REvision Rhinoplasty NY

Revision Rhinoplasty: Common Issues

MANHATTAN, NY – The most common functional problems encountered in revision rhinoplasty patients are deviated septums, nasal septal perforations, collapse of the narrowest part of the nose called the nasal valve, and small scar bands called synechea. Each needs to be checked for and treated if present. It surprises me that when examining patients, I ask if their original surgeon ever looked inside their nose and the answer is sometimes “no.”

Another common problem is the nose can be too long or too short. This may be from a long or short nasal septum or a tip that is over or under-rotated (points too far up or downward). There are a number of available techniques to correct nasal length as well as the nose to lip, nasolabial angle. This may require removing more cartilage, but more often for revision rhinoplasty, adding to the septum and alar cartilages for lengthening the nasal tip.

The tip of the nose is measured in projection, how far it sticks out from the face, rotation or tip angle and nasal tip width. Nasal tip projection can be excessive or inadequate. A bulbous tip may only require more removal or suture sculpting. When too much cartilage was removed, over-done nose can form bossae, lose projection and turn up showing too much nostril. Loss of tip strength can also cause narrowing of the nostrils that can block the external nasal valve as well. There are all treated with cartilage grafts. Prevention of these problems comes from understanding the consequences of all surgical maneuvers performed in rhinoplasty. Patients with strong cartilages will react differently than patients with weak cartilages to surgery. Each patient needs to be examined thoroughly and treated as an individual. A facial plastic surgeon can perform the same techniques on a number of revision rhinoplasty patients, yet the results may vary according to their anatomy. Therefore, “cookie-cutter” noses should be a thing of the past.

Dr Steven Pearlman, MD, FACS
Manhattan Revision Rhinoplasty Specialist