Revision Rhinoplasty in Denver, Colorado
Many people who have undergone a rhinoplasty (nose job) by other plastic surgeons may be unhappy with the aesthetic and/or functional results of their procedure, and may seek additional surgery to correct their problem in order to achieve the results they desire. Dr. Bershof is a 5280 Top Doctor in Revision Rhinoplasty and many patients are referred to him for this purpose. Unsatisfactory results may occur as a result of a complicated condition, an inexperienced surgeon, or simply due to the patient's healing tendencies. The reported revision rate amongst plastic surgeons, excluding Dr. Bershof is as high as 20% (1 in 5), but this statistic is not true in Dr. Bershof’s practice. He rarely has to re-operate on his rhinoplasties, perhaps less than 1% and these revisions are always minor.
Revision rhinoplasty, also known as secondary rhinoplasty, is a complicated procedure that is most successfully performed by a rhinoplasty specialist to reshape or re-size the nose after an initial procedure.
Practicing out of Denver, CO Dr. Bershof is known for his rhinoplasty skills, an operation considered to be the most difficult of all the cosmetic surgeries. Many plastic surgeons simply do not even perform rhinoplasties. Dr. Bershof often has patients referred to him who have had unsatisfactory results elsewhere, including referrals from other plastic surgeons.
Some of the problems patients complain of after their initial rhinoplasty procedure include:
- Pinched tip
- Pulled up nostrils
- Creases around the nostrils
- Scooped out profile
- Breathing difficulties
- Unnatural appearance/operated look
These problems can range from minor imperfections to severe deformities. Dr. Bershof strives to help patients achieve the highest level of satisfaction from their rhinoplasty and will do his best to produce the results that the patient desires. As difficult as primary rhinoplasties are, secondary or revision rhinoplasties are that much more difficult. It is important to select an experienced rhinoplasty surgeon, such as Dr. Bershof.
Candidates for Revision Rhinoplasty
Anyone who is unhappy with the results of their initial rhinoplasty (nose job) procedure may be a candidate for revision rhinoplasty. Patients should discuss their initial procedure with either their original surgeon or Dr. Bershof, in order to determine the new goals for revision. It is also important for patients to be both emotionally and financially prepared for additional surgery. What is equally important is for both the patient and the surgeon to set reasonable goals; due to scar tissue from the first rhinoplasty, not all goals might be achievable.
Dr. Bershof will determine whether or not revision surgery is a possibility for you after discussing your goals for surgery, performing an examination and reviewing the previous surgeon's operative dictation.
Revision Rhinoplasty Procedure
The revision rhinoplasty procedure is usually performed on an outpatient basis under general anesthesia in our Denver, CO office to help reduce any potential discomfort. Revision rhinoplasty is usually performed using an open technique, allowing for greater visualization of the underlying nasal structure, because the already-reshaped bone and cartilage may be more difficult to sculpt without direct visualization. An open approach also allows the overlying skin covering to be more freely released from scar tissue so that, as the new underlying anatomy is created, the skin can re-drape in a better fashion.
In cases where reshaping is difficult, a cartilage graft from the nasal septum, ear or rib may be required. Injectable fillers may also be used to correct small defects after the initial procedure, although the use of the patient's own cartilage is preferred. The entire procedure usually takes 3-4 hours to perform.
Recovery from Revision Rhinoplasty
After the revision rhinoplasty procedure, patients will usually experience bruising and swelling for 1-2 weeks, along with some mild pain that can be managed with medication prescribed by Dr. Bershof. Once bruising and swelling has subsided enough, patients can usually return to work and other regular activities. The nose will continue to heal and may change slightly in appearance over the course of a year or more after surgery, when full results will be visible. Revision rhinoplasty results take longer to fully achieve than primary rhinoplasty results.
Initial results of the revision procedure will be noticeable right away, but will continue to improve as swelling subsides and the nose heals. It is important for patients to wait until full results appear before deeming their procedure a success.
Revision Rhinoplasty Risks & Complications
Revision rhinoplasty carries the same risks associated with the initial rhinoplasty procedure, but also involves additional issues, such as thicker skin, scar tissue and less structural support within the nose. The patient's airway may also have been affected by the initial procedure, which makes revision surgery even that more difficult to perform.
It is important for patients to understand the risks associated with this procedure and to maintain realistic expectations for their revision rhinoplasty. The best results are achieved by choosing a highly skilled and experienced surgeon to perform your revision surgery, and in conjunction with the surgeon, clearly define realistic goals.
What are the benefits of having revision rhinoplasty?
The benefits of these revision procedures with Dr. Bershof are usually twofold. First, the patient can now be satisfied with the appearance of his or her nose. It’s difficult to have gone through surgery and recovery yet still feel as if your nose doesn’t look the way you had hoped. Maybe this was a result of the vagaries of healing, or maybe it was the surgeon.
Second, these procedures often have a necessary restoration side to them. A nose that has had previous surgery may have lost much of its structural support, and this needs to be rebuilt.
Bottom line, having a nose you like seeing in the mirror is important. Having a nose that breathes efficiently is critical.
As a double board-certified plastic surgeon, including specific certification in head and neck surgery, Dr. Bershof is the perfect surgeon to provide the nose surgery you had hoped to achieve in your previous surgery elsewhere.
What should I expect during my consultation for revision rhinoplasty?
Dr. Bershof views all of his consultations as a complete give and take of information between the two of you. For these revision procedures, you’ll start, detailing what you don’t like about your previous nose surgery. You’ll discuss what you’d like to change and areas from that procedure with your former surgeon that didn’t meet your expectations.
Next, Dr. Bershof will examine your nose. Revision procedures are complicated because the previous procedure may have removed tissue and jeopardized the underlying structural support of the nose.
He’ll then discuss with you what he feels can be achieved with your revision nose surgery. In some cases, the patient’s skin and soft tissues can somewhat limit the changes Dr. Bershof can make in your revision. He’ll frankly discuss with you what he thinks you can expect from your revision procedure.
How should I prepare for revision rhinoplasty?
Your preparations for revision nose surgery are the same as they were for your initial surgery. Because you have already had one or more surgeries on your nose, revision procedures tend to be less painful, and there is less bruising.
Are revision rhinoplasty procedures covered by insurance?
Rhinoplasty, whether the original procedure or a revision procedure, tends to be covered by insurance if there is a functional need. For instance, if you have problems with your septum or if you have issues with breathing and potential sleep. For insurance to cover these surgeries, usually your primary care provider or an ear, nose, throat specialist would have to attest that there are issues with the function of your nose.
If your revision procedure is to simply make cosmetic changes, such as reducing a flared nostril, those are deemed to be “elective” procedures and are not usually covered by insurance.
Does a revision rhinoplasty create much scarring?
Rhinoplasty in general doesn’t create any really noticeable scarring. If Dr. Bershof is able to use the closed method, any incisions are made within the nose, so there isn’t any scarring visible. If he needs to use the open method for more leeway in making your revisions, this only involves a tiny incision made along the columella, the tissue that separates your nostrils at the bottom of your nose. These incisions become virtually invisible.
At what age can you first have nose surgery?
To have nose surgery, the patient’s nose has to be finished growing. This occurs around the age of 13 or 14 in girls, and 15 or 16 in boys. Obviously, if you’re coming to Dr. Bershof for revision rhinoplasty, you’re already old enough as you’ve had a previous procedure.
Is revision rhinoplasty more complicated than original rhinoplasty?
Patients don’t know this, but rhinoplasty is one of the most difficult and complicated of all plastic surgery procedures. This is part of the reason many people need secondary surgeries. The revision surgery is more complicated than primary rhinoplasty. These surgeries tend to be long, complicated processes that often require tissue grafts harvested from the septum, ears, or from the rib to restore the underlying structural support. Also, the skin and soft tissues involved can limit the outcome due to previous scarring and other irregularities.
Because revision rhinoplasty is such a complex procedure, you need to trust only a surgeon with extensive experience. Dr. Bershof has double board certification in both plastic surgery and in head and neck surgery, giving him the extensive knowledge and training necessary for a successful secondary rhinoplasty. He has studied advanced rhinoplasty techniques, and this combination of training and experience is valuable for revision procedures.
How soon after my earlier rhinoplasty can I have a revision performed?
Generally, your nose should be fully healed from the previous surgery. This varies with individual healing rates, but a minimum of six months needs to pass and more likely nine months to a year before you could have a secondary procedure. This is because all swelling needs to resolve and your nose needs to fully settle into its final position and shape. There can be exceptions to this if the revisions need to be made only on the bridge, for instance. This may not require quite as long a timeframe. Dr. Bershof will discuss what you can expect during your consultation.