Revision Rhinoplasty

Yes, this can typically be fixed. There are many techniques that might be used, depending on the specifics of your nose. I would need to see and examine your nose to give you specific details. However, in general, the treatment for a hanging columella is to lift it!An example is shown here:

Posted by Dr. Becker

Two general types of rhinoplasty are the endonasal (“closed” rhinoplasty – all incisions hidden inside the nose) and the external (“open” rhinoplasty – all incisions EXCEPT one small incision are inside the nose.) In open rhinoplasty there is one small incision across the columella (the skin between the nostrils). This incision is generally extremely difficult to see, and is only about 3 mm (1/10th of an inch) long!

I perform both closed and open rhinoplasty. I have written a recent scientific article on this subject, entitled “Open Versus Closed Rhinoplasty.” Let me summarize the conclusions for you here: The decision on which technique to use depends on technical considerations with respect to the patient’s specific anatomy and his or her cosmetic requests, and also depends on physician experience with both techniques.

This patient had an open rhinoplasty 4 years ago. Look at his base view – see the incision?

The patient below had a closed rhinoplasty. His incisions were all on the inside of his nose:

In my experience, the closed approach is better for some noses, while the open technique is better for others. For example, in my practice the patient who requests simply a small hump removal may undergo endonasal rhinoplasty, while the patient with a severely twisted nose often requires – for technical reasons – an open approach for the best result. The approach I pick is based on what I think will provide the best outcome for you, and based upon our detailed discussion about the technical aspects of your procedure. The female patient shown here underwent an open approach because her nose was twisted and needed straightening. If she had only needed profile changes, I might have undertaken a closed approach. Can you tell that her surgery was open?!

Fortunately, there are no major disadvantages to either approach. However, each approach has special advantages for specific situations. Since every nose is different and has unique surgical requirements, I discuss the options with each patient and am happy to describe my surgical plan in detail.

Posted by Dr. Becker

Yes, it is possible to do a “tip rhinoplasty” in which I would change only the tip without making any changes to the rest of the nose.

Posted by D. Becker

The nasal cast comes off approximately 5 or 6 days after surgery. This is not painful or uncomfortable in our practice. Here is an example of a patient with her nasal bandage coming off. Also shown are before and after photos:

Posted by Dr. Becker

I do not use nasal packing. Some surgeons use nasal packing to prevent bleeding. However, it is painful to have nasal packing, and removal of nasal packing is painful and traumatic. We have found that we do NOT use it and we do NOT need it in our patients. With meticulous surgical technique and other precautions, nasal packing has not been necessary in my hands.

Posted by Dr. Becker

Time and gravity affect all parts of our bodies, including the nose! The nose often droops as we get older. Also, some of us are born with long or droopy noses. In these cases, lifting the droopy nose improves appearance and also makes the patient look younger. An example is shown here, and more can be seen in the Photo Gallery of my website, www.TheRhinoplastyCenter.com in the section entitled “Droopy Nose.”

Posted by Dr. Becker

Sleeping with your head elevated and avoiding salt may help. It sounds like you have a bit more swelling than we would expect to see, so it would also be important to communicate with your surgeon, and find out what other recommendations they may have. Sometimes some prescription medications may help in certain situations.

Posted by Dr. Becker

It is difficult to say without seeing you, but it is possible that this is a “pollybeak.” A pollybeak refers to a specific problem of the nasal dorsum, specifically postoperative fullness of the supratip region, with an abnormal tip-supratip relationship. This may have several causes, including failure to maintain adequate tip support (postoperative loss of tip projection), inadequate cartilaginous hump (anterior septal angle) removal, or supratip dead space and scar formation.

Treatment of the pollybeak deformity depends on the anatomic cause. If the cartilaginous hump was underresected, then the surgeon should resect additional dorsal septum. Adequate tip support must be ensured; maneuvers such as placement of a columellar strut may be of benefit. If the bony hump was overresected, a graft to augment the bony dorsum may be beneficial. If a pollybeak is from excessive scar formation, Kenalog (triamcinolone) injection or skin taping in the early postoperative period should be undertaken before any consideration of surgical revision.

Posted by Dr. Becker

Sometimes the patient has a request for a small refinement of the nose. The patient just wants a small change. This is known as Finesse Rhinoplasty. These small changes can require a high level of skill and expertise. Below is an example of a patient who had a “Finesse” rhinoplasty. She wanted some minor changes only to her nose. You can see other examples in the Photo Gallery of my website, www.TheRhinoplastyCenter.com.

Posted by Dr. Becker

The least risky, least expensive surgery is no surgery! If you are ambivalent about having anything done, if it hardly bothers you, then I would recommend that you leave it alone. My personal philosophy of rhinoplasty focuses on one essential goal – to achieve a result that makes the patient happy. There are very few noses that are “perfect” – if you look at most noses, you can find a small imperfection. So if it does not bother you, if you are happy, then leave it alone. If the nostril asymmetry does bother you, however, then of course I would be happy to see you and examine your nose, and discuss the possibilities with you.

Posted by Dr. Becker