In Office Correction and Revision Options?

Question

What kind of corrections/procedures can be done after rhinoplasty and how soon after the the first surgery? Can bones be re-adjusted, cartilage added, etc.? What can a surgeon correct and do in the office vs. operating room without having to actually do full revision and after first rhinoplasty? At what point do you feel that a revision is necessary if it’s your own client/work that didn't turn out as well as you expect it?

Kenneth Hughes, MD · Answer

I would agree that 6 months is the minimum.  If a patient has concerns about the tip, I would wait 1 year.  You would likely need general anesthesia or at least sedation if osteotomies need to be performed.  Other revisions may be performed under local anesthesia.

Paul S. Nassif, MD · Answer

In general, it is best to wait around one year before considering any revision surgery. Sometimes a touch up can be performed sooner if there is no tip work involved. The extent of the revision really depends on the individual circumstances of the patient and what they need in order to obtain the desired result, as every patient heals differently. An in-person exam would be necessary to determine if the patient is a candidate for a revision. I hope this helps, and best of luck!

Richard H. Tholen, MD, FACS · Answer

If your rhinoplasty surgeon is an ABPS-certified plastic surgeon who operates in an office surgical facility, the facility MUST be AAAASF accredited as a condition of maintaining our board certification and American Society of Plastic Surgeons membership. A reclining exam chair, local anesthesia, and a pair of gloves are NOT appropriate venues for revision rhinoplasty--one of the most challenging and difficult plastic surgical procedures to get right!

	Nasal bones can be repositioned for about 10-14 days, but are done so at the peril of swelling preventing accurate repositioning. This is why the splint must be left in place and not disturbed after rhinoplasty surgery, lest the proper position or healing be damaged. Get it right the first time; that way, after the splint is removed there will be only very rare cases where things don't look right and re-operation is considered.

	If excessive scar tissue is noted beneath the skin surface, conservative and judicious steroid injections can help to soften and diminish abnormal scar protrusion(s). This must be careful and low-dose/minimal concentration so as to avoid excessive thinning of the nasal skin! I generally consider this safe no sooner than 6-8 weeks after surgery.

	Regardless of the reason for considering re-operation on a rhinoplasty patient, and whether or not the patient is mine or another surgeon's, I recommend waiting a minimum of 6 months, and usually 12 months, for the most safe re-operation, and the highest likelihood of success.

	Of course, if the patient is my own rhinoplasty patient who requests or requires revisionary surgery, there is no surgeon's fee; secondary surgery is performed for OR and anesthesia fees only (and those at my AAAASF-accredited office surgical facility are far lower than those at a hospital or outpatient or hospital-affiliated surgicenter). (The cost for re-operating on another surgeon's patient is actually higher than for primary--first-time--rhinoplasty.)

	Secondary surgery should not be considered a "minor" touch-up operation; it is often more difficult because of prior scar tissue, requires even more finesse and skill, and is best done as a "real" operation under full anesthesia in a "real" operating room! Anything "less" (exam chair surgery) is often an effort to "get by" rather than achieve what was not accomplished at the first (easier) operation! In my opinion, secondary rhinoplasty should ALWAYS be done in an operating room under full anesthesia to allow the most precise surgery. Best wishes! Dr. Tholen

Ahmed Abdullah, MD, FACS · Answer

I do not recommend doing any re-surgical intervention for at least one year after the first surgery. This gives the tissues the maximum time needed to mature and soften, such that tissue manipulation is easily possible. All tissues can be readjusted, including cartilage, bone and soft tissue. Depending on the extent and complexity of the revision needed it can be determined where to perform the surgery. Most major tip or dorsum revisions require a full secondary rhinoplasty done under anesthesia requiring a full operating room. Lesser nasal alar and minor dorsal or septal revisions may be done in the clinic under local anesthesia.

Robert Kotler, MD, FACS · Answer

Hi there, Chicago friend, again.

	You may be a candidate for non-surgical revision rhinoplasty. Also known as injection revision rhinoplasty or as one patient called it: rhinoplasty rescue".

	Sometimes, very appropriate and economical to have an office touch-up using injections.

	There are shrinkers and fillers available.

	Only at consultation can the best decision be made.

	Check out the possibilties; I have been doing those for 40 years and many people are so grateful to have the outcome they want without yet another surgery.

	Best wishes.

	Robert Kotler, MD, FACS

	Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON and

	             THE ESSENTIAL COSMETIC SURGERY COMPANION.

In Office Correction and Revision Options?

Answers (10)

Answer: Revision rhinoplasty information

Answer: Revision rhinoplasty information

Answer: Consider Non-Surgical Revision Rhinoplasty

Answer: Consider Non-Surgical Revision Rhinoplasty

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Everything you need to know about Rhinoplasty

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In Office Correction and Revision Options?

Answers (10)

Answer: Revision rhinoplasty information

Answer: Revision rhinoplasty information

Answer: Consider Non-Surgical Revision Rhinoplasty

Answer: Consider Non-Surgical Revision Rhinoplasty

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Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.