Beverly Hills Rhinoplasty Surgery Blog

This example shows a man who had undergone Rhinoplasty twice in his home country many years previously. His nose changed over time, leaving him with a feminized pinched tip and severe nasal breathing problems. On breathing deeply through his nose, his nostrils collapsed completely into tiny slits. During his Beverly Hills Revision Rhinoplasty, he had multiple grafts placed including batten grafts, spreader grafts, and a tip graft to achieve significant improvement in his breathing and restoration of the nose he had wanted originally, as shown in this 1 year postoperative photo on the right.

We see many patients who had wanted a pretty, small, feminine nose and ended up with a pinched tip, nasal collapse, and breathing problems. We often enter into a lengthy discussion regarding what would need to be done during a revision surgery to correct both their breathing concerns and improve any aesthetic issues. Often, these two overwhelming concerns are aligned. That is, whatever must be done to improve breathing (usually involving grafts) would also tend to make your nose look better. On the other hand, sometimes these concerns may work against each other. For example, improving breathing might involve having to widen or enlarge your nose slightly at the bridge (with spreader grafts) or the tip (with tip or batten grafts), something we need to take into account when we consider nasal aesthetics.

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No one likes to think about going through surgery and recovery more than once.

At Profiles Beverly Hills, patients who have not been entirely happy with prior cosmetic results often are referred to us seeking revision surgery. This is not to say that many patients are unhappy after surgery…quite the contrary is true. A great majority of patients are happy with their outcomes and most are not looking for perfection. What is a minor imperfection to some, though, is not so to others.

Still fewer patients are left with a more significant deformity. Conditions that may increase chances for a suboptimal result are poor technique or lack of surgical experience, an uncommon complication such as an infection, or sometimes simply the unpredictability of healing. An honest dialogue between patient and surgeon regarding desires and expectations can go a long way toward avoiding postoperative disappointment.

This woman was unhappy with her twisted and bulbous, boxy tip despite a previous Rhinoplasty. Also, her nasal septum was poorly supported and deviated so much that it was jutting into her right nostril and compromising her breathing. She wanted an overall smaller, smoother, and more feminine nose with improvement in her breathing. The 1 year postoperative photo on the right shows that these goals were achieved and she was thrilled that her new nose no longer dominated her face.

If you have a suboptimal result, it can often be improved upon. However, you should be aware that the chances for unbridled success must be downgraded slightly in this situation. This is because we are faced with having to revise surgical alterations against a background of scar tissue and distorted or lost anatomy. Scar tissue also tends to build upon itself with each subsequent surgery while normal structures or layers within and below the skin may thin out or atrophy. Nevertheless, in well-considered cases, we have had numerous successes in third, fourth, or even fifth rhinoplasty revisions. There is no magic number for allowable procedures.

We consider each patient on an individual basis. If we believe that a person’s concerns are clear, motivations are honest, and desired improvements are achievable in our hands with acceptable risk, we may recommend proceeding. Sometimes, though, things are better left alone, and we will be frank with you in that event. If you have questions about revision surgery, feel free to contact us for a more detailed discussion.

A graft is any tissue that is taken from the body to use in another area of the body of the same person or another person. When we talk about grafts in the nose, we are talking about cartilage, soft tissue (fat and fibrous tissue), or sometimes bone that is used to improve the structure and shape of the nose. Sometimes synthetic materials such as Silicone or Goretex are also used in the nose as implants. There are differences in the properties and uses of these materials. In general, the majority of grafts that are used in the nose are usually made of cartilage.

Cartilage grafts are small bits of cartilage that are carefully carved and shaped. They are used to either reinforce weak tissues or replace tissues that have been lost to trauma or removed during surgery. Most patients who require a number of grafts are seeking revision rhinoplasty to fix things after their nasal tissues have been too aggressively removed. Or, they may have a small nose or flattened bridge to begin with and wish to have it augmented, such as in some ethnic rhinoplasty. In these cases, it’s not uncommon for many different types of grafts to be used in the same nose, each playing its own unique role. Patients seeking primary (first-time) rhinoplasty for reduction of a bump or for refining their features usually do not need grafts.

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Want to know the most significant complaint we hear about after Rhinoplasty surgery?

It’s not pain, pressure, headache, or even discomfort. In fact, rhinoplasty is rarely very painful.

The symptom we hear about most is nasal congestion.

The picture above shows one technique that some surgeons still use to pack the nose. Most surgeons still use some form of packing or splint, which can either be merocel, gauze, xeroform or a variety of other forms. The end result unfortunately is more discomfort for the patient.

While not being able to breathe through your nose is not earth-shattering, it is extremely annoying. Think of it like a bad head cold that lasts. So, anything we can do to prevent this symptom is meaningful to you, and therefore important to us. And the biggest thing we can do to help, is to avoid nasal packing.

Packing is routinely used by some to help prevent excessive bleeding or dripping. We find we almost never need it. By handling tissues exceedingly carefully and gently, we find that we can generally keep bleeding, bruising, and swelling to an absolute minimum…and the benefit to you is an earlier return to breathing through your nose, less blockage from the beginning, and no painful removal of crusted packing.

We really have a passion for rhinoplasty, and we do all we can to help make your experience with us the best it can be… so we encourage you to come in and experience the difference.

That’s an odd question coming from a Rhinoplasty surgeon, we know. But, it’s a question we face a lot in our practice. If you spend time on Rhinoplasty discussion forums, you will leave feeling very depressed about your chances for the nose you’ve always wanted. These sites are chock full of nightmare stories of bad results and even worse interactions between the patients and surgeons. Having had a bad result already, many patients find themselves understandably bitter, suspicious of doctors, and despairing for the nose they had. It’s enough to scare off someone considering a first-time Rhinoplasty. More sad is that many Revision Rhinoplasty patients are so scarred from their experience that they are too scared to even think about jumping in the pool again after they’ve almost drowned, even if they can afford to take the chance!

And, the picture may not appear much brighter if you read our blogs. Patients say, “You talk about high revision rates and how hard the surgery is…is it even worth it?”. There are few surgeons who make a practice of doing Rhinoplasty, let alone Revision Rhinoplasty….the technical challenges seem insurmountable in many cases and it can also be very hard to win back a patient’s trust. Well, the story should not be one of doom and gloom. Just because Rhinoplasty and, especially, Revision Rhinoplasty are challenging does not mean that they cannot be consistently done well.

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The effects of aging on the nose have been classically described.

Its obvious when we look at our grandparents that their noses age as well. These changes have all been classically defined and at Profiles we have developed a conservative surgical algorithm which removes most of the signs of an aging nose without making you look dramatically different.

In general terms, you will note that newborns have a nasal dorsum that is concave (naturally scooped) with an upturned tip while in the elderly, the tendency is for the dorsum to appear convex with a ptotic (droopy) tip. Not all people will experience age-related changes to the same degree nor will all patients necessarily find this cause for concern.

As we age, the nasal tip often droops, resulting in an apparent dorsal hump. All we need do to see this is to look at photographs of our grandparents in comparison to their younger counterparts. It always appears as if a hump has grown with time; in truth, this is an optical illusion since our noses don’t grow substantially after the age of maturity. Rather, as the tip drops creating an acute nasolabial angle, the dorsum appears more prominent in contrast to the tip.

To correct these changes, here at Beverly Hills Profiles we follow a specific surgical sequence which we have found allows us to optimally restore your nose to its more youthful appearance. We encourage you to read more in our Modern Rhinoplasty textbook under Aging Nose.