed rhinoplasty technique may be utilised. The suitability of this option for your specific case would be determined during your initial consultation.
Many surgeons opt for closed revision nose surgeries, even for minor adjustments, and prefer to use general anesthesia to guarantee patient comfort, considering the nose has many nerve endings. However, minor alterations such as nostril modifications or reducing the nose hump can be carried out with just local anesthesia.
How long does it take to recover from revision rhinoplasty?
The recovery process from a revision rhinoplasty is similar to what you underwent during your first nose job. However, recovery from nasal reconstructive surgery can extend longer, particularly if the operation was performed using an open technique.
Healing after a revision rhinoplasty is typically longer, due to the scar tissue from the first rhinoplasty which prolongs swelling. In cases where the alterations are minor, the swelling may recede more rapidly, but if a substantial amount of work is needed, a longer healing period is to be expected.
The nose will be stabilized with a splint and dressings to maintain proper alignment of the nasal structures. For the first week following the surgery, these bandages must be preserved.
Most individuals can resume their jobs 7 to 10 days post-surgery, but it's crucial to steer clear of environments that may cause your nose to be bumped or hit.
The nasal bones take approximately 2 weeks to begin solidifying after the surgery, but they don’t reach their full strength until 2 to 3 months post-surgery.
Your surgeon will schedule follow-up sessions to evaluate the progress of your healing.
How soon can you see revision rhinoplasty results?
Within a span of 3 to 4 months, the majority of the swelling in the top third of your nose should have diminished, giving you a fairly accurate sense of the size and shape of your newly altered nose.
Between 6 to 8 months, 90% of the swelling should have subsided.
Nevertheless, it requires at least a year, and sometimes up to 3, for the swelling to fully dissipate and for the nasal tissue to set in its final position. Only then will the final outcome of your revision rhinoplasty be visible.
Once the healing process is entirely complete, your results should be long-lasting, except for the natural changes that occur with aging.
Sources & Studies
de Souza, TSC, Patrial, MTCR de O, Meneguetti, AFC, de Souza, MSC, Meneguetti, ME & Rossato, VF 2020, ‘Body Dysmorphic Disorder in Rhinoplasty Candidates: Prevalence and Functional Correlations’, Aesthetic Plastic Surgery, vol. 45, no. 2, pp. 641–648, viewed 3 August 2023, <https://pubmed.ncbi.nlm.nih.gov/32875438/>.