A Quick Guide to Revision Rhinoplasty
Why Is Revision Rhinoplasty Surgery Complicated?
In a secondary nose job, the tissue inside the nose has undergone changes and may not tolerate extensive dissection, thinning procedures, or multiple incisions. Some noses have very thin skin and extensive scar tissue inside. The skin in revision surgery is not as pliable, which means that it does not easily tolerate expansion or contraction.
Therefore, the surgeon must use specialized techniques to effect a change in the structure of the nose to overcome the scar tissue. To create a greater tension than the scar tissue and skin envelope, Dr. Rizk uses suture and cartilage graft techniques. This translates into greater resistance and change in the structure of the nose.
Real Patient Results
*Results may vary.
*Results may vary.
*Results may vary.See more patient photos
Am I a Candidate for Revision Rhinoplasty?
Not everyone is a suitable candidate, and not all deformities can be corrected. It depends more on what was done in the original surgery and on factors specific to your anatomy than on how many procedures you have had.
Important factors include:
- The integrity of the skin
- How much cartilage was removed in the original procedure
- How much scar tissue there is
- The extent of the deformity and whether you need grafting
It is important that you have realistic expectations.Book an appointment
How Long Does Revision Rhinoplasty Take?
Dr. Rizk performs a meticulous operation to ensure the best results possible. He spends time creating his surgical plan before the surgery with detailed diagrams to decrease operating time.
Minimizing the Risk of Revision Rhinoplasty Complications
There are a number of things you can do to minimize your risk of experiencing complications following your revision procedure.
Choose the Right Surgeon
Choose an experienced, board-certified facial plastic surgeon who specializes in nose jobs and revision procedures. General plastic surgeons are well trained but do not have the same expertise in facial plastic procedures.
Prepare for Your Surgery
Before heading to your consultation, gather all of your medications, over-the-counter products, and any supplements you take so that you can show them to your doctor (in case any of them might cause problems with your surgery). If you are a smoker, then stop smoking well in advance of your surgery.
Make sure to follow your surgeon’s post-operative instructions and arrange for someone to help you with your aftercare. All revision nose job patients need some assistance during the postoperative period.
Things to Avoid
There are a number of things you should avoid if you will be undergoing revision surgery – your surgeon will discuss this with you. Definitely avoid having your surgery overseas. While it might save you money in the short term, it might cost you more if something goes wrong.
Revision Rhinoplasty Cost
Revision rhinoplasty tends to be more expensive than a primary procedure due to the experience and skill required to successfully perform this difficult procedure.
When you underwent your primary nose job, you should have been given a breakdown of three main fees that determine the price of your nose job. These same fees must be established to determine the price of a secondary nose job.
The total cost for a revision nose job includes:
- The surgeon’s fee, which will be calculated based upon the type of nose surgery being performed and the revisions required. Typically senior surgeons who have more specialized experience will charge a higher fee than more junior surgeons.
- The anesthesia fee, which encompasses the fee for the anesthetist and the medications that will be used.
- The operating facility fee that is charged by the surgical center. This fee may vary based upon the length of your surgery and whether an overnight stay is required.
Added together, these three fees will define the cost of your secondary nose surgery, which will be a unique amount based upon the details of your specific procedure. You should also consider the costs that will not be included in the secondary fee. For example, painkillers, antibiotics, ice packs, and bandages may need to be purchased to aid your recovery.
Patients frequently ask us if their health insurance will cover the cost of a revision nose job. We give patients the same advice for both primary and revision rhinoplasty – health insurance may cover procedures that are performed to correct or improve nasal function (for example, to straighten a deviated septum and improve the patient’s ability to breathe through the nose).
During the initial consultation, he provides them with the cost of surgery. A purely cosmetic procedure is never covered by insurance. However, in certain instances, part of the procedure may be covered by insurance.
Dr. Rizk’s Unique Approach to Nose Surgery
Dr. Rizk has pioneered a three-dimensional high-definition rhinoplasty surgery in his New York office. This allows him extreme precision in changing structures, while also reducing trauma and recovery time for patients.
He is highly sought-after throughout the United States and internationally, having treated members of royal families, celebrities, entertainers, and patients from around the globe. With each brushstroke, Dr. Rizk refines and sculpts to create a unique nose in harmony with a person’s face. The tools and techniques he uses allow for a precise operation with a virtually painless, rapid recovery.
Dr. Rizk performs both endoscopic (endonasal) and open (external) rhinoplasty through small inconspicuous incisions at the base of the nose. With a 3D high-definition nose job, Dr. Rizk can clearly see the structures before modifying them.
To determine how much to remove from a bump, Dr. Rizk uses a 3D high-definition camera rather than just filing it down. Then he addresses and sculpts it accordingly. Additionally, Dr. Rizk pioneered cartilage reshaping techniques with sutures that result in less excision of cartilage to preserve a natural framework. Furthermore, Dr. Rizk often adds cartilage in revision surgery to collapsed areas. This cartilage is usually obtained from the nasal septum or the ear (auricular cartilage.) Dr. Rizk may use this cartilage to:
- Camouflage defects
- Support a drooping tip
- Elongate an upturned nose
- Correct tip irregularities or asymmetries
Dr. Rizk strives to design a natural angle between the nose and forehead as well as the nose and upper lip. His procedure develops and compliments features of the natural nose to bring harmony to your facial profile. Although there are certain standards for the size of the nose in relation to the face and eyes, this is a very artistic operation.Book an Appointment
Dr. Rizk believes:
Dr. Rizk had developed his own techniques and published his methods for customizing procedures to the patient’s facial structure and degree of aging, as opposed to a one size fits all approach. As more and more younger patients, including men, are requesting cosmetic facial procedures, Dr. Rizk believes that his newer techniques are better tailored to them. To that end, Dr. Rizk authored some landmark articles on facelift, rhinoplasty, and blepharoplasty surgery, describing new techniques to be applied differently to younger versus older patients.
The Difference Between Rhinoplasty and Revision Rhinoplasty
Noses that have had work done previously might suffer from structural support defects resulting in a short, scooped out, or overly pointy appearance and sometimes breathing difficulties. To restore structure and nasal function, Dr. Rizk harvests cartilage from the septum or ear.
He also utilizes graft materials. The various grafts used in revision surgery by Dr. Rizk may include a spreader graft, alar batten graft, caudal septal extension graft, shield graft, tip graft, or camouflage graft. Occasionally he will also use a plumping graft to soften a very acute nasolabial angle. When Dr. Rizk adds cartilage grafts, he usually places another graft material on top of them so the edges of the cartilage are not palpable or visible. This helps to achieve a natural outcome.
As one of a handful of surgeons who are double board-certified in both otolaryngology and facial plastic surgery, Dr. Rizk routinely performs multiple revision rhinoplasty surgeries every week. Of the revision surgeries, seventy percent are performed with an open approach and thirty percent with an endonasal (closed) approach. However, Dr. Rizk finds that he can achieve a higher degree of precision and much more accurate results by using the three-dimensional high-definition telescope system for both open and closed approaches.
Open or Closed Rhinoplasty?
Open rhinoplasty is also referred to as external rhinoplasty, and involves altering the skin, bone, and/or cartilage to achieve the patient’s desired look. An incision is made in the inside of each nostril and through the skin between the nostrils. This allows the surgeon to ‘open’ the nose to reach its internal structure and make the necessary changes.
In a closed rhinoplasty, the only scars are on the inside of the nose and they are not visible. It is generally also a quicker procedure, although in some cases, more work may be needed if drastic results are required by the patient. Dr. Rizk can help you choose the best option between open vs closed rhinoplasty based on your individual needs and aesthetic goals.
Understanding The Recovery Period
As revision rhinoplasty candidates have already undergone the surgery at least once, they have a good idea of what the recovery period entails. Typically, revision rhinoplasty with Dr. Rizk in NYC is less painful than a primary nose job.
As a result, patients often experience very little pain during their recovery period. Once the procedure is complete, patients are given pain medications to help them manage any discomfort. Moreover, he prescribes antibiotics to his patients to prevent them from developing an infection following their operation.
The amount of bruising and swelling that a patient experiences following a revision surgery depend on the extent of the revisions being performed. Normally, patients will have less bruising and swelling than they did during their first surgery.
Revision patients in NYC should allow for approximately one week before they look presentable and are able to return to their daily routine, including work. If you experience only slight swelling and bruising following the procedure, you may also feel comfortable doing light activities such as walking.
Generally, patients can resume all of their normal activities within one month of their surgical operation. As with any form of rhinoplasty, it is important to understand that the full results of a nose job should only be judged one year after the surgery. This is because the nose will continue to change as it settles into its new position and all swelling subsides.Book an Appointment
Written Patient Testimonials
Dr. Rizk and his staff were absolutely incredible! They made me feel so comfortable throughout this entire process and I am so grateful for everyone (especially Dr. Rizk) for helping me look the best version of myself. My nose looks natural and perfect and I am in love with the results!!! If you are on the fence, I definitely encourage you to come to this office because Dr. Rizk gave me the confidence and grace to present myself to the world!
Words cannot express how tremendously grateful and impressed I am for his services. The process was painless and he produced beautiful results that I’m so happy with. Dr. Rizk is extremely precise, patient and detail orientated. He narrowed my nose 1mm at a time! I’m already looking forward to my next small tweek with him.
Fixed my nose that was extremely crooked from a car accident. Also did my brother’s nose which case out beautifully
I did a lot of research before choosing Dr. Rizk for my Rhinoplasty. I really loved how natural his ‘after’ photos looked and my friend spoke very highly of him. Him and I shared the same vision for what my nose should look like. I found everyone in his office to be so kind and thorough. I was amazed by how little bruising and swelling I had afterwards.
Dr Rizk and his staff did an amazing revision nose surgery. The experience was easy from the moment i stepped into the office. I would highly recommend Dr Rizk for anyone looking for rhinoplasty.
I’m 5 days post op from a revision rhinoplasty to narrow, elongate and de-rotate my nose. I couldn’t have asked for a better experience. Dr. Rizk and his staff are amazing and made me feel comfortable every step of the way, including the week before when I had doubts about going through the process again. I only wish I found this doctor and his team for my first surgery.Read More
Dr. Rizk is a great surgeon and to top it off he has a great personality, great bedside manners. The entire staff is very nice and friendly. My review is over due…I had Ethnic Rhinoplasty with Dr.Rizk. Before finding Dr.Rizk I did extensive research to find a doctor that specializes in African American rhinoplasty and also I had some breathing issues. There aren’t a lot of double board certified plastic surgeons that specializes in thick skin ethnic rhinoplasty.
5 months ago I had a rhinoplasty for an ethnic nose. I am a 31year old women from Dominican descent. My nose was very, very wide and no tip definition.
The first consult was good. I felt comfortable and heard because the Dr asked me first what I wanted and then he detailed his opinion in what procedure should be done and explained thoroughly. His entire staff was welcoming and well informed.
Dr. Rizk and his staff made me feel so comfortable. I love my Rhinoplasty because I now have a better looking African American nose. He preserved my ethnicity, which was a concern of mine. New York City is filled with plastic Surgeons but Dr. Rizk is in a class of his own.
Popular Nose Treatments
It is important to understand the psychology of secondary rhinoplasty patients who have been disappointed with their previous procedures and have less tolerance for postoperative problems. Patients also may feel guilty that they did not provide enough information to the surgeon, did not ask enough questions, did not do enough research into the surgeon’s qualifications, or did not communicate their desires correctly to the surgeon.
Understanding the Psychology Behind Revision Rhinoplasty
In addition, in revision surgery, it is necessary to assess patient motivation. Dr. Rizk points out that there are many types of patients who consider the procedure. The continuum ranges from patients with poor results that seek improvement but like their previous surgeons, to patients with objectively good results but who are desperately unhappy and furious with their first plastic surgeon.
Preoperative photography and thorough interviews with the revision patient are imperative. It is also important to distinguish patient anger toward their previous surgeon from disappointment with an outcome the patient didn’t expect.
Most surgeons’ intentions are to do their best to help their patients. Dr. Rizk reminds patients of this fact to try to diffuse their anger.
Dr. Rizk does not operate on angry patients and he attempts to convert an angry patient’s attitude towards their previous surgeon from that of resentment to one of disappointment. Patients must understand the margin of error inherent in human surgery and healing. All patients must understand that perfection is unattainable and any patient seeking perfect results is not considered a good candidate by him. Additionally, patients with body dysmorphic disorder who continually seek cosmetic surgery are not good candidates for revision nose surgery in NYC.
Types of Deformities Addressed in Revision Rhinoplasty
Below are explanations of some of the most common deformities addressed in revision procedures.
|Deformity||What is it?||How it occurs||How to correct it|
|Inverted V Deformity||This type of nasal deformity is characterized by an inverted V-shaped shadow in the area of the middle vault of the nose.||Overresection of the upper lateral cartilage, the cartilage that forms the sides of the nose’s bridge. It often occurs when the surgeon who performed the original procedure made a mistake during the removal of a nasal bump and during the fracturing of the nasal bones (this destabilizes the upper lateral cartilage).||Dr. Rizk prefers surgery to fillers because fillers do not fix the deformity permanently. The volume gained through hyaluronic acid-based fillers, for instance, lasts for about six months. Fillers are also less precise than surgery and can make the nose look larger. Moreover, they can cause inflammation and scar tissue, which makes a later surgery more difficult to perform. Finally, fillers can move around inside the nose. Therefore, he favors surgery to fillers when correcting an inverted V deformity. The surgery often involves the placement of dorsal cartilage above the nasal bridge to narrow the nose and widen the middle nasal vault.|
|Hanging Columella||The columella is the strip of skin between the nostrils. A hanging columella, or “alar-columellar disproportion,” is one that is visible from the profile and hangs lower than desired, typically about 4mm or more.||There are many potential causes of hanging columellae. Some people are born with it, in which case it is often the result of either a long septum and/or the columella cartilages pushing down on the columella. Other people end up with deformities due to a mistake made during their primary procedure.||This depends on the cause of the deformity. Excess tissue may be removed after making an incision, and a portion of the septum may be removed. Other cartilage may be removed or shaved. In rare cases, the nasal spine may be reduced.|
|Saddle Nose Deformity||A saddle-like formation in the area of the septum. This type of deformity is sometimes referred to as a “scooped nose.”||Typically, some type of trauma to the nose, like a blow to the face, causes the septum to lower.||The septum can be raised or a cartilage graft can be added to the depression, to fill it in.|
|External Nasal Valve Collapse||External nasal valve collapse is caused by weakness or narrowness in the nasal valve, the thinnest portion of the nasal airway.||Trauma to the nose or mistakes made during the original procedure.||In some cases, it is possible to treat by lifting the cheek tissue on the side of the nose that is blocked. In other cases, surgery may be needed. There are several different surgical approaches that may be employed. For example, alar batten grafts may be grafted as appropriate if the collapse was caused by weakness in the nasal sidewall. The surgeon performing the revision procedure will need to assess the cause prior to choosing which approach to adopt.|
|Pinched Tip||A nasal tip that appears too narrow, or “pinched.”||Some patients are born with a pinched tip, but this type of deformity is often the result of over-resection of the tip cartilages during the original procedure.||Usually, a “tip-plasty” is performed to reshape the tip with ear or other cartilage.|
|Pointy Nasal Tip||A nasal tip that appears pointy essentially means that the alar cartilages are too prominent and appear too pointy, or stick out too much.||Many patients are born with pointy nasal tips. This deformity is more common in individuals with thin skin.||It depends on the patient’s unique anatomy. The endonasal (internal incisions) approach is used on some patients, while an open approach is used on others. The cartilage may be shaved or trimmed. In thin-skinned patients, a soft tissue graft or fascia may be placed over the tip cartilage. Repairing a pointy nasal tip, or another deformity of the tip, is one of the most challenging of all rhinoplasty procedure|
|Open Roof Deformity||A space is formed when the nasal bones do not come together near the top of the nose. An open roof deformity makes the nose appear excessively wide. Typically, the nasal skin grows or droops, and vertical lines or depressions start to appear||It depends on how low or high the nasal bones are positioned. Osteotomies (fractures) may be necessary, and on-lay grafts may be used to close the gap between the nasal bones.|
|Cleft Lip Nose Deformity||Cleft lip nose deformity is a common birth defect that can severely impact a person’s appearance. In the United States, nearly all cleft lip nose deformities are corrected in infanthood, as failure to correct this deformity can result in developmental impairment, infection, and even death. Cleft lip nose patients commonly require additional surgery later in life to fully correct the deformity.||Cleft lip nose occurs when the upper lip does not form completely in utero, leaving a separation or “cleft” in the lip. About half of all children born with a cleft lip will also suffer from a cleft palate, which is a separation on the roof of the mouth and the most serious manifestation of the disorder. Cleft lip causes the lip and nose to develop asymmetrically, resulting in obvious deformities that can cause feeding issues, breathing difficulty, and speech problems, all of which contribute to developmental delays in the child. As such, early surgical intervention is almost always recommended.||Most often, the surgery will be performed to correct obvious asymmetries in the upper lip and nose. The surgery must be performed by a doctor who has received specific training in correcting cleft lip nose deformity. Cheiloplasty, the surgery performed to correct cleft lip nose, typically produces positive results and allows the child to enjoy a normal childhood after surgery. In most cases, the child will not remember the surgery or the difficulties they experienced as a result of the condition.|
Dr. Sam Rizk, a New York facial plastic surgeon specializing in surgery of the face and neck, is highly experienced in correcting deformities associated with the cleft lip nose defect.Book an appointment
Are There Any Risks To Revision Rhinoplasty?
All surgical procedures present possible risks and complications. Therefore, it is vital that you follow your surgeon’s instructions to minimize risks and optimize healing. Revision rhinoplasty is an invasive procedure and surgery risks may include:
Dr. Rizk will discuss the possible risks and complications with you before surgery.Book an appointment
Why Choose Dr. Rizk For Revision Rhinoplasty in NYC?
Dr. Rizk leverages decades of experience, a background in artistry, and his meticulous attention to detail to perform revision rhinoplasty procedures that are customized to each patient. His unique eye and understanding of anatomical structure allow him to address the “aesthetic units” with extreme precision and beautiful social presentation.
By Dr. Sam S. Rizk, M.D., FACS.
Dr. Rizk is a double board-certified facial plastic surgeon who specializes in rhinoplasty surgery and a recognized expert on the latest advances in facial plastic surgery techniques. He performs a range of facial plastic surgeries at his New York practice.