Ask the Expert: Revision Rhinoplasty [Q&A]

Dr. Angela Sturm shares her insight on frequently asked questions about getting revision rhinoplasty including what you should look for in a surgeon and how many nasal surgeries one can safely have.

Q. I had a rhinoplasty 20 years ago and have noticed that the shape has changed since then. Is this normal?

A. The nose does change over time. Naturally as we age, the nose itself does not grow, but the ligaments between the cartilages become looser causing the nose to look wider and tip to turn up less.

The changes can vary in people who have had previous nasal surgery depending on the techniques that were used and the patient’s cartilage and skin. The rhinoplasty techniques 20 years ago included removing cartilage to achieve the desired look—this worked short term. However, as the skin contracts around the smaller underlying skeleton over many years, the nose can become shorter, more upturned and have sharp edges on the tip, among other things.

Alternatively, the nose can lose support making the tip droop and bridge dip in or “saddle.” The rhinoplasty techniques have changed from reductive to rearranging and using the cartilage that you have to retain the strength and appearance for much longer.

Q. Is it safe to have another nasal surgery if I am not happy with the way it looks now?

A. Revison rhinoplasty is a safe procedure to address the previously discussed changes. You may need additional cartilage to rebuild the nasal structure—this can come from the septum, inside the nose, the ear or the rib. Depending on what is needed, your surgeon can discuss the options with you.

Keep in mind that revision rhinoplasty is a complicated procedure with many factors including changed or missing nasal anatomy, changed or scarred skin and possibly limited cartilage available for grafting, if this has already been taken during the previous surgery.

Q. If I had a surgery recently and am not happy with the results, how soon can I have a revision surgery?

A. You want to wait at least a year before having a revision surgery on your nose since the skin and soft tissue are swollen for about a year after surgery. This limits mobility of the tissue and optimal healing. Furthermore, you do not want to miss the opportunity to smooth out any irregularities that could be obscured by starting with swollen tissues.

Q. How many nasal surgeries can a person safely have?

A. There is not a magic number that you shouldn’t exceed, but each surgery does add a level of complexity due to change in anatomy and scarring. So, make sure that you seek out and research a surgeon who specializes in rhinoplasty and revision rhinoplasty.

Q. What should I look for in a revision rhinoplasty surgeon?

A. Revision rhinoplasty is a complex surgery that requires extensive knowledge of not only the anatomy that is there but the anatomy that should be there, how to reconstruct the nose, how the underlying cartilage will look with your type of skin (thick vs. thin) and how the tissues usually heal over the course of a year, 5 years and 20 years so that the nose will continue to look good. Therefore, you should do research to find someone who specializes in rhinoplasty and revision rhinoplasty, has a bedside manner that you click with and critically evaluates their own outcomes to continuously better themselves.

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