October 22, 2025 • 18 mins
Ever looked in the mirror after your nose job and thought, “This isn’t what I expected”?
You’re not alone — revision rhinoplasty, or secondary nose surgery, is one of the most complex and emotionally charged procedures in plastic surgery. In this week’s episode of Plastic Surgery Uncensored, Dr. Rady Rahban breaks down why so many rhinoplasties require revision, what truly makes them difficult, and what you must know before going under the knife again. From scar tissue and missing cartilage to breathing problems, asymmetry, and collapsed nasal valves, Dr. Rahban walks you through the anatomy, decision-making, and step-by-step realities of redoing a nose that’s already been operated on.
Learn:
🎙️ Plastic Surgery Uncensored is hosted by board-certified plastic surgeon Dr. Rady Rahban, known for his honest, no-nonsense insights and patient-advocate approach.
✨ If you enjoyed this episode of Plastic Surgery Uncensored:
✔️ Subscribe on Apple Podcasts, Spotify, or wherever you listen.
✔️ Rate & Review—your feedback helps more people find us.
✔️ Follow Dr. Rady Rahban across all platforms for daily insights, behind-the-scenes, and patient education:
You’re not alone — revision rhinoplasty, or secondary nose surgery, is one of the most complex and emotionally charged procedures in plastic surgery. In this week’s episode of Plastic Surgery Uncensored, Dr. Rady Rahban breaks down why so many rhinoplasties require revision, what truly makes them difficult, and what you must know before going under the knife again. From scar tissue and missing cartilage to breathing problems, asymmetry, and collapsed nasal valves, Dr. Rahban walks you through the anatomy, decision-making, and step-by-step realities of redoing a nose that’s already been operated on.
Learn:
- Why revision rhinoplasty recovery can take 18–24 months
- When to wait (and when not to) after your first surgery
- The truth about structural grafting using septal, ear, or rib cartilage
- How to know if you’re a candidate — and when filler camouflage might be better than another surgery
- The biggest red flags when choosing a surgeon for your revision
🎙️ Plastic Surgery Uncensored is hosted by board-certified plastic surgeon Dr. Rady Rahban, known for his honest, no-nonsense insights and patient-advocate approach.
✨ If you enjoyed this episode of Plastic Surgery Uncensored:
✔️ Subscribe on Apple Podcasts, Spotify, or wherever you listen.
✔️ Rate & Review—your feedback helps more people find us.
✔️ Follow Dr. Rady Rahban across all platforms for daily insights, behind-the-scenes, and patient education:
- Instagram: @drradyrahban
- TikTok: @radyrahbanMD
- YouTube: @Rady Rahban
- Facebook: @Rady Rahban
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:06):
Welcome to another episode of plastic Surgery on Censored. I'm
your host, doctor Roddy Rabond, and we have a fantastic
episode for you. The episode is about revision rhinoplasty. That's right,
redoing your nose after you heard it already done. Why
would you ever do that? Because you're very unhappy and
unfortunately and sadly, rhino flasty has an incredibly high revision
(00:27):
rate and as a result, there are thousands, if not
hundreds of thousands of people who have had their noses
done and unfortunately are unhappy and therefore they are seeking
or looking to fix it. This is a really important
topic because fixing noses is really not that simple and
as a matter of fact, is super complicated. So we're
going to dive into every aspect of a revision rhinoplasty,
(00:48):
from what it means, why it happens, what you can expect,
and it's going to be a kind of a very
intellectual and educational episode. So let's dive in with as
I always do, which is let's do definitions. Let's explain things.
So primary nose or primary rhinoplasty versus revision. Primary means
(01:10):
it's your first time you go in you find a
doctor your anatomy, your nose has never been operated on.
In general, rhinoplasty is a very difficult procedure in comparison
to say liposection or a breast dog. It's up there
because technically, anatomically it's very challenging. So now you went
(01:31):
and had your nose done and you're unhappy and you
want to have it fixed. Now you fall under the
category of what's called revision rhinoplasty. So if primary rhinoplasty
was difficult, well, then revision rhinoplasty is in another stratosphere. Therefore,
you must be exceptionally careful that if you decide to
go down that route, that you identify someone who's truly
(01:53):
an expert or truly specializes in noses. As it is,
most plastic surgeons don't do rhinoplasty because, as I said,
it's pretty complicated. Within that group of individuals who do rhinoplasty,
many of them don't do revision rhinoplasty. So you're getting
it kind of a gist of how challenging it becomes.
(02:14):
So why is it so difficult, Like, Okay, it's difficult,
but why is it more difficult? The reason it's more
difficult the second or third time or fourth time is
because number one, you develop a tremendous amount of scar
tissue in a small area of very delicate anatomical pieces.
Imagine the inside of a watch. You open it, everything's there.
(02:34):
The second time there's gum in there. Secondly, you're missing things.
The previous surgeon removed things, rearrange things, so it's not native,
it's not virgin, things aren't where they ought to be.
And lastly, you have a very small margin for correction.
In other words, sometimes the thing you're trying to fix it,
if you go to fix it, you may overdo it
(02:54):
and make things worse. So revision rhinoplasty is definitely not
for the faint at heart. Things you need to know
if you're considering a revision rhinoplasty. Let's say you had
your nose done. You app solutely need to wait at
least a year. Let me reiterate that this is very important.
You get your nose done, you decast comes off, and
(03:17):
you're in massive panic mode. Oh my god, what have
I done? Naturally, totally makes sense. You want this thing
fixed yesterday, So you're gonna freak out and you're gonna
want to fix it as quickly as possible. And while
that is a natural instinct, it's a horrible idea. And
the reason being is that noses swell up a lot
more than any other area. And if you go in
(03:38):
the middle of that shit storm, in the middle of
that hurricane and you try to fix it, you're almost
guaranteed to make things worse. So you have to tolerate
the twelve month that's right, twelve months period for the
swelling to settle, so that if you're gonna have a
chance at making it better, the surgeon has a good opportunity.
(04:00):
So in general, I who do a lot of noses
and then does a lot of revisions, I don't more
or less ever do third time revisions. That means you
had your nose done, now you want to fix I'll
do it. You had your nose done, someone tried to
fix it, now you want me to fix it, and
or more I don't do it generally, And the reason
(04:21):
being is it's diminishing returns. It's not that I'm not
a good surgeon or you're not going to pay enough.
It's that the likelihood that we're going to go into
a nose that's been operated on that many times and
fix things that are one piece of cement is very
unlikely and I'm not interested in being a hero nor
making your situation worse. So I would caution you if
(04:43):
you are in the third or fourth revision, it's really
sometimes you just got to cut your losses. So, as
a result, when people call to our practice and they
want a revision nose, which is the only type of
procedure we do this with, we send a questionnaire. We
send them a questionnaire because we don't want to waste
their time nor my time and drag you in when
(05:07):
I know for a fact I can't help you. Again,
what is the objective for you to do better? For
you to be better? Sometimes it's just not possible. And
therefore we get a questionnaire sent to you and we
ask you for photos. We're going to ask you for
your op report, that is the surgeon, what did they do.
We're going to ask whether it was open surgery or
(05:28):
close surgery. We're going to ask you if they did
your septoplasty at the time, and all these pieces of
information are going to let me know if I believe
or I feel confident that I can help you, then
of course naturally you'll come in and we'll do the
examine whatnot. So what goes wrong? What happens to a
nose that leads someone to be so dissatisfied that they
(05:50):
literally have to go back and revise it. So here
are the things that are most commonly go wrong. Number One,
patients went in their breathing was either poor to begin with.
For five, they go get their rhinoposse done cosmetically and
their breathing is significantly worse. That is so common. That's
going to be caused by either one of a few things. One,
(06:12):
the septum that was deviated is still deviated or more deviated.
Two they get pinching of their nostrils and when they
take a deep breath they can't breathe. This is called
external valve collapse or three and most commonly the inside
valve internal valve collapses, and that means that they can't breathe.
(06:33):
Sometimes the issue is that they went in to remove
a hump and the doctor removed way too much and
now they're looked super scooped. Another time they went into
remove a hump and they're still a hump or a
weird hump or half a hump. Sometimes they go in
and their noses fatty and bulbous, and they want it
made it a little more refined, and now it's pinched
or overly skeletonized. Another time they go in and it's
(06:55):
just as big as it was before. And lastly, the
nose may be droop or overturned, which is one way
or the other. Actually there's one more which is actually
the most common, which is the nose is now asymmetric
or crooked or just isn't isn't straight. So those are
all and only some of the reasons why people decide
(07:17):
that they want to go and get a revision nose job.
So the question then is okay, So the patient comes
in and we ask them these questionnaires. They deemed the
good candidate. They come into my office and what does
it entail? So I'm gonna do a thorough exam, and
I'm gonna look at your nose and determine whether or
not I feel that the soft tissue the soft tissue
is mobile, meaning I can lift it up and go
(07:38):
down and see what I can do. Two, you're looking
for something that can be improved. In other words, sometimes
patients come in and what they want improved I just
can't improve it. It's too small, or it's too dramatic
and ice, there's no real room for improvement. Three. Sometimes
what they want improved, believe it or not, is best
(07:58):
addressed with a liquid rhinoplasty. And I'll be careful about this.
What I'm saying is that sometimes what they want is
a little bit of irregularity, and using a little bit
of filler, in the hands of a very skilled rhinoplasty surgeon,
you can just camouflage some irregularities and boom, make it
go away without having to do surgery. So I think
(08:20):
it's really important to go in and get multiple evaluations
and see what different doctors are suggesting to before you
jump in and do things. Now, I don't ever do
any more photoshop. I don't do that with primary noses
where I actually have a pretty decent control, let alone
(08:40):
a revision surgery. So if you go in and you
have a really messed up nose, and you go sit
with a doctor and they morph your photo on a
computer and oh my god, wow, that looks so good.
Oh my god, what would I do if my nose
look like that? You need to get up and walk
out the door, because there is no way in hell
that that's going to happen. That's why it says in
the bottom reason alt may vary. That means that's just
(09:02):
not gonna happen. I'm not gonna be able to help you. Now.
I'm gonna give you the basic gist of primary rhinoplasty
and more so revision rhinoplus. What is it that I do?
What are the techniques? So the first thing we're gonna
do is open up the skin, and I always do
an open rhinoplastic So let's get into this. When you
(09:23):
want to get inside a nose, whether it's the first
time or a revision, you need to enter through somewhere.
That's either a closed technique cut in each nostril or
an open technique cut in each nostril and one across
the base. I prefer the open technique for all my surgeries,
but absolutely for a revision because you want to be
(09:44):
able to open up the nose and see what the
hell you're talking about. Where's the anatomy where everything is
the Second thing I'm gonna notice is how thick or
how oily or how scarred is the skin. You're gonna
hope that the scar the skin isn't too scarred because
there isn't really much you can do. You can't go
removing scar out of the skin because you run the
risk of causing necrosis or the skin to die. And
(10:07):
then I want to say the bulk ninety five percent
of what we do with revision rhinoplasty is AD structure.
That's right, you heard it, AD structure. So what does
that mean? Most of the things that go wrong with
rhinoplasty today is that the previous surgeon was either too
(10:28):
aggressive and removed way too much or removed the wrong items.
And now your nose is small and collapse in places
it doesn't need to be. So what I do with
my primary noses, and for sure with my revisions is
AD structure in places that have collapse, for example, right
here in the top of the nose, where it's pinched,
(10:50):
if the nostrils are pinched, if the nose is over
rotated and you want to bring it back, if the
hump is gone and needs to be added soructure, what
the hell you talking about? You're gonna add plastic? No
structure comes in the form of cartilage. Therefore, the cartilage
that we use to reconstruct your nose. There are a
(11:11):
handful of them. The best and by far, my favorite
cartilage is your septum that are So that's why I
like when patients come in for their primary nose and
I fix their cosmetic and fix their function. That is,
I fix the way they look and the way they breathe,
and in doing so, I take the septum that is
(11:34):
almost always crooked and then recycle the cartilage back in
the nose. So now you're coming in for a revision. Notice,
I asked you on your questionnaire, did you get a septoplasty?
Because if that septum is unavailable, which it sometimes is,
I need to get cartlage from somewhere else where the hair.
Am I gonna get the carlage from? Well, that leaves
(11:55):
the ear, not the ear ear, but the ear inner
bowl or the rib or I have to take cadaver.
I have to borrow it from a cadaver. So we
need cartilage or you can't do ninety percent of revision
rhinoplasty because there's something missing and we need structure. So
that's really, really, really important. Once you get the nose
(12:18):
job done, be prepared. Be prepared because it's going to
be a long recovery. If you thought your first note
job was a long recovery, this is going to overshadow that. Unfortunately,
if you're one of those people who had your nose
done and you're unhappy with your nose, whether that's immediate
and or after many years, you're listening to this and
(12:39):
hopefully we're giving you information that's going to be helpful
to you. So we've talked about now revising your nose
by adding structure into places, adding to the bridge if
it's been overscooped, trying to straighten the nose by adding
structure to the sides, essentially building you a new nose.
It's what we do. And then the question is, now
that I've done that, let's talk about the recovery. So
(12:59):
normally we tell you that the time it takes for
your nose to heal is twelve to eighteen months. When
you do a revision rhinoplasy, I tell you eighteen to
twenty four months, and I'm not giving you lipsirs. I
mean eighteen to twenty four months. Now, you don't look horrible,
you may look excellent at the beginning, but the swelling
will take a long time to go away. You need
(13:19):
to take about two weeks off work because you usually
have a cast or some tape on your nose for
about two weeks. You then go back to exercising right
around the six week mark, and at that point you
kind of just go live your life. There isn't anything
you could do at that point other than just ride
the wave and the nose waves. As follows, the nose
tends to get more and more and more and more
(13:39):
swollen up until around six seven months, and then the
slowly slowly declining swelling that takes upwards of years to
go away. How long does a revision rhinoplas you take? Well,
it can take anywhere from three to six hours, depending
on how complicated it is. I do them always under
general anesthesia, and I do it in a obviously a
(14:00):
surgery center. Now, how many follow ups do I need
to have? So we see all of our noses revision
and or otherwise at one week, two weeks, six weeks
in one year, one week, two weeks, six weeks in
one year. But we also see you at two years,
three years, and five years. Now, why the hell would
I see you at two years, three years, five years
(14:22):
if you had a face of what I see you
five years later. What about if you had your chin augmentation.
I never see patients five years later if they're happy.
The reason we see nose patients for two, three and
five years is as I had said to you, the
nose they swollen for a very long time. And as
a good surgeon who does a lot of rhinoplast, you
know that you can't pack yourself on the back. Wow,
(14:44):
I done a great job until you've seen the horse
come through the finish line. And so a lot of
surgeons will see you for a few weeks and then
like not see you again. And then unfortunately patients go
on too being unhappy and they never come back. So
you really want to follow your patient's long term. Now
let's shift to what are the risks. So the risks
in general are as follows, but this is now a
(15:05):
higher risk. The risks of a revision surgery are higher
than the risks of a regular rhinoplasty. So bleeding and
infections in general are very small and almost never happen scars. Well,
if you had a previous open rhinoplasty, we have to
cut that old scar out and close it again. And
(15:27):
despite all of your efforts, your breathing may be no
better than it was, it may be worse than it was.
I cannot tell you the number of people I've seen
who've had revision rhinoplasty done and now they're breathing is
worse than before. Because, as I told you, this is
a very delicate house of cards. You can get necrosis
(15:49):
of skin. Remember you're lifting up the skin multiple times
and that little edge has to survive. But by and large,
the number one risk is irregular asymmetry and contour deformity.
What does that mean, I'm going to repeat it. Irregularities,
asymmetries and contour deformities, which basically means your nose is
(16:11):
not perfect. And despite your surgeon's skill, the amount of
money you spend, how much homework you did, the issues
you have still persist, and if you're lucky, they're better.
So you ever meet a surgeon and they lead you
to believe that your revision rhinoplasty results are going to
be a slam dunk or a home run, I assure
(16:31):
you they're lying to you. As it is. They should
never tell you that for a primary noes let alone,
or revision rhinoplasty, what you hope in the best case
scenario is the following. You do your homework, hopefully more
so than you did the first time. You interview a
few plastic surgeons whose work you like. You get a
realistic understanding of whether or not you are or aren't
(16:54):
a good candidate. You realize what things can and can't
be improved, and then when you have surgery, you pray
that the majority of the things that you went to
improve you got some percentage improvement such that at the end,
while you're not perfect, you're better than you were. And
(17:16):
if you are, I highly recommend you bury the hatchet
and you don't continue on this path, because I have
seen many patients in whom I've not operated on seeking
improvement of their nose, only to find that every time
they touch it, it only gets worse. I am, it's sad,
and it's unfortunate, and you know, I wish that I
(17:37):
could help every patient that I see, but revision rhinoplasty
is one of those places that's humbling for both patient
and doctor at any rate. I hope this sort of
synopsis of revision rhinoplasty was helpful. We've had many episodes
on rhinoplasty and things of that nature. But I really
(17:58):
want to impart some of the basic principles of redoing
one's nose. As always, thank you so much for joining
us on this podcast. If you enjoy the podcast, you
find it educational, informative, etc. Go write something nice, Go
write a nice review. We love nice reviews. Everyone who
puts time into this production would be grateful. And lastly,
if there's anyone you care about, you never know when
(18:20):
they're going to want to do an aesthetic surgery. You
never know when they're going to go get a Ryan o'blasty,
and you'll want to have sent our podcast to them
before it's too late. So, as always, signing off your host,
Doctor Rody Raband until next week on Plastic Surgery Uncensored
Welcome to another episode of plastic Surgery on Censored. I'm
your host, doctor Roddy Rabond, and we have a fantastic
episode for you. The episode is about revision rhinoplasty. That's right,
redoing your nose after you heard it already done. Why
would you ever do that? Because you're very unhappy and
unfortunately and sadly, rhino flasty has an incredibly high revision
(00:27):
rate and as a result, there are thousands, if not
hundreds of thousands of people who have had their noses
done and unfortunately are unhappy and therefore they are seeking
or looking to fix it. This is a really important
topic because fixing noses is really not that simple and
as a matter of fact, is super complicated. So we're
going to dive into every aspect of a revision rhinoplasty,
(00:48):
from what it means, why it happens, what you can expect,
and it's going to be a kind of a very
intellectual and educational episode. So let's dive in with as
I always do, which is let's do definitions. Let's explain things.
So primary nose or primary rhinoplasty versus revision. Primary means
(01:10):
it's your first time you go in you find a
doctor your anatomy, your nose has never been operated on.
In general, rhinoplasty is a very difficult procedure in comparison
to say liposection or a breast dog. It's up there
because technically, anatomically it's very challenging. So now you went
(01:31):
and had your nose done and you're unhappy and you
want to have it fixed. Now you fall under the
category of what's called revision rhinoplasty. So if primary rhinoplasty
was difficult, well, then revision rhinoplasty is in another stratosphere. Therefore,
you must be exceptionally careful that if you decide to
go down that route, that you identify someone who's truly
(01:53):
an expert or truly specializes in noses. As it is,
most plastic surgeons don't do rhinoplasty because, as I said,
it's pretty complicated. Within that group of individuals who do rhinoplasty,
many of them don't do revision rhinoplasty. So you're getting
it kind of a gist of how challenging it becomes.
(02:14):
So why is it so difficult, Like, Okay, it's difficult,
but why is it more difficult? The reason it's more
difficult the second or third time or fourth time is
because number one, you develop a tremendous amount of scar
tissue in a small area of very delicate anatomical pieces.
Imagine the inside of a watch. You open it, everything's there.
(02:34):
The second time there's gum in there. Secondly, you're missing things.
The previous surgeon removed things, rearrange things, so it's not native,
it's not virgin, things aren't where they ought to be.
And lastly, you have a very small margin for correction.
In other words, sometimes the thing you're trying to fix it,
if you go to fix it, you may overdo it
(02:54):
and make things worse. So revision rhinoplasty is definitely not
for the faint at heart. Things you need to know
if you're considering a revision rhinoplasty. Let's say you had
your nose done. You app solutely need to wait at
least a year. Let me reiterate that this is very important.
You get your nose done, you decast comes off, and
(03:17):
you're in massive panic mode. Oh my god, what have
I done? Naturally, totally makes sense. You want this thing
fixed yesterday, So you're gonna freak out and you're gonna
want to fix it as quickly as possible. And while
that is a natural instinct, it's a horrible idea. And
the reason being is that noses swell up a lot
more than any other area. And if you go in
(03:38):
the middle of that shit storm, in the middle of
that hurricane and you try to fix it, you're almost
guaranteed to make things worse. So you have to tolerate
the twelve month that's right, twelve months period for the
swelling to settle, so that if you're gonna have a
chance at making it better, the surgeon has a good opportunity.
(04:00):
So in general, I who do a lot of noses
and then does a lot of revisions, I don't more
or less ever do third time revisions. That means you
had your nose done, now you want to fix I'll
do it. You had your nose done, someone tried to
fix it, now you want me to fix it, and
or more I don't do it generally, And the reason
(04:21):
being is it's diminishing returns. It's not that I'm not
a good surgeon or you're not going to pay enough.
It's that the likelihood that we're going to go into
a nose that's been operated on that many times and
fix things that are one piece of cement is very
unlikely and I'm not interested in being a hero nor
making your situation worse. So I would caution you if
(04:43):
you are in the third or fourth revision, it's really
sometimes you just got to cut your losses. So, as
a result, when people call to our practice and they
want a revision nose, which is the only type of
procedure we do this with, we send a questionnaire. We
send them a questionnaire because we don't want to waste
their time nor my time and drag you in when
(05:07):
I know for a fact I can't help you. Again,
what is the objective for you to do better? For
you to be better? Sometimes it's just not possible. And
therefore we get a questionnaire sent to you and we
ask you for photos. We're going to ask you for
your op report, that is the surgeon, what did they do.
We're going to ask whether it was open surgery or
(05:28):
close surgery. We're going to ask you if they did
your septoplasty at the time, and all these pieces of
information are going to let me know if I believe
or I feel confident that I can help you, then
of course naturally you'll come in and we'll do the
examine whatnot. So what goes wrong? What happens to a
nose that leads someone to be so dissatisfied that they
(05:50):
literally have to go back and revise it. So here
are the things that are most commonly go wrong. Number One,
patients went in their breathing was either poor to begin with.
For five, they go get their rhinoposse done cosmetically and
their breathing is significantly worse. That is so common. That's
going to be caused by either one of a few things. One,
(06:12):
the septum that was deviated is still deviated or more deviated.
Two they get pinching of their nostrils and when they
take a deep breath they can't breathe. This is called
external valve collapse or three and most commonly the inside
valve internal valve collapses, and that means that they can't breathe.
(06:33):
Sometimes the issue is that they went in to remove
a hump and the doctor removed way too much and
now they're looked super scooped. Another time they went into
remove a hump and they're still a hump or a
weird hump or half a hump. Sometimes they go in
and their noses fatty and bulbous, and they want it
made it a little more refined, and now it's pinched
or overly skeletonized. Another time they go in and it's
(06:55):
just as big as it was before. And lastly, the
nose may be droop or overturned, which is one way
or the other. Actually there's one more which is actually
the most common, which is the nose is now asymmetric
or crooked or just isn't isn't straight. So those are
all and only some of the reasons why people decide
(07:17):
that they want to go and get a revision nose job.
So the question then is okay, So the patient comes
in and we ask them these questionnaires. They deemed the
good candidate. They come into my office and what does
it entail? So I'm gonna do a thorough exam, and
I'm gonna look at your nose and determine whether or
not I feel that the soft tissue the soft tissue
is mobile, meaning I can lift it up and go
(07:38):
down and see what I can do. Two, you're looking
for something that can be improved. In other words, sometimes
patients come in and what they want improved I just
can't improve it. It's too small, or it's too dramatic
and ice, there's no real room for improvement. Three. Sometimes
what they want improved, believe it or not, is best
(07:58):
addressed with a liquid rhinoplasty. And I'll be careful about this.
What I'm saying is that sometimes what they want is
a little bit of irregularity, and using a little bit
of filler, in the hands of a very skilled rhinoplasty surgeon,
you can just camouflage some irregularities and boom, make it
go away without having to do surgery. So I think
(08:20):
it's really important to go in and get multiple evaluations
and see what different doctors are suggesting to before you
jump in and do things. Now, I don't ever do
any more photoshop. I don't do that with primary noses
where I actually have a pretty decent control, let alone
(08:40):
a revision surgery. So if you go in and you
have a really messed up nose, and you go sit
with a doctor and they morph your photo on a
computer and oh my god, wow, that looks so good.
Oh my god, what would I do if my nose
look like that? You need to get up and walk
out the door, because there is no way in hell
that that's going to happen. That's why it says in
the bottom reason alt may vary. That means that's just
(09:02):
not gonna happen. I'm not gonna be able to help you. Now.
I'm gonna give you the basic gist of primary rhinoplasty
and more so revision rhinoplus. What is it that I do?
What are the techniques? So the first thing we're gonna
do is open up the skin, and I always do
an open rhinoplastic So let's get into this. When you
(09:23):
want to get inside a nose, whether it's the first
time or a revision, you need to enter through somewhere.
That's either a closed technique cut in each nostril or
an open technique cut in each nostril and one across
the base. I prefer the open technique for all my surgeries,
but absolutely for a revision because you want to be
(09:44):
able to open up the nose and see what the
hell you're talking about. Where's the anatomy where everything is
the Second thing I'm gonna notice is how thick or
how oily or how scarred is the skin. You're gonna
hope that the scar the skin isn't too scarred because
there isn't really much you can do. You can't go
removing scar out of the skin because you run the
risk of causing necrosis or the skin to die. And
(10:07):
then I want to say the bulk ninety five percent
of what we do with revision rhinoplasty is AD structure.
That's right, you heard it, AD structure. So what does
that mean? Most of the things that go wrong with
rhinoplasty today is that the previous surgeon was either too
(10:28):
aggressive and removed way too much or removed the wrong items.
And now your nose is small and collapse in places
it doesn't need to be. So what I do with
my primary noses, and for sure with my revisions is
AD structure in places that have collapse, for example, right
here in the top of the nose, where it's pinched,
(10:50):
if the nostrils are pinched, if the nose is over
rotated and you want to bring it back, if the
hump is gone and needs to be added soructure, what
the hell you talking about? You're gonna add plastic? No
structure comes in the form of cartilage. Therefore, the cartilage
that we use to reconstruct your nose. There are a
(11:11):
handful of them. The best and by far, my favorite
cartilage is your septum that are So that's why I
like when patients come in for their primary nose and
I fix their cosmetic and fix their function. That is,
I fix the way they look and the way they breathe,
and in doing so, I take the septum that is
(11:34):
almost always crooked and then recycle the cartilage back in
the nose. So now you're coming in for a revision. Notice,
I asked you on your questionnaire, did you get a septoplasty?
Because if that septum is unavailable, which it sometimes is,
I need to get cartlage from somewhere else where the hair.
Am I gonna get the carlage from? Well, that leaves
(11:55):
the ear, not the ear ear, but the ear inner
bowl or the rib or I have to take cadaver.
I have to borrow it from a cadaver. So we
need cartilage or you can't do ninety percent of revision
rhinoplasty because there's something missing and we need structure. So
that's really, really, really important. Once you get the nose
(12:18):
job done, be prepared. Be prepared because it's going to
be a long recovery. If you thought your first note
job was a long recovery, this is going to overshadow that. Unfortunately,
if you're one of those people who had your nose
done and you're unhappy with your nose, whether that's immediate
and or after many years, you're listening to this and
(12:39):
hopefully we're giving you information that's going to be helpful
to you. So we've talked about now revising your nose
by adding structure into places, adding to the bridge if
it's been overscooped, trying to straighten the nose by adding
structure to the sides, essentially building you a new nose.
It's what we do. And then the question is, now
that I've done that, let's talk about the recovery. So
(12:59):
normally we tell you that the time it takes for
your nose to heal is twelve to eighteen months. When
you do a revision rhinoplasy, I tell you eighteen to
twenty four months, and I'm not giving you lipsirs. I
mean eighteen to twenty four months. Now, you don't look horrible,
you may look excellent at the beginning, but the swelling
will take a long time to go away. You need
(13:19):
to take about two weeks off work because you usually
have a cast or some tape on your nose for
about two weeks. You then go back to exercising right
around the six week mark, and at that point you
kind of just go live your life. There isn't anything
you could do at that point other than just ride
the wave and the nose waves. As follows, the nose
tends to get more and more and more and more
(13:39):
swollen up until around six seven months, and then the
slowly slowly declining swelling that takes upwards of years to
go away. How long does a revision rhinoplas you take? Well,
it can take anywhere from three to six hours, depending
on how complicated it is. I do them always under
general anesthesia, and I do it in a obviously a
(14:00):
surgery center. Now, how many follow ups do I need
to have? So we see all of our noses revision
and or otherwise at one week, two weeks, six weeks
in one year, one week, two weeks, six weeks in
one year. But we also see you at two years,
three years, and five years. Now, why the hell would
I see you at two years, three years, five years
(14:22):
if you had a face of what I see you
five years later. What about if you had your chin augmentation.
I never see patients five years later if they're happy.
The reason we see nose patients for two, three and
five years is as I had said to you, the
nose they swollen for a very long time. And as
a good surgeon who does a lot of rhinoplast, you
know that you can't pack yourself on the back. Wow,
(14:44):
I done a great job until you've seen the horse
come through the finish line. And so a lot of
surgeons will see you for a few weeks and then
like not see you again. And then unfortunately patients go
on too being unhappy and they never come back. So
you really want to follow your patient's long term. Now
let's shift to what are the risks. So the risks
in general are as follows, but this is now a
(15:05):
higher risk. The risks of a revision surgery are higher
than the risks of a regular rhinoplasty. So bleeding and
infections in general are very small and almost never happen scars. Well,
if you had a previous open rhinoplasty, we have to
cut that old scar out and close it again. And
(15:27):
despite all of your efforts, your breathing may be no
better than it was, it may be worse than it was.
I cannot tell you the number of people I've seen
who've had revision rhinoplasty done and now they're breathing is
worse than before. Because, as I told you, this is
a very delicate house of cards. You can get necrosis
(15:49):
of skin. Remember you're lifting up the skin multiple times
and that little edge has to survive. But by and large,
the number one risk is irregular asymmetry and contour deformity.
What does that mean, I'm going to repeat it. Irregularities,
asymmetries and contour deformities, which basically means your nose is
(16:11):
not perfect. And despite your surgeon's skill, the amount of
money you spend, how much homework you did, the issues
you have still persist, and if you're lucky, they're better.
So you ever meet a surgeon and they lead you
to believe that your revision rhinoplasty results are going to
be a slam dunk or a home run, I assure
(16:31):
you they're lying to you. As it is. They should
never tell you that for a primary noes let alone,
or revision rhinoplasty, what you hope in the best case
scenario is the following. You do your homework, hopefully more
so than you did the first time. You interview a
few plastic surgeons whose work you like. You get a
realistic understanding of whether or not you are or aren't
(16:54):
a good candidate. You realize what things can and can't
be improved, and then when you have surgery, you pray
that the majority of the things that you went to
improve you got some percentage improvement such that at the end,
while you're not perfect, you're better than you were. And
(17:16):
if you are, I highly recommend you bury the hatchet
and you don't continue on this path, because I have
seen many patients in whom I've not operated on seeking
improvement of their nose, only to find that every time
they touch it, it only gets worse. I am, it's sad,
and it's unfortunate, and you know, I wish that I
(17:37):
could help every patient that I see, but revision rhinoplasty
is one of those places that's humbling for both patient
and doctor at any rate. I hope this sort of
synopsis of revision rhinoplasty was helpful. We've had many episodes
on rhinoplasty and things of that nature. But I really
(17:58):
want to impart some of the basic principles of redoing
one's nose. As always, thank you so much for joining
us on this podcast. If you enjoy the podcast, you
find it educational, informative, etc. Go write something nice, Go
write a nice review. We love nice reviews. Everyone who
puts time into this production would be grateful. And lastly,
if there's anyone you care about, you never know when
(18:20):
they're going to want to do an aesthetic surgery. You
never know when they're going to go get a Ryan o'blasty,
and you'll want to have sent our podcast to them
before it's too late. So, as always, signing off your host,
Doctor Rody Raband until next week on Plastic Surgery Uncensored
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