I would like to introduce myself. I am Alvin Glasgold, founder of the Glasgold Group Plastic Surgery. I am a Board Certified Facial Plastic Surgeon and I specialize in Rhinoplasty. Today, I will speak about Revision Rhinoplasty, which is surgery to correct a previously unsuccessful Rhinoplasty. Approximately 1/3rd of the Rhinoplasties I perform fall in the category of Revision Rhinoplasty so I have extensive experience with this procedure. When meeting with a patient my goal is to evaluate the complexity of the problem and decide whether additional surgery is indicated and worthwhile. The problems I see are varied and sometimes what appears to be simple to a patient may actually be complex. Many patients have had multiple procedures so in proceeding with additional surgery we want to ensure that we can anticipate a high degree of success.
The majority of problems encountered in Revision Rhinoplasty, are related to various types of distortion of the nasal tip.
The anatomy of the nasal tip is presented in detail on our video Blog called “About your Nose.” Suffice to say, the nasal tip is comprised of two cartilaginous arches, termed the lower lateral cartilages as demonstrated in this image. These cartilages vary in shape, and thus primarily account for the different appearances of the un-operated nasal tip. In addition, when we refer to the columella it is the central post separating the nostrils.
During Rhinoplasty, these cartilages are usually modified to change tip shape and position. In some cases… this modification may produce undesirable results which can be classified into the categories such as over-projection, loss of tip support and/or definition, various types of asymmetry, and sometimes excess visibility of the nostrils and/or columella.
Correction of these deformities occur by exposing and reshaping the cartilage structure which may include rebuilding the tip with cartilage grafts usually taken from the nasal septum. This is completed through an external rhinoplasty approach which utilizes a small, almost invisible incision on the columella.
In the following slides, we are going to examine some examples of post operative complications or “bad results” that presented to our practice after primary rhinoplasty elsewhere…. as well as the corrected nose after revision surgery.
The first photographs that we will examine are two examples of what appear to be completely absent tip structure resulting in what is commonly referred to as a parrot beak deformity. This is probably one of the most common undesirable results that I encounter after Rhinoplasty. It is best demonstrated on the lateral view as shown in these two photographs. As you can see, there is an associated excess visibility of the nostrils which is also not an aesthetically desirable result.
Their postoperative revision results are shown here underneath their preoperative photos. Tip restructuring in both of these patients involved utilizing septal cartilage to form a new and appropriately shaped tip. I also corrected the excess nostril visibility and slightly reduced profile. (Heather Baron front and profile – Danni Levine -profile).
These second examples are contour failures resulting in a bulbous tip. As you can see, the tip is rounded and not-well defined in these first two photographs….(Frances Alexander and Gelashvili)
The last photograph demonstrates a significant countour abnormality at the tip. She has a pinched nose, yet the tip is rounded and ill-defined.(Mitchell) In addition, she also has a hanging columella, which is an excessive downward projection of the columella resulting in a rounding of the inferior portion of the nose and excess nostril visibility.
Again, their postoperative photographs are demonstrated to the left of their preoperative photos. I corrected these problems by reshaping the tip cartilage, utilizing cartilage grafts, and removing some redundant scar tissue in the tip… thus producing a more normal and pleasant tip structure in relation to the rest of the nose.
In this third category, are cases in which the supporting structure of the tip has been lost… so that the tip has dropped. It is now below the normal profile line, resulting in an under projected tip and an unpleasant profile. (Elizabeth Occhipinti, and Makarowski, profile, and maybe front)
These are the postoperative results utilizing septal cartilage to augment and refine the nasal tip.
These final photographs are demonstrating poor results due to over-projection. The first example is a patient who requested a revision Rhinoplasty due to an over projected nasal tip from her original surgery done elsewhere. What I mean by over-projection is that the nasal tip is too far out from the face. You best see this on a lateral or side view. In addition, you may also notice that her nose appears “pinched” in the tip which is best appreciated in frontal view (Vecci).
The second patient was also dissatisfied. Her original Rhinoplasty resulted in a severe distortion of the nasal tip associated with over projection of the tip.(Parente)
The postoperative results of Revision Rhinoplasty are shown in the lower photographs are just a few examples of the many problems we encounter and correct. Correction of these deformities was performed with an external Rhinoplasty approach as previously described….and produced a significantly more normal appearing tip as well as improved aesthetic balance between the tip and the remainder of the nose.
In my career I have personally performed over 7,000 Rhinoplasty’s. A significant number of these are Revisions. From this extensive experience, I have realized the challenges and technical difficulty in converting a bad result into a very good result. If you are considering Rhinoplasty or especially Revision Rhinoplasty, I recommend that you seek a Board Certified Facial Plastic Surgeon who focuses on Rhinoplasty and has extensive experience in Revision Rhinoplasty. It is important that you feel comfortable with the surgeon and that at consultation he can answer all your questions and that he is able to demonstrate his expertise in Revision Rhinoplasty with appropriate before and after photographs, such as I have shown.
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