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Secondary (Revision) Rhinoplasty

Secondary (Revision) Rhinoplasty


Rhinoplasty, also referred to as a nose job or nasal reshaping, is a commonly performed surgical procedure that changes the shape of the nose to improve appearance. Secondary Rhinoplasty, sometimes called revision rhinoplasty, is needed when patients have new or persistent problems after previous rhinoplasty, trauma or other nasal surgery. Dr. Derderian frequently performs secondary rhinoplasty at his practice in Dallas and customizes his approach to each patient based upon the patient’s nasal anatomy, functional concerns and goals for change in their appearance. Secondary rhinoplasty is frequently combined with procedures to improve breathing through the nose such as septoplasty for deviated septum. This page will discuss secondary rhinoplasty in detail. Primary rhinoplasty is the term used to describe rhinoplasty in a patient who has never had any nasal surgery before. If you have not had nasal surgery before visit Dr. Derderian’s primary rhinoplasty page. Dr. Derderian also commonly performs Cleft Rhinoplasty for patients with an abnormal nasal due to cleft lip and palate. Cleft Rhinoplasty is widely considered to be the most difficult rhinoplasty to achieve consistently good results. Common reasons for secondary rhinoplasty include:

  • An unnatural operated on appearance to the nose after rhinoplasty
  • New or persistent breathing problems after rhinoplasty
  • Nasal deformity from surgery or trauma
Secondary rhinoplasty is far more difficult than primary rhinoplasty for a number of reasons. The normal anatomy of the nose has been altered. There is usually less cartilage available for grafts needed to reshape the nose. Perhaps the most challenging factor is that the skin and soft tissues of the nose are scarred which makes reshaping the nose far more difficult than it is in a nose without previous surgery or injury.

Am I a good candidate for Secondary Rhinoplasty?

It is typically best to wait at least 1 year from the time of the most recent nasal surgery to seek consultation for secondary rhinoplasty. This provides time for swelling to fully resolve and gives the healing process time to complete and allow the skin and soft tissue to soften. The best candidates for secondary rhinoplasty are physically and psychologically healthy, do not smoke and have realistic goals for what can be achieved from surgery.

How Is The Surgery Performed?

Dr. Derderian uses only an open approach to secondary rhinoplasty because the open approach allows direct visualization of the nasal cartilages. Open rhinoplasty requires a small incision in the columella (the skin between the nostrils) through which the skin of the nose is elevated off of the underlying cartilage and bone. This incision typically heals with an imperceivable scar. Dr. Derderian believes that the control that the open approach affords more precise change during surgery that is important to achieve consistently good results. The duration of surgery varies from patient to patient. Typically the procedure takes 2-4 hours. During surgery the skin is elevated from the underlying cartilage and bone. Depending on the strength and position of the cartilage and bone and the goals of surgery, a variety of maneuvers are used to reshape the nose and improve breathing. Graft material is need in almost every secondary rhinoplasty to change the shape of the nose. Cartilage from the nasal septum is the easiest site to get cartilage grafts from, but it is common that this cartilage was harvested in the initial rhinoplasty. If additional cartilage is needed to support the new nasal shape, cartilage may be harvested from the patient’s ears or ribs. Today there is also an alternative source of rib cartilage harvested from organ donors that has been treated to remove all immune markers that prevents rejection of the graft. After the desired changes in shape are achieved the nose is closed with fine stitches. At the end of surgery soft splints may be placed inside your nose to support the nasal septum. Soft splints are frequently used on the outside of the nose also to help shape the skin. Tapes and a splint are placed over the nasal bridge to support and protect the nose for 7 days. After recovering from anesthesia you will be taken home the same day as surgery by the family or friends who bring you to the hospital.

What is the recovery period?

Minimal activity is recommended for the next week. Most patients take a week off from work or school. Oral pain medication is used for 2-3 days. Splints and sutures are removed after 7 days. No vigorous activity is allowed for 3 weeks. After 3 weeks normal cardiovascular exercise and non contact sports may be resumed gradually. No restrictions on activity after 6 weeks. The majority of swelling subsides within a few weeks after surgery, but it takes one year for your new nasal contour to fully refine. During this time, your nose will look normal but you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome.

What Does Rhinoplasty Cost?

Cost may include:
  • Anesthesia fees – cover the anesthesiologist, their staff and medications
  • Hospital or surgical facility costs – covers the operating room, staff and equipment
  • Surgeon’s fee

Why Choose Dr. Derderian?

It is critical to have an experienced surgeon perform your secondary rhinoplasty. During his residency Dr. Derderian had extensive training in primary and secondary rhinoplasty at New York University and at the Manhattan Eye, Ear and Throat Hospital (MEETH). After completing his residency, Dr. Derderian did a fellowship in craniofacial surgery (complex skull and facial reconstruction) at the University of Pennsylvania. Dr. Derderian is board certified by the American Board of Plastic Surgery. He frequently performs both secondary rhinoplasty and Cleft Rhinoplasty in his practice. He has been invited yearly as an instructor at the world renowned Dallas Rhinoplasty Symposium since arriving in Dallas in 2011.

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