Repair or improve the results of your previous rhinoplasty and achieve the harmonious outcome you’ve always wanted with revision nose surgery from one of the best revision rhinoplasty surgeons, Dr. Raghu Athré.
What is revision rhinoplasty?
Revision rhinoplasty is the term applied to patients who have had a prior procedure on their nose. Other terms that mean the same thing are secondary rhinoplasty and secondary nasal surgery. Some patients may not have had a prior surgical nose job but might still be considered revision rhinoplasty patients. Examples of such patients include:
- patients with a prior septoplasty,
- patients with other surgical procedures of the nose, such as a Moh’s skin cancer surgery
- patients with prior nasal filler injections, and
- patients with significant or multiple nasal traumas.
This type of surgery is exceptionally complex because previous nasal surgery causes a certain amount of scarring. If the previous surgery was performed incorrectly, or the patient’s tissues did not heal well, the scarring can:
- significantly alter the shape of the nose,
- can cause twisting of the nasal tip,
- can cause twisting and loss of support of the nasal septum (deviated nasal septum)
- and can cause breathing difficulty.
In primary rhinoplasty, all anatomic structures are intact and without scarring or distortion. When nasal surgery is done, just elevating the tissues of the underlying cartilage causes mild scarring.
But cartilage is cut, removed, and repositioned in primary nasal surgery. The result of this can be a nose that is twisted, has lost support, lacks septal cartilage, etc.
A revision rhinoplasty is a delicate procedure where first, the tissues are elevated, and all the structures that need to be repaired or rebuilt are categorized. Frequently, additional cartilage is required for revision rhinoplasty. This additional cartilage may be obtained from your ear, one of your ribs, or cadaveric rib cartilage grafts.
Why should I do a revision rhinoplasty?
A revision rhinoplasty is done for two main categories of reasons: Cosmetic and Functional.
Though we draw an artificial line between cosmetic and functional issues, these two categories are intimately related, and it is impossible to completely divide these issues into two separate categories.
The nose is perhaps the most defining facial feature. When the nose is in balance with the entirety of the face, the nose disappears into the background. However, when the nose is not proportionate to the features of the face, it stands out.
A beautiful nose is a nose that is straight, balanced, soft, natural, proportional, aesthetically pleasing, AND FUNCTIONS WELL.
Here’s an example of how closely cosmetic and functional attributes are.
Before and after of a patient with two prior rhinoplasty surgeries is shown. Revision rhinoplasty via open approach was done under general anesthesia.
Her main complaint was the bulbousness of the tip and the increased width of the tip and dorsum (nasal bones). She underwent a tertiary rhinoplasty for correction of these cosmetic concerns. In her surgery, her alar cartilages and her alar sidewalls were reshaped to give her more definition overall. The nasal bones were rasped as a cosmetic portion of her surgery.
The result of this modification of her lower lateral cartilage actually improved the patient’s nasal airway. The slight change in the angle of the nostrils improved the external nasal valve, and the patient looks better and breathes better.
What happened in my primary rhinoplasty? Why do I need a revision?
In the best of rhinoplasty surgeon’s hands, some patients will require a revision rhinoplasty. There is no surgeon who can boast that they have never had to do a revision rhinoplasty on one of their own patients. Why? What happened?
When rhinoplasty surgery is done, cartilage and tissues are modified. Once the surgery is over, we depend on the body’s natural healing mechanisms to scar the tissues, heal the tissue, and achieve their final shape.
This scarring process is sometimes unpredictable and can cause significant contracture of the tissues. As this happens, twisting, etc, can happen, which can necessitate a revision. Also, patients can complain of breathing problems and a deviated septum as the nose has lost support after primary surgery. To combat this, cartilage grafting, etc, is performed to combat the forces of scarring and contracture.
Despite this, contracture and scarring can still occur. Dr. Athre’s extensive experience with primary and revision rhinoplasty and his engineering background allows him to perform rhinoplasty surgery, controlling as many variables as possible to give you the most reproducible result and minimize the chance of such complications. Experience is key to the best revision rhinoplasty results.
I need a revision rhinoplasty, but am scared
Being scared is NORMAL!
The revision rhinoplasty patient is one of the most difficult patients.
Why? The revision rhinoplasty patient has already undergone surgery. That first surgery was filled with hope and expectations of an amazing result. When that result did not quite happen, and complications arose, a certain amount of depression, anxiety, disappointment, and fear set in.
The most important part of the revision rhinoplasty process is the consultation. Dr. Athré specializes in revision rhinoplasty and has successfully corrected patients who have had as many as 5 prior rhinoplasty surgeries. In consultation, all of the above apprehensions and fears are discussed with the patient, including expectations and the chances of success.
The consultation is for the patient and Dr. Athre. The patient normally has questions and concerns about the revision rhinoplasty procedure. Dr. Athre needs to understand what happened in the prior procedure, make sure that the patient has realistic expectations, AND develop a detailed plan on what is necessary.
The only way to combat the fear and apprehension is with honesty and information! During the consultation process, Dr. Athré will create a detailed schema of items that need to be corrected, and a blueprint of possible options that may be required in your case will be outlined.
As in anything, the first step of the process is the hardest step. If you are interested in learning more about a revision rhinoplasty, please contact us through our contact form.
Ancillary procedures in revision rhinoplasty
As discussed in many places, cartilage is the key structural component of the nose. It is the “framing” behind the structure of the nose. You cannot build a house without wooden studs, and you cannot build a nose without cartilage.In revision rhinoplasty procedures, cartilage has frequently been resected, is missing, or is deformed and cannot support the nose. In such cases, additional cartilage is required to rebuild the nose. There are 3 general sources of cartilage.
- Auricular cartilage. Auricular cartilage is cartilage from your own ear.
A small amount of cartilage is removed from the ear through an incision made on the back side of the ear. This procedure does NOT change the cosmetics of the ear, the shape of the ear, the size of the ear, or your capacity to hear. You will never know that a small piece of cartilage was removed from the ear. This type of cartilage is really poor for structural support but is excellent for contouring and for camouflage.
- Costal cartilage. Costal cartilage is rib cartilage.
A small incision (approximately 2 inches) is made on the right side of the chest. In women, this incision is made in the inframammary fold of the crease, where your bra strap sits against the bottom part of your right breast. This type of cartilage is awesome for structural support and poor for camouflage.
- Cadaveric rib cartilage. This type of cartilage is rib cartilage, except that it is harvested from a donor cadaver.
Persons who have indicated that they would like to donate their bodies are the source of these biological products. The cadavers of these persons are screened for numerous diseases such as HIV, Hepatitis A/B/C, CMV, HPV, etc. Once the cadaver has passed all the exams, it is appropriate for willed body donation. The rib cartilage from these cadavers is harvested, processed, and sold for implantation in such surgical cases. More Info (PDF)
|Easy to harvest
Autologous (It’s your own tissue)
|Increased OR time
Does not require increased OR time
Revision Rhinoplasty FAQs
What is the success rate of revision rhinoplasty?
Some studies show that the rate of revision after a rhinoplasty is in the 10-15% range. This means that 10-15% of the patients having a rhinoplasty surgery will go in for a second revision surgery.
First, Dr. Athre’s revision rate after primary rhinoplasty is less than 2%. His revision rate for a revision rhinoplasty is 0% over 15+ years.
How can the revision rate of revision rhinoplasty be so low? When you start the process on a revision rhinoplasty, Dr. Athre first starts with the philosophy of do no harm. So, if the revision surgery does not have a significant probability that the patient is going to be better and the risk/benefit analysis does not favor the patient, he will not offer revision surgery to the patient. Second, during revision surgery, Dr. Athre is aware that the primary surgery did not work out. Hence, revision surgery is “over-engineered” to minimize the risk of complications.
Revision rhinoplasty surgeries are almost always done via the open rhinoplasty technique. This is because the open rhinoplasty technique allows better visualization of all possible issues and structures contributing to the suboptimal result after primary nose surgery.
Is a revision rhinoplasty more or less expensive than a primary rhinoplasty? Why?
A revision rhinoplasty starts at about $10,000 and can go up depending on what all is needed.
A revision rhinoplasty is more expensive than a primary rhinoplasty. A primary rhinoplasty starts at about $5,500 and is approximately $9,000 when facility fees and anesthesia fees are added.
Additional cartilage requirements, like rib cartilage, will make the price go up.
The reason that revision rhinoplasty is more expensive is TIME. Dissection in revision surgery is harder and more tedious, requiring more time. Ancillary procedures take more time. All of this adds up and increases the surgical cost and the anesthesia/facility costs for a revision rhinoplasty. Everything included, revision rhinoplasty starts at approximately $15-16,000+.
How long after a primary rhinoplasty can I do a revision rhinoplasty?
There are no steadfast rules on this. The earliest Dr. Athre will see a patient for a potential revision is six months after their primary rhinoplasty. Usually, Dr. Athre likes to wait 9-12 months after the primary rhinoplasty to let complete healing occur. This also minimizes dissection in a fresh surgical site that has a tendency to bleed more, making the difficult discussion even more difficult.
What risks are associated with revision rhinoplasty?
From an entirely surgical point of view, the exact same risks that existed for primary rhinoplasty exist for revision rhinoplasty. This includes difficulty breathing through the nose, poor cosmetic outcome, septal perforation, and nasal synechiae. There might be additional risks IF ancillary procedures are also done.
Despite this, most patients can still return to work within ten days after revision rhinoplasty surgery.
Will insurance pay for my revision rhinoplasty?
Your insurance company may or may not pay for a revision rhinoplasty. Insurance will not cover any cosmetic surgeries and will not cover any of the cosmetic portions of nasal surgery.
Dr. Athre does not accept insurance for revision rhinoplasty. You are welcome to obtain your own pre-authorization and file your own insurance.
“Dr. Athre did an amazing job on my nose. His staff treated me like family and I felt very comfortable getting the work done. He was very intuitive on what I was trying to accomplish and knowledgable enough to work through the issues involved to get the result I wanted, especially considering it was a revision surgery. The whole experience was great and helped me so much!”