Manhattan Revision Rhinoplasty Specialist

Revision Rhinoplasty: Correcting an over done nose

MANHATTAN, NY - Revision rhinoplasty is a very unique and specialized discipline within facial plastic and reconstructive surgery. It corrects inferior results of what is often considered the most difficult procedure in cosmetic surgery: rhinoplasty. For both primary and revision surgery of the nose, the surgeon must address not only functional and aesthetic issues, but the emotional concerns of patients who have been "traumatized" by one or more previously undesirable results. This is why patients should seek out a revision rhinoplasty specialist who understands the consequences of surgical maneuvers on the nose. All too often, patients are offered "simple" solutions to primary and secondary nasal defects that may end up making the situation worse as well as making further revision more complex.

Patients seeking revision rhinoplasty have a number of concerns. The foremost is a poor aesthetic and functional result (breathing problems). Second comes from loss of trust in their first surgeon, and third: that further surgery may cause further deformity. Regarding the third issue, patients will often bring up the well known musical genius, Michael Jackson, a fear that almost every patient, or a relative or friend of theirs, will eventually bring up.

When it comes to revision rhinoplasty surgery, the first thing we do on most patients is to create strength and structure. This is in contradistinction to what was done back in the 70's and 80's, remove-remove-remove. I believe that revision rhinoplasty follows the architectural theme "form follows function." Noses that look pinched typically don't work well and vice versa. Improving nasal airflow usually has the consequence of also enhancing the appearance of the nose. Revision surgery is first about getting noses to work. The functional improvements also correct some of the aesthetic deficiencies.

Over the past few years, I have given a number of lectures on revision rhinoplasty. The most instructive two topics are titled: "Lessons in revision rhinoplasty: How to avoid needing it in the first place" and "What makes the nose look over-done." As in other areas of medicine, patient outcomes have become paramount. There is a long list of causes that have been identified over the years by revision rhinoplasty surgeons in lectures and publications. However, they haven't been categorized by patient findings linked with likely causes. By exploring the reasons for revision rhinoplasty, it makes it easier to practice and teach one of the most basic tenets in medicine: prevention is the best treatment. If surgeons can anticipate potential problems, hopefully most can be avoided in the first place.

Dr Steven Pearlman, MD, FACS
Manhattan Revision Rhinoplasty Specialist