Revision Rhinoplasty Houston

Revision Rhinoplasty Specialist Dr. Etai Funk - Houston Facial Plastic Surgeon

Revision rhinoplasty is a type of surgery performed on patients who have had previous rhinoplasty or septoplasty. Revision rhinoplasty addresses the aesthetic and/or functional aspects of the nose.  Unlike initial rhinoplasty or nose surgery, revision of a bad nose job or unsatisfactory result after rhinoplasty is a much more difficult operation.  Scar tissue makes the dissection of the nose much more challenging and cartilage can be very weak and scarce.  

Patients who feel they may have had a bad nose job can lead to many discouraging feelings. Whether you have a pinched tip, collapsed cartilage, or slooped nose after rhinoplasty, Dr Funk specializes in revision rhinoplasty and receives multiple consultations from referring physicians, patients, and their families throughout Houston for this purpose. If he feels as though improvement is possible with revision rhinoplasty, he will take your hand and slowly gain your confidence and trust to provide you not only with a pleasing result, but a memorable and enjoyable surgical course.

Many patients complain of difficulty breathing after their initial rhinoplasty or nose job surgery.  This may be due to over-resection of cartilage in the tip or valve collapse leading to obstruction of the nasal airway.  In addition, a deviated septum or turbinate hypertophy may not have been addressed during the first surgery leading to continued difficulty breathing.  

Why is revision rhinoplasty more difficult than primary rhinoplasty?

Revision rhinoplasty requires the surgeon to get through a considerable amount of scar tissue and deal with a previously operated nose.  This can be considerably difficult.  The nasal skin may be quite adherent to the residual cartilage.  This cartilage may also be weak and collapsed.  There may not be suffiicient cartilage left in the septum for grafting purposes which may lead to the need for ear or rib cartilage.  The healing process is quite different as now there is a new layer of scar forming on top of an old layer of scar.  This may lead to more unpredictabliity regarding how the nose heals.  Lastly, there may be functional compromise or breathing issues with the nose after the previous rhinoplasty or nose job that will need to be fixed with revision rhinoplasty.

This patient underwent revision rhinoplasty and septoplasty.  She could not breathe well after her original rhinoplasty and was unhappy with the result.  Notice how the tip of the nose is no longer crooke and pointy but now the nose is straight and more feminine.  She also had Otoplasty to pin back her ears.

This patient presents after previous rhinoplasty or nose job and underwent an open revision rhinoplasty to address her pollybeak deformity and straighten her crooked nose. 

Do I have a pollybeak after rhinoplasty? 

A pollybeak deformity occurs in the area just above the tip defining point of the nose.  This typically occurs after rhinoplasty when not enough cartilage was taken down in this area or if excessive scar tissue built up in this region.  Thicker skinned patients may be more prone to developing a pollybeak deformity after nose surgery or a nose job.

 This patient had a previous nose job or rhinoplasty which left her with what is termed a pollybeak nose.  Revision rhinoplasty was performed and her before and after nose surgery photos are seen below.  

I am unhappy with my result but am concerned about worsening things with another nose surgery.  

Nose surgery or rhinoplasty is not a painful surgery, but is an uncomfortable one.  No one wants to have to go through the discomfort of another surgery.  After a poor result from a nose job, you may become skeptical of the plastic surgery experience and plastic surgeons or facial plastic surgeons in general.  Understandably so!  It takes a lot of courage to see a surgeon for a revision surgery.  Your first step is making that appointment with a credible, board certified surgeon who is well versed and experienced in revision rhinoplasty surgery.  

Why does my tip look twisted after rhinoplasty?

Rhinoplasty is an extremely difficult operation.  You are dealing with a three-dimensional object composed of both cartilage, bone, and soft tissue.  Function and form must be accounted for and a natural result is essential.  The nasal tip cartilages can become particularly twisted and knuckled after nose surgery and frequently must be completely reconfigured to an even and symmetric nasal tip.  The patient below underwent revision rhinoplasty after a previous nose surgery left her nasal tip quite uneven and irregular.  Notice the more symmetric nose with better lines and a natural unoperated result.

This patient had a previous rhinoplasty, aka nose job, and had difficulty breathing, recurring sinusitis, and was unhappy with the appearance of her nose.  Revision rhinoplasty, septoplasty, and sinus surgery was performed.  

What is revision rhinoplasty?

Revision rhinoplasty is a surgical procedure performed to enhance the appearance of the nose or the nasal airway after the nose has already been operated on. Patients may feel they had a "bad nose job" or are unhappy with their rhinoplasty results. 

 Is revision rhinoplasty harder than primary rhinoplasty or my first surgery?

Yes. Revision rhinoplasty is more difficult than primary rhinoplasty for numerous reasons. After the initial surgery, there is scarring that is formed between the skin and the bony and cartilage framework of the nose. This makes for a more difficult dissection during rhinoplasty and more unpredictable healing. In addition, during the first surgery, septal cartilage may have been taken and used for grafting purposes. In this case, residual septal cartilage may be insufficient or unstable for the revision rhinoplasty. Ear cartilage or rib cartilage may need to be used for revision rhinoplasty. 

I can't breathe after rhinoplasty. Can revision rhinoplasty fix my breathing?

Difficulty breathing after rhinoplasty can be due to numerous anatomical or healing concerns. A deviated septum may not have been addressed or the deviation to the septum may have returned and lost its correction. Another major cause of nasal airway obstruction after rhinoplasty or nose job is nasal valve collapse. If the internal nasal valve and external nasal valve are not respected, supported, or treated during surgery, this can lead to nasal vavle insufficiency. Dr Funk performs many revision septoplasties and rhinoplasties in which the nasal valve was not addressed in order to improve nasal breathing. Lastly, the turbinates may be enlarged. These are structures that act to humidify and moisten the air as it passes through the inside of the nose. Somes inferior turbinates need to be made smaller in order to allow greater passage of air through the nose. 

This patient underwent tertiary revision rhinoplasty or nose surgery for breathing difficulty and cosmetic dissatisfaction.  Ear cartilage was used.  She also had Dysport to forehead, frown lines, and filler under the eyes (Restylane) and to cheeks (Radiesse).

Will I need ear cartilage or rib cartilage for my revision rhinoplasty?

Ear cartilage or rib cartilage may be needed for grafts during revision rhinoplasty. Depending on the presence and amount of residual septal cartilage, these other sources of cartilage are frequently necessary to provide structural integrity back to the nose.

Removing ear cartilage for revision rhinoplasty will NOT alter the shape of the ear. Post operatively there is minimal pain from the ear and there are no stitches to be removed.

Rib cartilage for revision rhinoplasty (costal cartilage) requires a small incision in the fold under the breast or chest. The scar heals extremely well in this fold and is hidden by the bra/bikini in women. The pain is well tolerated post-operatively.  If your own rib cartilage is not suitable or your do not desire this, another option is cadaveric irradiated rib cartilage.  

Patient before and after revision nose surgery.

Patient after revision rhinoplasty.  Upturned nose and irregularity on profile corrected.

This patient required a revision rhinoplasty specialist for her retracted nostril and crooked nose.  

 Revision rhinoplasty using ear cartilage by Houston rhinoplasty expert Dr. Funk.

Revision rhinoplasty for patient with crooked nose, abnormal profile and breathing problems.

Ethnic revision rhinoplasty in patient who had too much nostril show, a shortened and overrotated tip.  

Revision Rhinoplasty with ear cartilage on a patient who had two previous rhinoplasties.  Notice the more natural tip and more refined appearance.

This patient had severe cartilage collapse with a saddle nose deformity.  Rhinoplasty with rib cartilage was performed.

 This patient felt she had a pinched and crooked appearance to her nose after previous rhinoplasty.  Eyelid surgery was also performed.  

This patient had previous septoplasty with sinus surgery and had severe trauma to the bridge 2 weeks after surgery.  Her nasal bones are splayed and widened and she has a saddle nose with collapse.  She had severe nasal airway obstruction.  Reconstructive nose surgery or functional rhinoplasty was performed with ear cartilage.

This patient had breathing difficulty after previous nose surgery and required revision rhinoplasty.  He was unhappy with his upturned and overprojected nasal tip.  A more masculine nose was achieved. 

This patient had previous rhinoplasty and was unhappy with her pinched tip and difficulty breathing.  Her deviated septum was corrected with septoplasty and revision rhinoplasty was performed.  Natural result after nose surgery.

This patient had a previous rhinoplasty with an undesirable result.  She disliked the upturned and operated appearance of her nose.  Etai Funk, MD performed revision rhinoplasty in Houston using ear cartilage was performed to provide a more balanced and natural appearing nose.

This patient had a previous rhinoplasty with an undesirable result.  He disliked the upturned appearance of his nose and felt he still had a big nose.  Revision rhinoplasty  was performed to provide a more balanced and natural appearing nose.  He also had a deviated septum which was corrected.

This patient had a previous rhinoplasty with an undesirable result.  She disliked the upturned appearance of her nose and her nostril show.  Revision rhinoplasty using ear cartilage was performed to provide a more balanced and natural appearing nose.

This patient had a previous rhinoplasty with an undesirable result.  She had a pinched tip and her nasal tip was croooked.  She had nasal valve collapse, a residual dorsal hump and a hanging columella.  Revision rhinpolasty was performed to improve function and cosmesis of the nose.

This patient had a residual hump after previous rhinoplasty in addition to nasal airway obstruction.  Revision rhinoplasty was performed to provide a straighter nose, take her hump down, and improve her breathing.

This patient had a revision rhinoplasty leaving her with a crooked nose and crooked nasal tip.  Revision rhinoplasty using ear cartilage was used to straighten her nose.

Etai Funk is a Houston plastic surgeon specializing in the face including Revision Rhinoplasty in Houston. He is a board certified, fellowship trained, facial plastic surgeon. He practices in Houston, Texas treating patients from Katy, Memorial City, Memorial, The Woodlands, Spring Cypress, and Sugarland.  Dr Funk also sees many international patients for plastic surgery in Houston and from all over the US.