Revision rhinoplasty is a unique and specialized operation that involves correcting aesthetic and functional issues that persist despite of, or because of, prior nasal surgery. Revision rhinoplasty is the most challenging of all plastic surgical operations, and a successful outcome requires a very experienced surgeon who has a passion for this type of work. Dr. Frankel is renowned among the medical community for his revision rhinoplasty expertise.
Contact us to schedule a consultation for revision rhinoplasty surgery.
Table of Contents
Consultation and Planning
Dr. Frankel understands what a big step it is to undergo a revision rhinoplasty and he does his best to set expectations and to inform his patients of his detailed plan. He invests the time to learn a complete history, review prior operative reports, evaluate the inside and outside of the nose, and take digital images.
Dr. Frankel will discuss the cosmetic and functional expectations of your rhinoplasty in detail to ensure all your questions are answered. Pre-operative computer imaging, or “photo-morphing,” is performed with all rhinoplasty patients before surgery, so they may have an active role in determining the desired outcome.
Surgical Process
The surgery is performed at the Lasky Clinic Surgical Center under twilight anesthesia. Procedures can vary widely depending on patient goals and how much scar tissue and distortion of the underlying anatomy is present. Revision rhinoplasty cases often require grafting cartilage to reestablish structure and to replace cartilage that has previously been removed or weakened.
Both open and closed approaches are utilized, depending on the situation and the patient’s anatomy, and will be discussed with Dr. Frankel before surgery.
Revision Rhinoplasty Procedure
Preparing for Revision Rhinoplasty
Preoperative requirements
The doctor is thorough and places patient safety as his top priority while carrying out a treatment plan, which is why he has set a standard for preoperative requirements. Dr. Frankel requests that each patient have blood work done, and his staff can facilitate a quick workup to be delivered directly to his office. In addition, patients 45 years of age or older must be medically cleared for surgery through a physical examination, an EKG, and an assessment of their medical history. Patients who are 65 years of age or older have the additional requirement of having x-rays performed.
Schedule the procedure
After a patient is deemed medically healthy and able to undergo revision rhinoplasty, they can schedule the procedure. If a patient plans to travel to Beverly Hills, he or she can schedule a time to speak with the staff at Dr. Frankel’s office to learn more about local accommodations, which can also be found on the concierge services page. In addition to booking a comfortable place to stay in California, one must plan to take time off of work and other events during the healing period. Local patients should have someone accompany them to surgery and must plan to recuperate away from work and other daily activities.
Recovery Instructions
A week or so before the actual procedure, revision rhinoplasty patients should prepare for their recovery. All prescription medications written by Dr. Frankel should be filled, and other necessities for the healing process purchased. These items may vary from one patient to the next but often include a lightweight ice pack, saline nasal solution, and ways to entertain oneself while laid up. In addition to this, the patient should clean their home, or at least their recovery area. Clean bedding and extra pillows are essential to postoperative healing.
What to expect on the day of surgery
Anesthesia
The majority of all operations that Dr. Frankel performs will be under the direction of a board-certified anesthesiologist, and involve twilight anesthesia without the need for a breathing tube, ventilator or paralysis.
Even in surgeries taking several hours, the anesthetic is well tolerated and patients wake up quickly feeling very good. The entire experience is enhanced.
Day of surgery
The first one to two hours after rhinoplasty are spent in the recovery room on monitors and under the care of a registered nurse.
Patients are transferred to private rooms once they are more awake, where their families or friends can join them. Once fully alert, patients will be able to return home with a set of post-operative instructions.
Pain management
Rhinoplasty is not typically very painful, and most patients experience more discomfort than pain, particularly immediately after surgery while the local anesthesia is still working.
While recovering at the clinic, patients may receive intravenous medications to stem any acute pain. Patients are discharged from the clinic with their prescribed medications.
Emotions
You will likely feel a variety of different emotions before your surgery: excitement, anxiety, fear, etc. It is normal to have some apprehension before any operation, and in particular one that will change your appearance.
If you are questioning things, Dr. Frankel suggests that you trust yourself and the time and effort you spent making the decision to have surgery and choosing the best doctor.
What to expect after surgery
Swelling
Following surgery, a splint will be placed on the nose, both for protection and to help it maintain its new shape. The nose will be moderately swollen and stuffy for several weeks, and the remainder of the swelling will gradually resolve over the course of the next six to eighteen months.
Hydration
Sleeping with a humidifier can be helpful for the first two weeks after surgery. Once Dr. Frankel gives the go-ahead, use a nasal saline spray to help keep the inside of your nose moist. Using a saline spray will minimize crusting in your nose and will make breathing easier.
Rest and exercise
Rest for the week after surgery and avoid excessive smiling or bending over. Most patients can drive a car and return to work and social activities after eight days. Avoid strenuous/extreme physical exercise for three weeks, and contact sports should be avoided for eight weeks.
Recovery
Every patient heals differently. If you notice that a particular behavior or activity is causing swelling, do your best to avoid that activity until you have healed. Physical recovery from the surgery is fairly quick, but the nose will not achieve its final form for well over a year.
Revision Rhinoplasty FAQs
What is revision rhinoplasty?
Revision rhinoplasty is a surgical procedure designed to repair problems of form and function of the nose that have resulted from previous rhinoplasty procedures.
How do I know if I’m a good candidate for revision rhinoplasty?
Men and women who are physically healthy, realistic in their expectations and looking to improve the results of a previous rhinoplasty procedure may be good candidates for revision rhinoplasty.
Are there any age restrictions when it comes to rhinoplasty?
Rhinoplasty is best postponed on young patients until the nose has completed its growth. In general, this tends to occur around the age of 14 or 15 for girls and a bit later for boys.
What can I expect during a consultation for revision rhinoplasty?
During a consultation, there is an in-depth discussion with the patient about his/her desires and previous procedure(s). There is a pre-operative evaluation of the nose and the overall facial balance. Computer imaging may also be used.
Where can revision rhinoplasty be performed?
Revision rhinoplasty often takes place in a free-standing ambulatory surgery center or a surgeon’s office-based facility, such as the Lasky Clinic. Some cases may be performed in a hospital.
What type of anesthesia is used for revision rhinoplasty?
Revision rhinoplasty is usually performed with either general anesthesia or a combination of local anesthesia and sedation.
How is revision rhinoplasty performed?
Once the anesthesia is administered, the incisions are made and the skin of the nose is separated from the underlying bone and cartilage. Depending upon the particular case, cartilage may be repositioned or missing structures may be replaced. When the desired shape is achieved, the skin is pulled back down and the incisions are closed.
How long does the actual revision rhinoplasty procedure last?
Primary rhinoplasty tends to take between one and two hours to perform and revision rhinoplasty typically takes longer.
Where are the incisions made for revision rhinoplasty?
For revision rhinoplasty, the incisions may be confined solely to the inside of the nose or an additional small incision may be made under the tip of the nose. When the incisions are confined to the inside of the nose, the procedure is referred to as closed rhinoplasty, whereas procedures involving an incision under the tip of the nose are referred to as open rhinoplasty.
Does revision rhinoplasty result in scars?
With closed rhinoplasty procedures, in which the incisions are confined to the inside of the nose, there will be no visible scarring. With open rhinoplasty, in which an additional small incision is made under the tip of the nose, a small, fine-line scar will result though it is well-concealed and will fade with time.
Is revision rhinoplasty a painful procedure?
Revision rhinoplasty tends to involve less pain, as well as less bruising, than primary rhinoplasty procedures. Patients can be prescribed pain medication to help alleviate any discomfort that they may feel.
Will I be able to drive myself home after my revision rhinoplasty procedure?
No, you will need to have a family member or friend drive you home.
Will I need someone to stay with me after my revision rhinoplasty procedure and help me out?
It’s often a good idea to have a family member or friend accompany you to surgery and to your home or your place of recovery for the evening.
What sort of recovery can I expect after revision rhinoplasty?
Revision rhinoplasty is usually a less painful procedure than primary rhinoplasty and often involves less bruising as well. Most of the bruising that patients experience will have faded by about the tenth day. Swelling is also common and this can take months to fully fade. The splint and stitches will be removed within about six to seven days. Patients are typically able to return to work within about a week, though strenuous activities will need to be postponed for about two to three weeks. Patients should also avoid bumping or jarring the nose or getting a sunburn for eight weeks.
When will I be able to go back to work after my revision rhinoplasty procedure?
Patients are typically able to return to work within about a week after their revision rhinoplasty procedure.
When can I exercise after my revision rhinoplasty procedure?
To prevent bleeding and increased swelling, avoid extreme physical activity, including athletic activities and intercourse. After 24 hours, you are encouraged to go for light walks and strolls. Light cardio, such as an elliptical machine or spin bike on a low resistance can begin on post-operative day seven (7). Do not engage in any heavy cardiovascular activity (running), any activity that involves straining (weight lifting) or anything that involves bending over (yoga, pilates) for at least three (3) weeks, unless otherwise instructed.
When are the stitches removed after revision rhinoplasty?
The stitches are usually removed within about six to seven days after revision rhinoplasty.
What are the risks or complications that can occur with revision rhinoplasty?
Some of the potential complications associated with revision rhinoplasty may include adverse anesthesia reactions, excessive scarring, prolonged swelling, pulling of the nose to one side, small burst blood vessels and the need for additional surgery.
Is revision rhinoplasty covered by insurance?
Procedures which are performed to repair functions of the nose, such as breathing, may be covered to some degree. However, procedures which are solely cosmetic are typically not covered by insurance.
Is financing available for revision rhinoplasty?
Yes, we offer financing for surgery. We accept Care Credit, Alphaeon Financing, and VISA and MasterCard.
Are there medications that I will need to avoid before my surgery?
As with any surgery, there are certain medications, vitamins and herbs that should be avoided beforehand, as they can cause you to bleed more than normal. These should generally be stopped two weeks prior to surgery, and your doctor should provide you with a list of these medications.
Revision Rhinoplasty Candidates
Unexpected Outcome
After a patient has fully healed from rhinoplasty surgery, he or she may feel that the surgery did not meet initial expectations. When the aesthetics of the nose disappoint a patient, they may ask their original surgeon for a redo, or visit a specialist surgeon like Dr. Andrew Frankel to improve the shape of the nose. Dated surgical practices or inexperienced doctors can create less-than-pleasing results with poor or inadequate cosmetic corrections. In other instances, the patient may not have fully explained their goals for the surgical outcome, and therefore feel dissatisfied with the results. When doctor and patient expectations do not fully align, a revision or secondary rhinoplasty may remedy a previous surgery.
Healing Complications
After rhinoplasty surgery, a patient may feel that the nose is more swollen or discolored, or feels more painful, than expected from details discussed during the consultation. These symptoms can signal infection or an issue with the healing process. Any trauma to the nose following surgery can also create a flawed recovery period where the nose may need additional surgical correction. Revision rhinoplasty can treat issues such as an overabundance of scar tissue or a collapsed septum that interferes with regular breathing. Other issues such as irritation and soreness may be addressed with prescription medications, such as those for anti-inflammatory and antibiotic purposes.
Different Aesthetic Ideals
Most patients seeking rhinoplasty have a specific vision of how they would like their nose to look. It is through photo imaging that patients have the ability to see potential results of rhinoplasty before they undergo the surgery. Careful planning in addition to this demonstration leads to the success in many patient procedures; however, some may feel differently about their plans once the results of a nose surgery have healed. Revision rhinoplasty can be performed when one wishes to change the look of the nose for a second time. This measure is taken to ensure patient satisfaction, but numerous surgeries to the nose for cosmetic purposes can be an indication of a serious psychological disorder.