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Revision Rhinoplasty
What is Revision Rhinoplasty?
Revision rhinoplasty is considered if the patient has had previous rhinoplasty at least one time before and wishes to undergo another procedure to improve appearance or function. Revision rhinoplasties require a level of sophistication and complexity to the surgical approaches and techniques employed to improve the aesthetic results in a more predictable and durable manner. The challenge of these procedures is the variability and unpredictability of techniques employed by different surgeons that require finesse and skill to correct. Although considered to be one of the most challenging procedures in plastic surgery, with advanced techniques using autologous grafts, patients who are left dissatisfied can look forward to reshaping and reconstructing their nose to the desired result.
Why do patients choose revision rhinoplasty?
Patients who seek revision rhinoplasty are usually left with results that affect them both physically and emotionally. The complexity of each case depends on the individual nature of the anatomy, number of revisions, and also the very personalized aesthetic unique to each patient. Suboptimal surgical results or use of certain implants can lead to physical deformities such as pollybeak, saddle nose, migration or extrusion of implants, or infection. Previous procedures can cause damage to the anatomy, buildup of scar tissue, or loss of structure support which contributes to the appearance of the nose.
What is done in a revision rhinoplasty?
Intraoperatively, the anatomy is carefully examined and dissected to separate any previously placed implants and remove any unwanted scar tissue. The foundation of the nose is carefully re-crafted for the most stable structural support that will allow for an improved aesthetic result. Rib cartilage gives the least amount of problems in regards to shaping, attachment, and infection. It is important that each cartilage graft be carefully shaped to make sure that it blends seamlessly into the nose.
Why should you just choose autologous grafts for revision rhinoplasty?
The advantage of using tissue from your own body (autologous grafts) such as rib cartilage, is that it provides a lower rate of complications - a lower chance of infection, migration and extrusion. The additional advantage is that when done well, autologous grafts will provide a more natural appearing, attractive result than a silastic implant will. Especially for projecting and refining the tip of the nose, your own tissue is a much safer and more permanent solution.
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FAQ
How many rhinoplasty revisions can you have?
The number of revisions is limited to the anatomy of the nose, skin integrity, and autologous grafts available.
How long should I wait before Revision?
The safest option is to allow the nose to heal for a full year before pursuing revision surgery. This is optimal for 2 reasons:
- The nose will have healed to the point that all the asymmetries and contour irregularities from the primary surgery will be evident and for the revision surgeon to address.
- The blood supply and nasal skin will have healed so that it can recover quickly from a revision surgery without prolonged swelling.
How do I choose a revision rhinoplasty specialist?
As a patient, it's important to be completely confident in your surgeon's abilities and abilities to provide you with the best care than it is with the specific techniques. If you have any doubt, then it may be a good idea to consult with a few revision rhinoplasty specialists to get some different perspectives.
What is the rate of revision after rhinoplasty?
A recently published study put the revision rate at 17%, but you are right, the actual rate may be even higher than that. Why is the rate so high? One of the most common reasons may be a disconnect between the patient's expectations and the surgeon's vision. Most board-certified rhinoplasty surgeons have the intellectual and technical skills to perform a rhinoplasty surgery. However, unlike other surgeries with concrete goals - like removing an appendix - rhinoplasty surgery is a complex interplay of what the patient desires, what is surgically attainable, and managing the patient's expectations.
Beyond this, the reasons are multifactorial. After seeing top surgeons, the issue of patients still requiring revisions may be due to the following.
- Healing after rhinoplasty can be unpredictable. The nose may look perfect on the operating table, but as the skin shrinks down around the nose, irregularities may be more pronounced.
- Perfection can not be achieved with rhinoplasty. Subtle asymmetries and contour irregularities will always remain, and for individuals who seek to constantly correct these things there is no limit to the number of revisions that may be performed.
How much does revision rhinoplasty cost?
This is a bit of a loaded question since so many variables exist that affect the price beyond geographical variation, surgeon, and complexity of the revision. And unfortunately with rhinoplasty the idiom "you get what you pay for" is not always true. When it comes to your nose, price should not be the deciding factor. Do you like your surgeon and have faith in her/him? Do you believe in her/his work? If so, that's certainly a reasonable price.
Why do surgeons avoid revision rhinoplasty?
This may not be applicable to all surgeons, but a reasonable illustration is this: Let's say you are picking cherries from a tree. The cherries on the lowest part of the tree are easy for you to grab without any extra effort of getting a ladder or trying to climb the tree. They taste the same as the other cherries on the tree.
Most surgeons do not want the additional stress of revision surgery - it's more challenging, the patients have higher expectations, and the chances for an A+ outcome are lower since you are beginning with a nose that has already been operated on. For that reason, surgeons often "cherry pick" noses that they are confident of achieving a fantastic outcome on.
Revision surgery is more challenging because of scar tissue, distorted anatomy, and increased patient anxiety/expectations, amongst other reasons.
Should revision rhinoplasty be done with the same surgeon as the previous rhinoplasty?
The cost associated with a revision rhinoplasty with the same surgeon that performed the primary surgery will typically be much lower than consulting with another surgeon. No surgeon wants a dissatisfied patient showcasing results that are not positive. For that reasons most surgeons, when they see there is something entirely correctable, will perform the revision surgery for a much lower rate than had they encountered the same issue on some other surgeon's patient.
Is my skin too thin for revision?
Thin skin alone does not preclude you from being a candidate for revision rhinoplasty. The chance of grafts and other irregularities being visible in your tip is higher with thin skin, but there are techniques to camouflage them. One of these techniques is to use fascia (thin tissue around our scalp) to camouflage these grafts.
"Destabilized nose" and "at risk for collapse" with a revision rhinoplasty? What does this mean, and why would this happen?
During revision rhinoplasty it is common to add structural support by restoring elements of the nasal skeleton that were resected or removed during prior surgeries. It is not uncommon to need rib cartilage as a source of straight, strong cartilage to rebuild a "destabilized" nose.
Would you use a gore-tex graft in revision rhinoplasty with thick skin?
Especially for revision rhinoplasty where the skin has been altered and scarred from previous surgery, using tissue from your own body will be a more permanent and safer option with a much lower risk of complications.
Gore-tex has a higher risk of infection, migration and extrusion than using your own tissue, and will not last a lifetime.
Choosing autologous cartilage grafts during revision rhinoplasty
Assuming your septal cartilage was left intact during the first rhinoplasty, for the degree of lengthening you are looking for it is likely possible to achieve the desired counter-rotation with your septal cartilage. Rib cartilage is usually necessary for cases in which significant lengthening is desired, and/or the septum is cartilage-depleted.
Revision Rhinoplasty Before & After Gallery
Before and after restoration revision rhinoplasty with rib cartilage and DCF (diced cartilage fascia) to create a more balanced nose with smoother contours and a prettier appearance.
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Restoration revision rhinoplasty with ear cartilage to re-establish nasal tip project and aesthetics after previously scarless rhinoplasty resulted in a loss of tip support and visible tip bossae.
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After two previous rhinoplasties this patient was left with alar retraction, pinched nostrils, and significant nasal obstruction. Restoration revision rhinoplasty with rib cartilage and composite grafts from the ears were used to improve the airway and restore a natural appearance to his nose.
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Before and after restoration revision rhinoplasty to create a more refined appearance in a permanent fashion. A previously placed silicone implant was replaced with her own rib cartilage and fascia (DCF) to create a more unified and balanced aesthetic.
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The Results I Hoped for Delivered by Dr. Yoo
In December 2019, I had a revision rhinoplasty and lower blepharoplasty with Dr. Donald Yoo. I just had my 1.5 year follow up appointment and could not be more pleased with the final results! His skills are exceptional. As a matter of fact, I was very happy with the results even as early as week two post-op (understanding there is some normal swelling following a surgical procedure.)
I highly recommend him for his skill, artistry, and attention to detail, as well as his post follow up. Also, he has a wonderful staff and you can tell they love what they do- helping patients become their “best selves”!
You cannot ask for a better surgeon than Dr. Yoo!
I Had an Incredible Experience of Dr. Yoo and His Team.
I had a revision rhinoplasty by Dr. Yoo on 9/24. When i woke up, i immediately love my new nose. Dr. Yoo is amazingly skillful. And his team is most efficiency and high quality i have ever met. I am satisfied and also “worried”. Because the nose is too perfect, I do not want any tiny damage on my nose. I am going to protect my nose very very carefully.
Dr. Yoo is the true artist. And I will never waste this nose he gave to me. This is the first light of dark. And I will work harder for everything. Working, exercise, family and so on.
I wish Dr. Yoo will be more famous, and he deserves that. He is the rising star. I have faith in Dr. Yoo and his team!
My 4th Revision Rhinoplasty
I had my revision rhinoplasty done in dec 2020. I am pleased with my results. I came in with a very bad rhinoplasty and a lot of issues. He explained everything from procedure to healing time process. He also answered all my questions and concerns. I feel really comfortable with Dr. Yoo And his team. It was the best decision I had ever made!
1.5 year update
I’ve had one rhinoplasty in 2017 and it was done by a very well known surgeon in LA. The surgeon called it a rib rhinoplasty and I didn’t know what the difference between the rib rhinoplasty and DCF rib rhinoplasty was back then. I just knew rib rhinoplasty gave a permanent result so I researched surgeons who used rib cartilage. I wish I had known that a block of rib and DCF are very very different. I won't disclose the doctor's name here but inbox me if you must know.
My first rhinoplasty was with en bloc rib cartilage. The surgeon harvested a piece of rib cartilage and carved it down to a shape of an implant and placed it inside my nose. 5-6 months out, my nose started showing irregularity and asymmetry. The tip of my nose basically started shifting to the left as time went by and it was obvious that the rib was warping already during the first few months of recovery. My nose also became very pointy over the time and I could see and feel the tip graft. Ironically though, the height wasn't there. Bridge was also very narrow which made my nose look unnatural. Overall, it wasn't a proportionate nose. The surgeon said he would perform a revision but I didn’t go back simply because I didn’t believe he was skillful enough to make my nose better.
Then I immediately started searching for a revision surgeon. Had a couple of consultations with other well known doctors but I felt like Dr. Donald Yoo understood exactly how to approach the revision. I had to wait for a few months because Dr. Yoo didn't want to perform revision until my nose was fully healed. Revision was done with rib cartilage and DCF - diced cartilage fascia basically he took out whatever graft the previous surgeon put in my nose, harvested a new piece of rib cartilage, finely diced it and then made an implant with it. He placed the DCF along with other grafts he made out of the rib. My nose was very swollen for few months because of fascia but it went down eventually. I took arnica everyday and it helped with swelling. I am at my 1.5 year post op now and I couldn’t be more happier with the shape of my nose. It is straight and much more symmetrical than my first nose job. First surgeon left a 3 cm scar below my breast when he harvested the rib but Dr. Yoo left less than 1 cm scar using the same incision site. He is a true artisan. I really wish I had done more research before I jumped into my first one because then I would have saved a lot of money, time and scars but I take it as a life lesson. I hope this is helpful for anyone who is considering a revision or rib cartilage nose job.
Best Rhinoplasty Doctor...worth Every Penny
Dr Yoo is the best hands down. He gave me a second chance to life by fixing my nose from a previous disastrous surgery from another doctor. He takes good care of you from the beginning to end. He is extremely professional, attentive to small details, careful and gentle. I would highly recommend him to anyone who is seeking rhinoplasty surgery!! A+++++
I had an initial rhinoplasty when I was 16
I had an initial rhinoplasty when I was 16. The results were catastrophic. I had exposed cartilage, a twisted tip and a severely uneven nose. I then had a revision rhinoplasty at the age of 18. This time around the results were better but they did not last long. The doctor over resected the cartilage leaving me with breathing problems, a twisted tip, collapsed nostrils, etc. I was feeling hopeless and was not expecting a doctor to be able to significantly fix my nose. I found Dr. Yoo through researching Dr. Nassif.
Dr. Yoo has had a great academic career and residency. I was very pleased with his before and after results as well as his talent for doing asian rhinoplasties. The whole surgery process was simple and comforting. I was very scared to get another nose job but Dr. Yoo and his staff eased my concerns. I was worried about swelling and asked the doctor to see me on a Sunday. Dr. Yoo took the time out of his weekend to meet me at his office and examine me. I left feeling much better. I am only 5 weeks post op but so far I am very pleased!
Revision Rhinoplasty Videos
Dr. Yoo looks forward to taking you from pretty to prettier®.
Call now for your consultation: 310-772-0766