Revision rhinoplasty, Secondary rhinoplasty, rhinoplasty expert Maryland, Virginia, Washington DC, New York , Pennsylvania |
If you are seeking a revision rhinoplasty then you are not alone. At least 10% of all patients who have undergone rhinoplasty undergo a secondary procedure to acheive their desired result." The best revision rhinoplasty surgery everperformed was the one that was never done" That is to say, it is best to get it right suring the first surgery. Most of the time, when the primary rhinoplasty is performed by an experienced facial plastic surgeon, only minor touch up surgery is needed to further refine your results. However in some cases, major revision nasal surgery is needed and slight changes are just not enough. If this is your case, then you have come to the right place. First educate yourself about revision rhinoplasty before undergoing another nasal surgery. | Common reasons for revision rhinoplasty |
- an over-operated, unnatural looking nose
- collapsed and obstructed nose.
- breathing difficulty
- overly up-turned nose
- assymetric, twisted, disproportionate nose
- no facial balance
- nasal tip problems
- nose remains too wide
- nose too thin
- crooked nose
- nostril assymmetry
- undesirable scars
- too pinched
- lost of ethnic features
- infected or exposed implant
| Understanding the basics of rhinoplasty |
In a simplified way, the nose is made up of an internal mucosal lining, a supporting structure of cartilage and bone and an outer lining of skin and muscle. Most changes done in rhinoplasty are made by altering the shape of the underlying nasal cartilages and nasal bone. Occasionally the skin requires some minor alteration. Over time, the nasal skin adapts to the restructured cartilage and bone. Minor changes to the structure of the nose — often measured in millimeters — can make a large difference in how your nose looks. It can take up to one year for your final result to show. The nasal cartilages and bones provide structural support to the nose preventing nasal collapse during breathing. Thus, overzealous violation of these structural elements without compensatory techniques often results in a bad nose job that requires revision. The nasal skin can be thin or thick. Thin skin adapts quicker and better to alterations made to the underlying nasal bone and cartilages. Individuals with thin nasal skin will see their final results quicker as swelling and adaptation occurs faster. One disadvantage with the thin nasal skin is that any irregularities in the nasal structure is also obvious and difficult to hide. Patients with thicker skin have slower healing and skin adaptation but they hide any irregularies better. Thicker skin needs more structural support therefore overzealous alteration of the cartilages without compensatory measures will eventually lead to an amorphous nose that just does not work well. It is not too uncommon to have people tell us that their rhinoplasty looked great for 6 months then things begun to change. To avoid these predictible changes of wound healing and the need for major rhinoplasty revisions, we carefully evalaute each patient to determine their nasal skin type, nasal bone structure and strength of their nasal cartilage. We have found that creating highlights and shawdow points on the nose by reshaping the nasal cartilage and bones and actually adding more structure provides an natural looking, balanced result that withstands the forces of wound healing. Cutting stuff out are not always necessary to acheive the desired result.
|  Dr. Boahene was the opening speaker at this international conference of Plastic surgeons in Lima , Peru. Theconference attracted partipants from Europe, Latin America and North America. Dr.Boahene's presentation was titled" Tip rhinoplasty: creating shadows and highligths"He emphasized techniques that created a natural looking rhinoplastyresults by reshaping native cartilage.This approach minimizes the need for major revision rhinoplasty Contact Dr. Boahene for a revision rhinoplasty consultation 410. 502. 2145 | |
|---|
|
| Case examples showing major revision rhinoplasty |
 African American female who presented interested in revision rhinoplasty. The nasal tip is bulbous and without definition after 2 previous rhinoplasties perfomed by another surgeon. |  Abnormally shaped nasal tip cartilages found during revision rhinoplasty. Too much cartilage had been removed and the remaining cartilage was also misshapen. Removal of excess cartillage in an attempt to make a thin nose leaves the nasal tip with inadquate strenght and shape to allow sculpting of the think nasal skin as seen in this patient. This is a classic error made in african American rhinoplasty | Excessive scar encountered during the revision rhinoplasty. We debulked the nasal tip extensively | Through a 1.5 incision hidden in the breast crease, a small piece of rib cartilage was harvested and used in the revision rhinoplasty. We prefer to use cartilage from within the nose (septal cartilage) for our rhinoplasty cases. In revision cases where septal cartilage is absent, we prefer to use rib cartilage grafts. We occasionally use ear cartilage grafts. | We have rebuilt the tip cartilages replacing the missing parts with carved rib cartilage. We recreated the septum adding more strength and support . Now the thick nasal skin can adapt to the cartilages. In this case, to refine the nasal tip, we created a new pocket for the tip cartilages, rotating them inferiorly ( caudal rotation of cephalic malpositioned cartilages). |  Reconstructed tip cartilages now placed in a more natural position, restoring strenght to the amorphous tip. Compare this shape to that of the picture above.We measured the patients skin thickness as 1.5mm. We established that the desire nasal tip width that will look natural based on her facial features will be 8mm. Based on this the tip cartilages are placed 5mm apart. 5 mm with 1.5 mm thick skin on both sides will yeild a 8mm wide tip with slight variation based on swelling and scarring.Revision rhinoplasty requires careful analysis and planning. |
| |