Revision Rhinoplasty

Of the many patients that come to Dr. Swartout for consultation, some have had prior nose surgery by other physicians and are unhappy with the results. During the early postoperative period the results may have been favorable, but over time certain changes can occur. Bumps or irregularities can develop, the nose can pinch, and sometimes the nose can become more crooked. Frequently the breathing will worsen as well.

Functional = Breathing

Most patients presenting for correction following a prior rhinoplasty have some sort of functional deficit, meaning a decreased ability to move air through the nostrils. Often, the purpose of the original surgery was to improve breathing, but after the surgery the breathing has actually gotten worse.

There is much discussion of nasal septal deviation, and this may be a factor, but it may by only one of the factors. Another common reason why a nose may be blocked is if there is insufficient support in the nasal valve area. The nasal valves are the narrowest areas in the nose and can be prone to collapse. Although the nostrils may be of sufficient size at rest, with a moderate inspiration of air, the nostril or deeper areas in the nose may collapse. This indicates that there is not enough support in the nose. This is best diagnosed with a physical exam where an instrument is used to support the different distinct areas within the nose and checking improvement in air flow.

Another possible reason why the nose may be blocked is swollen soft tissue on the inside of the nose. This swelling may relate to allergies or environmental sensitivity. This kind of blockage may not be consistent throughout the day, and may switch from side to side. This is best diagnosed with a physical exam by a physician looking inside the nose and may be improved with medical therapy.

Question:

I had a nose job when I was a teenager, and now, 15 years later, my nose looks pinched and I can't breathe. Can you help me?

Answer:

Some rhinoplasty techniques used in the past were successful at creating a narrowing nose during the initial post operative period, but, unfortunately, as the nose healed and the swelling subsided, the nose became too narrow and the inside became pinched and obstructed. Typically, this pinching and nasal obstruction gets worse over time. The goals of any revision rhinoplasty would be to strengthen the supportive structure of your nose and try to restore normal function. Of course, this would depend on the exact nature of your obstruction and would require a complete physical exam.


Question:

I have heard about patients needing a rib graft for a nose surgery. How does that work?

Answer:

Sometimes, because of the surgery that was done before, there is not enough cartilage inside the nose to build an adequate nasal structure to create a healthy breathing, normal looking nose. When this is the case, additional cartilage will need to be taken from another part of the body. Sometimes a small piece of cartilage can be taken from the ear, but when more material is needed the rib can be used.

The ribs are made of bone on the back and on the sides, but in the front, they are made of cartilage. I make a small (1.25 inch) incision in the bottom of the right breast and remove a small section of cartilage. I take this cartilage and carve thin, delicate sheets of cartilage to replace the cartilage removed from prior surgery and to reinforce the structure of the nose.

After the surgery, the area can be a little sore for the first week. It typically heals quickly with a thin scar (about 1.25 inches long) hidden in the crease under the right breast.

Question:

I had a rhinoplasty 10 years ago and now an area on the bridge of my nose turns red in the cold. Why?

Answer:

Sometimes during a rhinoplasty the skin is injured and this area of skin heals with increased blood vessels. This thin, vascular area is prone to redness or sometimes even pain in the cold. When the skin has been thinned it can also reveal some irregularities in the bone or cartilage underneath, giving an operated appearance. Frequently this can be improved at the time of the revision by smoothing the underlying cartilage and bone, and by placing some soft tissue directly underneath this thin region.