The 6 Big Worries People Have Before Revision Rhinoplasty

Dr. DeBusk (00:08):
Welcome to Behind the Double Doors. I'm Dr. Taylor DeBusk. Today on Behind the Double Doors. We're talking about the things that revision rhinoplasty patients worry about the most. These concerns are often different than the first surgery. So let's talk through these. If you've had an initial rhinoplasty and the results don't look exactly like the way that you anticipated them to, I tell people not to wait until you hit at least that 12 month mark. It takes a long time for a lot of the swelling, one to go down, and then two for the skin to complete its wound healing or the contracture around the underlying nasal framework, and you don't really see the final result until you hit 12 months up to 18 months after surgery. Some of the skin on the nose or the thin skin on the nose is on the nasal bridge, and sometimes you get asymmetric resolution of that swelling.

(01:00):
So at times, the nose can look crooked or the nose looks too wide. But that's all because of the illusion of the residual swelling. Casting these shadows, making the nose look asymmetric because after rhinoplasty surgery, you're much more acutely aware of any little subtle asymmetries. So some of the most common reasons patients seek a revision rhinoplasty is just subtle asymmetries or gross asymmetries of the nasal bridge of the tip of the nose. If you develop excess scar causing buckling of the nasal tip or rounding, or also known as the poly beak deformity, as well as a myriad of functional problems or issues that can result from either improper rhinoplasty technique or just the inadvertent development of excessive scar. One of the few complications or reasons to have a revision rhinoplasty before that 12 month time span is if you develop what's called a saddle nose deformity.

(02:03):
So what is that? So the bridge of the nose is part bone, part cartilage. If a surgeon over resect the cartilage in the bridge of the nose, the bridge can sink and it kind of looks like a saddle. The reason that you'd want to intervene early is because as the soft tissue heals, it contracts down and develops more severe or significant scar. So if you intervene or re-operate and put strong structural cartilage or bone and cartilage to prevent worsening of the saddle nose deformity, it will result in a better long-term outcome, both aesthetic and functional with revision surgery. Also, I always talk to patients about the need for extra tissue, whether that's soft tissue like fascia or fat, or if that's more structural tissue like cartilage or bone. I always talk about the need for ear cartilage or the bowl of the ear. I use that with some frequency to rebuild the structural component of the nose.

(03:08):
But in revision rhinoplasty, I always talk about rib cartilage, whether that's their own rib or if it's donor rib. The reason that I really like this is because it's strong, very sturdy cartilage, as well as relatively long pieces so that you can rebuild that underlying framework of the nose and ensure that, number one, the nose will have a good aesthetic result as well as a good functional result. Because again, as we always talk about, you want to build the nose on a strong structural foundation or framework, and you can obtain or achieve that using donor rib. Some patients also need revision rhinoplasty surgery strictly for functional reasons or concerns. Then most of these patients I also recommend waiting at least 12 months because the functional issue with the nose can be very complex. You can have issues with the septum itself with some of the valves on the inside of the nose.

(04:08):
You can have issues with scarring, which can be very common, especially if you have a lot of manipulation of the turbinates, which are structures on the inside of the nose that can cause nasal obstruction. So again, with rhinoplasty, it's extremely complex, and I always try to tell the patients to be patient because some of these issues can resolve on their own if you have a lot of swelling or anything in the postoperative period. But once you hit that 12 month timeframe, you're really getting a good sense of what your long-term result is and whether or not you need any sort of secondary intervention. So if you do a revision rhinoplasty revision surgery too soon, a few months into a few months after your initial surgery, number one, it can result in a poor aesthetic result. What that means is that your initial swelling and scar tissue have not resolved, so you don't even know what the final product's going to look like and you start to do surgery to combat some sort of asymmetry that is only temporary.

(05:13):
And then two, you're actually at an increased risk for infection because you have still a lot of residual edema and swelling from the first surgery, as well as that scar tissue and having an infection in the nose can be catastrophic. And I've personally seen this where an infection can basically melt or eat away at all the cartilage, both structural and cosmetic inside the nose, resulting in basically as just a scar ball, which is a severe complication and extremely hard to correct. Another worry patients have that I don't think you should stress or worry about is whether or not the surgeon's going to think you're a crazy patient. Like I said, the nose is the centerpiece of your face, and I think that you're warranted to have concern if there are asymmetries or are functional problems, I'd encourage patients to voice these concerns. Because again, this is the centerpiece of your face and it is a major surgery.

(06:10):
But I also always emphasize that you have to trust the process because it is takes, like I said, 12 months to really see the final result. So if you can't go back to your original surgeon for a revision rhinoplasty for any reason, you do want to go to somebody that's extremely comfortable and well-versed in both primary and revision rhinoplasty. In my training, we did hundreds of primary, as well as secondary or revision rhinoplasties, both for aesthetic and functional or combination of both. So I feel very comfortable in not only performing the surgery or procedures, but walking the patients through it, making you understand what to expect and putting a lot of your concerns or questions at ease. But I do want to emphasize revision rhinoplasty is relatively rare. It's less than one in 10 patients even need a revision rhinoplasty, and that's whether it's a small graft, a little bit of a steroid to help with some swelling, or a full on second complete revision rhinoplasty. If you're ready or you're interested in rhinoplasty, I definitely encourage you to come check us out@basuplasticsurgery.com and give us a call.

Speaker 2 (07:28):
Basu Aesthetics and Plastic Surgery is located in Northwest Houston in the Towne Lake area of Cypress. If you'd like to be a guest or ask a question for Dr. Basu to answer on the podcast, go to basu plastic surgery.com/podcast. On Instagram. Follow Dr. Basu and the team at Basu Plastic Surgery. That's B A S U Plastic Surgery. Behind the Double Doors is a production of The Axis, T H E A X I S.io.