In Office Correction and Revision Options?

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

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.