Revision Rhinoplasty in Seattle Washington

Revision rhinoplasty involves an additional surgery performed on the nasal anatomy and structure of the nose to accomplish additional improvement in the appearance of the nose. The nose is comprised of 2 nasal bones, 2 upper lateral cartilages and 2 lower lateral cartilages in addition to the skin soft tissue envelope and the nasal septum. This revision procedure involves making the required changes to the nose to give the patient a very natural-appearing result. This facial procedure is much harder than a primary rhinoplasty due to the fact that there is scar tissue present, and there have been previous alterations to the anatomy of the nose. Many times, those changes are not apparent to the surgeon until the actual procedure is performed. Experienced facial plastic surgeons usually have a surgical plan outlined prior to placing this patient’s asleep under general anesthesia. All facial procedures at The Seattle Rhinoplasty Center are performed under general anesthesia by board certified physician anesthesiologists for patient safety and comfort.

Revisional surgery is sometimes performed for patients who have one or both nasal bones that have drifted outwards from the previous surgery and need to be straightened or narrowed with osteotomies. Some patients have a residual minor dorsal hump, which can be shaved down with a rasp. The irregularities across the bridge line can be composed of either cartilage or bone, and are the most common of the irregularities present after a primary nose job , especially when patients have thin skin. When patients have concave upper-lateral cartilages in the mid-section of the nose, or an inverted V. deformity, spreader grafts are inserted under the concave upper lateral cartilage. Some patients require spreader grafts placed on both sides of the nose for an inverted V deformity, or only on the concave side when there is a crooked nose present. The nasal tip cartilages can be asymmetric after a nasal surgery, therefore, cartilage grafting techniques are performed either as an onlay graft or sutured onto the tip cartilages. A residual bulbous nasal tip is reduced with suture techniques applied to the lower lateral cartilages of the tip of the nose, which reduces the width of the tip. Thick skin and extensive scar tissue in the tip of the nose prevent significant reduction in the width of the tip. When patients have alar rim collapse, an alar rim graft is performed to restore the anatomy in that location and prevent the nostril rim from collapsing with inspiration. Another telltale sign of having had a nose job is a hanging columella. A hanging columella gives the nose a “bottom heavy” look. To reduce a hanging columella requires incisions placed on each side of the internal part of the nose and shaving down the excess cartilage and skin that is present in that area. In addition, the tip of the nose can be rotated upwards or rotated downwards, depending upon where the skin and cartilage are removed. An alar-plasty is performed when there are residual wide nostrils after a primary rhinoplasty. An alar-plasty involves removal of a wedge of skin at the base of the nostrils to narrow them. Revision rhinoplasty can be accomplished with either open or closed  approach, depending upon the surgeon’s choice and preference. A closed  approach involves placement of all the incisions on the inside of the nose to gain access to the tip, bridge, and nasal bones to make the required changes. An open rhinoplasty involves the same incisions on the inside of the nose plus an external incision across the columella. The Seattle Facial Plastic Surgery Center – a Medicare certified outpatient surgery center in downtown Seattle, Washington located adjacent to Swedish/Providence Medical Center under the direction of Dr William Portuese and Joseph Shvidler MD.