Revision Rhinoplasty Surgeon

Revision rhinoplasty is a type of corrective surgery performed on patients who have had previous rhinoplasty or septoplasty from another surgeon. Revision rhinoplasty addresses the aesthetic and/or functional aspects of the nose.  Unlike initial rhinoplasty or nose surgery, revision of a bad nose job or unsatisfactory result after rhinoplasty is a much more difficult operation.  Scar tissue makes the dissection of the nose much more challenging and cartilage can be very weak and scarce. 

Houston facial plastic surgeon, Dr. Etai Funk, understands that patients who feel they may have had a bad nose job can lead to many discouraging feelings. Whether you have a pinched tip, collapsed cartilage, or slooped nose after rhinoplasty, Dr. Funk specializes in revision rhinoplasty and receives multiple consultations from referring physicians, patients, and their families throughout Houston and all over Texas for this purpose. If he feels as though improvement is possible with revision rhinoplasty, he works with you to provide you not only with a pleasing result, but a memorable and enjoyable surgical course.

Aside from aesthetic purposes, many revision rhinoplasty patients complain of difficulty breathing after their initial rhinoplasty or nose job surgery. This may be due to over-resection of cartilage in the tip or valve collapse leading to obstruction of the nasal airway. In addition, a deviated septum or turbinate hypertophy may not have been addressed during the first surgery leading to continued difficulty breathing. Dr. Funk is Double Board Certified as a facial plastic surgeon and ENT surgeon and is experienced in performing revision rhinoplasties for both cosmetic and functional purposes.

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Revision Rhinoplasty Surgery Process

Consultation

When visiting our Houston office for a revision rhinoplasty consultation, you will meet with Dr. Funk to discuss your concerns regarding your nose after your previous surgery(s).  Dr. Funk will focus on your functional breathing issues, what you did not like about the previous surgery, and what your major cosmetic concerns are since your last procedure. 

Dr. Funk will then examine your nose on the inside and out.  He may need to pass a camera inside your nose and assess your septum to assure you still have some cartilage there for grafting purposes.  Photographs will be taken and you and Dr. Funk will sit in his office reviewing these photographs and making digital changes to provide an approximation of what revision rhinoplasty can achieve.    You and Dr. Funk will review before and after photos of revision rhinoplasty patients who have had surgery with Dr. Funk.  Once all your questions are answered, you will meet with our patient care coordinator to review the quote for revision rhinoplasty.  This may take insurance into consideration if you have functional breathing issues. 

Preoperative Appointment

Your preoperative appointment will usually occur the day prior to surgery.  On this day, you will meet with Dr. Funk once more to re-discuss your goals for the surgery, review risks of revision rhinoplasty, and discuss some of the healing processes.  The majority of the time will be spent with the patient care coordinator who will discuss preoperative and postoperative care.  They will review what you can expect after surgery, things that may cause concern, and what should appear as normal healing versus abnormal.  Your final payment will also be collected at this time.

Day of Surgery/Procedure

On the day of your revision rhinoplasty surgery, you will check-in at the facility and then move on to the preop area.  There you will change into a surgical gown and have an IV started.  Consent forms will be signed and you will meet the surgical team.  You will then move on to the operating room.  Your revision rhinoplasty will be performed in Houston usually at a surgery center.  Dr. Funk typically performs his rhinoplasty under general anesthesia.  Revision rhinoplasty usually takes between 2-3 hours depending on the amount of work.  You will be taken to the recovery room after surgery.   

Recovery

Recovery after revision rhinoplasty depends on the extent of work that is required.  Revision rhinoplasty is not a painful procedure but described more as uncomfortable.  Patients feel very congested during the first few days and this slowly improves.  Patients are social after 8-10 days and able to return to a full work-out routine at 2 weeks.  Swelling is definitely more prolonged in revision rhinoplasty than primary rhinoplasty.  10% of swelling is down at 3-4 weeks, 30% at 8 weeks, but it will take a full 1.5 years for all the swelling to subside.    

 

How many rhinoplasty surgeries can I have?

There are no finite amounts of rhinoplasty surgeries a patient can have. However, after each rhinoplasty, there is more scar tissue present which can make the surgery more difficult.  At times, a decision has to be made as to whether another rhinoplasty surgery will make an improvement.  During the consultation, Dr. Funk will evaluate your nose and concerns.  He will discuss what can be improved and what areas of the nose cannot.  

Why is revision rhinoplasty more difficult than primary rhinoplasty?

Revision rhinoplasty requires the surgeon to get through a considerable amount of scar tissue and deal with a previously operated nose. This can be considerably difficult. The nasal skin may be quite adherent to the residual cartilage. This cartilage may also be weak and collapsed. There may not be suffiicient cartilage left in the septum for grafting purposes which may lead to the need for ear or rib cartilage. The healing process is quite different as now there is a new layer of scar forming on top of an old layer of scar. This may lead to more unpredictabliity regarding how the nose heals. Lastly, there may be functional compromise or breathing issues with the nose after the previous rhinoplasty or nose job that will need to be fixed with revision rhinoplasty.

Do I have a pollybeak after rhinoplasty?

A pollybeak deformity occurs in the area just above the tip defining point of the nose.  This typically occurs after rhinoplasty when not enough cartilage was taken down in this area or if excessive scar tissue built up in this region.  Thicker skinned patients may be more prone to developing a pollybeak deformity after nose surgery or a nose job.

I am unhappy with my result but am concerned about worsening things with another nose surgery.

Nose surgery or rhinoplasty is not a painful surgery, but is an uncomfortable one.  No one wants to have to go through the discomfort of another surgery.  After a poor result from a nose job, you may become skeptical of the plastic surgery experience and plastic surgeons or facial plastic surgeons in general.  Understandably so!  It takes a lot of courage to see a surgeon for a revision surgery.  Your first step is making that appointment with a credible, board certified surgeon who is well versed and experienced in revision rhinoplasty surgery. 

Why does my tip look twisted after rhinoplasty?

Rhinoplasty is an extremely difficult operation.  You are dealing with a three-dimensional object composed of both cartilage, bone, and soft tissue.  Function and form must be accounted for and a natural result is essential.  The nasal tip cartilages can become particularly twisted and knuckled after nose surgery and frequently must be completely reconfigured to an even and symmetric nasal tip.  The patient below underwent revision rhinoplasty after a previous nose surgery left her nasal tip quite uneven and irregular.  Notice the more symmetric nose with better lines and a natural unoperated result.

What is revision rhinoplasty?

Revision rhinoplasty is a surgical procedure performed to enhance the appearance of the nose or the nasal airway after the nose has already been operated on. Patients may feel they had a "bad nose job" or are unhappy with their rhinoplasty results. 

Is revision rhinoplasty harder than primary rhinoplasty or my first surgery?

Yes. Revision rhinoplasty is more difficult than primary rhinoplasty for numerous reasons. After the initial surgery, there is scarring that is formed between the skin and the bony and cartilage framework of the nose. This makes for a more difficult dissection during rhinoplasty and more unpredictable healing. In addition, during the first surgery, septal cartilage may have been taken and used for grafting purposes. In this case, residual septal cartilage may be insufficient or unstable for the revision rhinoplasty. Ear cartilage or rib cartilage may need to be used for revision rhinoplasty.

How long after my first rhinoplasty can I have my revision rhinoplasty?

Typically it takes a full year for the nose to completely heal and the swelling to subside after rhinoplasty. However, some patients with very thick skin may take 1.5-2 years until there swelling subsides. Dr. Funk will perform a thorough evaluation to assess your nose and decide if you are ready for revision rhinoplasty.

Am I a good candidate for revision rhinoplasty?

If you are unhappy with the appearance of your nose after nasal surgery or perhaps cannot breathe after rhinoplasty, you may be a candidate for revision nasal surgery. Dr Funk will evaluate the external appearance of your nose and assess whether he feels that he may be able to provide an approvement on the appearance of your nose. If your breathing is an issue, this can typically be corrected by treating a residual or recurring deviated nasal septum, the nasal valves, or the turbinates.

I can't breathe after rhinoplasty. Can revision rhinoplasty fix my breathing?

Difficulty breathing after rhinoplasty can be due to numerous anatomical or healing concerns. A deviated septum may not have been addressed or the deviation to the septum may have returned and lost its correction. Another major cause of nasal airway obstruction after rhinoplasty or nose job is nasal valve collapse. If the internal nasal valve and external nasal valve are not respected, supported, or treated during surgery, this can lead to nasal vavle insufficiency.

Dr. Funk performs many revision septoplasties and rhinoplasties in which the nasal valve was not addressed in order to improve nasal breathing. Lastly, the turbinates may be enlarged. These are structures that act to humidify and moisten the air as it passes through the inside of the nose. Somes inferior turbinates need to be made smaller in order to allow greater passage of air through the nose. For Houston patients, more of the turbinates can be reduced during rhinoplasty due to the humid climate.

Will I need ear cartilage or rib cartilage for my revision rhinoplasty?

Ear cartilage or rib cartilage may be needed for grafts during revision rhinoplasty. Depending on the presence and amount of residual septal cartilage, these other sources of cartilage are frequently necessary to provide structural integrity back to the nose.

Removing ear cartilage for revision rhinoplasty will NOT alter the shape of the ear. Post operatively there is minimal pain from the ear and there are no stitches to be removed.

Rib cartilage for revision rhinoplasty (costal cartilage) requires a small incision in the fold under the breast or chest. The scar heals extremely well in this fold and is hidden by the bra/bikini in women. The pain is well tolerated post-operatively.  If your own rib cartilage is not suitable or your do not desire this, another option is cadaveric irradiated rib cartilage.