Revision Rhinoplasty

Patients seeking revision rhinoplasty have a number of concerns. The foremost is a poor aesthetic and functional result. Second is often the loss of trust in their first surgeon, and the third: will surgery help improve them or just cause more deformity. Dr. Pearlman and his staff are well trained in helping patients overcome these fears. They are sensitive to the reluctance patients have over considering more surgery. The staff will help you feel at ease from the beginning; recognizing your courage to address the need for revision surgery and consider improving upon what was your less than ideal surgical result. Together we can work towards achieving our mutual goals of looking and breathing better.

Dr. Pearlman specializes in revision rhinoplasty.

By choosing the right specialist for surgery, the goal is to improve the functional and aesthetic results from prior treatment. Dr. Pearlman often states 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 about restoring structure and strength. The majority of patients who undergo revision rhinoplasty by Dr. Pearlman report significant improvement.

Over the past year Dr. Pearlman has given a number of lectures on revision rhinoplasty. The most enlightening 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." Dr. Pearlman has studied the many patients who come to him for revision rhinoplasty. There is a long list of causes that have long been identified over the years. However, no prior surgeon has systematically categorized the patient findings with likely causes. By investigating these reasons for revision rhinoplasty, Dr. Pearlman has taken on the mission of teaching other rhinoplasty surgeons - both novice and experienced - which surgical techniques can cause problems. If surgeons can understand these causes, hopefully they can be avoided in the first place. As in all of medicine today, a primary focus is prevention; anticipating and avoiding a potential problem in the first place is the best treatment.

At the annual meeting of the American Academy of Facial Plastic and Reconstructive Surgery in September 2009, and pending publication, Dr. Pearlman is presenting a study entitled "Functional and aesthetic concerns of patients seeking revision rhinoplasty." The medical literature is replete with articles on the findings and causes for revision rhinoplasty. However, these articles are from the examining physician's point of view. Our study starts by asking patients what they are unhappy with. We seek to address patients' concerns directly in this article instead of what surgeons feel might be the surgical priorities.

So, what makes a nose look over-operated?

• Pinched tip

Pulled up nostrils (notched)

Deep creases above the nostrils

Tip "knuckles" called bossae

Narrow middle third, called an "inverted" V deformity

Scooped out profile

These findings are identified and separated into upper, middle and lower third of the nose; according to nasal anatomy. Problems are identified for the upper or bony portion of the nose, the central third that gives the overall shape as well as the tip of the nose. Other considerations are functional problems, those that cause difficulty breathing, nasal length discrepancies, and abnormalities in the bottom of the nose. The latter category addresses nostril shape as well as the columella; the column that divides the two nostrils.

In the study above, patients seeking revision rhinoplasty were given a questionnaire of over 40 potential problems; it was found that the most common deformity they requested to be fixed is tip asymmetry. Second is nasal obstruction and third a crooked nose.

Therefore, if you are seeking any surgery, especially revision surgery you must ask the specialist about their experience and expertise in this area. How many revision rhinoplasties do they actually perform a month? Even after multiple surgeries by other doctors, the majority of our patients enjoy significant improvement. Thus we help restore in our patients their self confidence and assurance in their appearance, as well as the decision to have had surgery in the first place.

We share the same goal as our patients, for improved aesthetic and functional results by restoration of self confidence. Dr. Pearlman will conduct a thorough evaluation of your nose, inside and out. He performs a thorough exam of the inside of the nose during the consultation, using a specialized headlight. Sometimes we may need to use nasal endoscopic equipment to get a better view. It is disheartening when talking with patients and Dr. Pearlman finds out that the original surgeon never even looked inside the patient's nose. Dr. Pearlman will evaluate the nasal structures including the septum, turbinates, internal and external nasal valves and the underlying anatomy of the nose in both the bony and cartilagenous framework. We often use computer imaging to review the external changes expected for your nose and to demonstrate changes that can be mutually decided upon between doctor and patient.

For all rhinoplasty, aesthetic improvement must not be made at the expense of normal breathing. It is important to seek out a recognized expert such as Dr. Pearlman, hopefully the first time around. If not, our expertise will help guide you through the emotional experience of seeking revision rhinoplasty and the results will help restore your self confidence.

To quote Dr. G. Jan Beekhius, one of the most respected rhinoplasty teachers of the late 20th century: "Anyone with proficient technical ability can be taught to perform a rhinoplasty; obtaining consistently good results, though, is difficult." Archives of Otolaryngology, 1986

Back to Top