Revision rhinoplasty is a term used 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.

Manish H. Shah, MD, FACS is a specialist in revision rhinoplasty in Denver, Colorado.  His fellowship at the Manhattan Eye, Ear and Throat Hospital in New York City, allowed him to work with his mentor, Dr. Tabbal.  Dr. Tabbal is one of the best revision rhinoplasty surgeons in the world and Dr. Shah was able to learn many advanced techniques to help patients with post-operative nasal deformities.  Revision rhinoplasty makes up at least 30% of the rhinoplasty operations he performs each year.  Patients from Colorado and surrounding  states consult with him to correct their noses after failed primary rhinoplasty procedures.  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.  Blood supply to the nose is altered and is usually diminished.  

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. 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 you and Dr. 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. 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.  A recent favorite of Dr. Shah’s is the DCF (diced cartilage-fascia) graft for rebuilding a bridge that has been over-reduced or over-resected. He has even perfected his own version of the operation known as the SCF (shaved cartilage-fascia) graft procedure.

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 feel like you 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. 

Check out Dr. Shah’s RealSelf.com video page in which he discusses Revision Rhinoplasty!

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. 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.