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Jacob D. Steiger, M.D.
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Revision Rhinoplasty

Revision rhinoplasty is a surgical procedure performed to correct problems resulting from prior rhinoplasty procedures. These problems generally fall under two categories: aesthetic and functional (ability to breath). There are a wide range of aesthetic reasons for which patients seek revision nasal surgery, most of which can be corrected (see below for examples). Unfortunately, some patients accept results which they may be unhappy with because they are unaware that correction is possible.

In addition, many patients seek revision surgery because they are no longer capable of breathing well out of their noses. The size and shape of the nose is closely related to its functional ability, and nasal obstruction is frequently encountered along with aesthetically displeasing results. Revision rhinoplasty is a very detailed and complex procedure. Patients seeking revision rhinoplasty must choose a surgeon capable of treating the nose comprehensively.

Dr. Steiger is an expert in primary rhinoplasty and revision rhinoplasty, frequently performing these procedures. He uses the latest, advanced techniques in order to restore balance to the nose. Both a fellowship-trained facial plastic surgeon and board-certified otolaryngologist, Dr. Steiger is a nasal expert; inside and out. He has published numerous research articles and chapters related to rhinoplasty and nasal surgery.

Revision Rhinoplasty Overview
Revision Rhinoplasty was performed to repair the saddle nose and alar retraction of this deformed nose a bad nose job. Rib cartilage graft was used to repair the nose.
This patient had a prior rhinoplasty resulting in an unnatural looking nose. Dr. Steiger utilized rib cartilage to reconstruct the nose and reestablish a more natural appearance.

Goals To surgically refine the size and shape of the nose after a prior rhinoplasty procedure, improving facial balance. Revision rhinoplasty may also be performed to improve obstructed breathing caused by prior surgery.

The Procedure Incisions are placed within the nose, where they are not visible. In some cases, a small incision is hidden between the skin of the nostril, underneath the nose. The underlying cartilage and bone is sculpted to create the new shape. In some cases, cartilage grafts are used to re-build and re-enforce an over-operated nose. A successful revision rhinoplasty improves facial harmony and draws attention away from the nose.

Anesthesia Deep sedation/twilight sleep is preferred, however some patients opt for a general anesthetic.

Length of Time The amount of time varies based upon the individual nose and necessary refinements. The procedure averages between one and a half to three hours. It is performed in our state of the art, fully accredited outpatient surgical facility (link) or at the hospital (link). Other procedures, such as a chin augmentation (link), may be combined with revision rhinoplasty and may be recommended after a detailed consultation with Dr. Steiger.

After the Procedure Most patients go home comfortably after the procedure. If you prefer, professional in-home nursing care or overnight hospital suites are available upon request. Our friendly staff can assist you in coordinating these services upon request.

Recovery Most patients return to work after 1 week and are back to full activities after 10 days. However, activities which risk bumping or traumatizing the nose should be limited for four to six weeks. Bruising around the eyes may occur in some cases, and can be camouflaged . Most patients feel remarkably well immediately after the procedure, and have minimal pain which is alleviated with a mild narcotic.

FAQs
Revision Rhinoplasty to repair alar retraction (retracted nostrils)
This patient had previous rhinoplasty which resulted in excessive retraction of her nostrils, while leaving the nose too long. Cartilage from her own septum was used to repair the retraction and create a proportionate, natural-appearing nose.
Revision Rhinoplasty to repair a saddle nose deformity resulting from nasal collapse after a bad nose job
This patient had several previous rhinoplasty procedures removing too much cartilage. The nose is both collapsed and severely pinched. This affected her appearance and ability to breath. Dr. Steiger utilized cartilage grafts to repair her nose and restore a more natural appearance.
What is revision rhinoplasty?

Revision rhinoplasty is a surgical procedure performed to repair problems with the appearance and/or function of the nose, which have resulted from previous rhinoplasty surgeries.

How is revision rhinoplasty performed?

The nose is made up of skin and soft tissue that is draped over an underlying nasal framework. The nasal framework, made up of both bone and cartilage, gives shape to the nose. When your nose was operated on previously, this framework was altered. Revision rhinoplasty involves reshaping and/or restoring the altered nasal framework to achieve a more natural and pleasing appearance.

Where are the incisions made?

Revision Rhinoplasty is performed through either an endonasal (closed) approach or an external (open) approach. In the closed approach all of the incisions are made on the inside of the nose. The surgeon then manipulates the nasal framework (bone and cartilage) from within.

The open approach is performed similar to a closed rhinoplasty, however a very small incision is made on the bottom of the nose, between the skin of the nostrils (called the collumela). This tiny incision is approximately 3 millimeters in length and is not noticeable. The open approach, as the name implies, allows for better visualization and access to the nasal framework than the closed approach.

Which approach to you use?

Whichever approach will produce the best result!

Dr. Steiger utilizes both approaches in his practice. Since every nose is different, the approach is individualized to the patient. Each approach has its benefits. This will be determined after a thorough consultation, evaluating your nasal appearance and desires.

Can you make my nose look natural again?

In most cases, revision rhinoplasty can produce significant improvement. Dr. Steiger uses advanced techniques to help achieve a more natural appearing nose. After a thorough consultation, Dr. Steiger will be able to discuss the possibilities with you.

I think they took out too much cartilage, can this be repaired?

An "over-operated" nose is a common reason for which patients seek consultation for revision rhinoplasty. This is usually a result of removing too much cartilage. Cartilage grafts are used to replace missing cartilage, and restore nasal appearance.

Where do you obtain these cartilage grafts from?

Dr. Steiger prefers to use your own native cartilage for grafting purposes. In the majority of cases, cartilage is harvested from the septum without having to make any other incisions. In cases where the septum is unavailable, cartilage from the inside of your ear can by used to create grafts. Not to worry, this will not change the shape of your ear. In the most severe cases, Dr. Steiger can harvest a small portion of rib cartilage to reconstruct the nose.

Revision Rhinoplasty to repair nasal collapse.
This patient had previous rhinoplasty where too much cartilage was removed. This resulted in a nose that was collapsed, too short, too narrow, and partially saddled (caved in). Using cartilage from her own septum, Dr. Steiger was able to create a more natural appearing nose.
What are some of the possibilities with revision rhinoplasty?

Every case is different and advanced revision rhinoplasty can repair many deformities created by an unsuccessfuly rhinoplasty. Dr. Steiger will be able to determine the possibilities for repair after a thorough consultation. The following are select examples of revision rhinoplasty patients.

Do you perform this surgery often?

Yes. Revision rhinoplasty is a significant portion of Dr. Steigerís practice. As a plastic surgeon dedicated to the face, he is experienced in the most advanced revision rhinoplasty techniques.

Will insurance cover the procedure?

If you have nasal obstruction caused by a functional nasal problem, insurance often covers the portion of the septorhinoplasty aimed at repairing this. Most insurances do not cover the cosmetic portion of the procedure. Our office will help you get preauthorization from your insurance company, if necessary, for the functional aspect of the procedure.

Can I see more photos of some of the patients you have treated?

Yes. During the consultation, we can review before and after photographs of patients who have kindly given us permission to do so.

If you desire, our office will put you in touch with patients who have undergone the procedure and voluntarily agreed to speak with you.

 





Dr. Jacob D Steiger MD is board certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology- Head & Neck Surgery. He practices in Boca Raton and Delray Beach, Florida treating patients from Palm Beach, Ft. Lauderdale, Miami, as well as patients from all over the US and from around the world.



Call 561-499-9339 or 866-994-FACE to schedule an appointment today, or email info@drsteiger.com for more information