Manish Shah, M.D., FACS

Board-Certified Plastic Surgeon

101 University Blvd Ste #220, Denver, CO 80206 | 720-575-1600
As heard on 95.5 PLJ CoolSculpting at The Peer Group

Revision Rhinoplasty

Revision Rhinoplasty - Denver, CO*

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Overview

Revision rhinoplasty is a term to describe a nose surgery procedure to correct problems or deformities that are the result of a previous rhinoplasty. There are many reasons a rhinoplasty may fail to produce the desired results, but in any case it can be an exceptionally traumatic event to face. Dr. Manish H. Shah is a specialist in revision rhinoplasty in Denver, CO. His fellowship at the Manhattan Eye, Ear, and Throat Hospital in New York City, allowed him to work with his mentor, Dr. Tabbal, one of the best revision rhinoplasty surgeons in the world. during this fellowhips, Dr. Manish Shah was able to learn many advanced techniques to help patients with postoperative nasal deformities. Revision rhinoplasty makes up at least 30% of the rhinoplasty operations he performs each year. Revision rhinoplasty is generally considered the hardest procedure amongst all cosmetic surgeries. This is due to the fact that once a nose has been operated on, there are multiple soft tissue types that are now scarred. Skin, mucosal lining, cartilage, fat, and bone are all damaged in the process of performing the initial rhinoplasty, plus blood supply to the nose is altered and is usually diminished. 

Surgical Technique

Full Rhinoplasty Revision

When the initial rhinoplasty results in unsightly features, it can be difficult for the plastic surgeon to revise the initial surgery. Open rhinoplasty is the ideal technique because it allows the doctor access to the nose’s supporting framework, and corrects the internal structure of the nose as originally intended. It may involve re-cutting and reattaching the cartilage or bone. It may even need skin, tissue or fat grafting to make sure the aesthetic intent is achieved. The peeled skin will be draped back, and a nose splint or packets may be provided to aid with healing.

Touch-Up Rhinoplasty

Similarly, secondary rhinoplasty may be necessary to adjust minor issues from the initial surgery. It may be a case of slight unevenness or misshapen contours. In these cases, the first surgeon is often the one who will perform the touch up as the procedure is less complex and typically involves minor techniques, such as slight shaving of the bone, augmentation or reduction for volume issues. The results from minor revision rhinoplasty are mostly satisfying.

During/After Surgery

Oftentimes, damaged cartilage will need to be virtually rebuilt from scratch to create the new nasal skeleton. Sometimes, too much cartilage was removed at the first surgery and now needs to be put back to fix the nose and improve its support. To build a new nasal skeleton, graft material, or cartilage, may be harvested from one of three areas of the body: the nasal septum (septal) cartilage, ear (conchal) cartilage, or the rib (costal) cartilage. In extreme cases, Dr. Manish Shah has taken split calvarial (skull) bone to rebuild noses. These particular cases require the use of titanium hardware to fix the bone in place. There are pros and cons to the use of each of these materials, which should be discussed between the patient and Dr. Manish Shah. In some cases the damage may be too severe so synthetic tissue may be used instead. Various synthetic tissues include silicone, e-PTFE, and Gore-tex. Another possibility is that all of the above materials may be used, both the natural and synthetic. If at all possible, Dr. Manish Shah prefers the use of natural materials over synthetic ones. They are less likely to cause long term complications like infection, rejection, skin erosion, palpability, capsular contraction, and malposition. The soft tissues of the nose are prone to inflammation after having plastic surgery. The inflammatory changes result in scarring that increases the stiffness of the tissues. When patients have had several revision rhinoplasty surgeries, it can make the plastic surgeon feel like they are operating on cement. It can take much longer just to remove all the scar to see what the “normal” anatomy looks like. When scar that is obstructing function has to be removed, new tissue in the form of skin grafts or mucosal grafts may need to be used. Due to all these various reasons, revision rhinoplasty takes much longer to perform in the operating room. Postoperatively there is a longer recovery time also. Recovery time might be anywhere from 6 months to 2 years depending on the severity of the damage and the health of the skin.

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Revision Rhinoplasty FAQs

Better or Worse?

Revision procedures can be really complex since there is always the possibility of a worse outcome. It is extremely important to find a revision specialist who has years of experience with this particular treatment. It is critical for the surgeon to understand what went wrong with the initial surgery to be able to shape it into the intended surgical plan. This involves manipulating the internal structures of the nose and resetting the wrongly placed elements.

Donor Sites?

In cases when there is loss of cartilage or bone, it will be harvested from other parts of the body – the ribs for example. The grafted bone or cartilage will make up for the reconstruction of the internal framework of the nose. However, this is only likely in severe botched cases, which accounts for a small rate of rhinoplasty procedures.

Revision Philosophy?

The most important thing for revision rhinoplasty patients to understand is that each time their nose gets operated on, the outcome of a “perfect” nose becomes harder to achieve. Dr. Shah advises to be patient and have realistic goals. The lesson is that it is best to get it right the first time. But that is not always possible. If you need revision rhinoplasty in Denver, Colorado, make sure you see a rhinoplasty specialist like Dr. Manish H. Shah.

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* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.