Revision rhinoplasty, also known as redo rhinoplasty, is when additional surgery is required after a previous rhinoplasty has been performed. Patients seeking revision rhinoplasty may be looking for improved breathing, a change similar to their previous nose, or improvement on their existing rhinoplasty result.
Many advances have been made in revision rhinoplasty over the past five years. Many persons with nasal deformities thought to be "unoperable" in years past by surgeons from other decades may be able to be addressed by newer techniques and better understanding of nasal dynamics.
Revision rhinoplasty is probably the most difficult procedure in all of plastic surgery. While rhinoplasty is difficult procedure by itself, revision rhinoplasty makes this procedure even more challenging. Often times, patients need cartilage grafting to help recreate natural structures and create nasal shape.
Personal Philosophy of Revision Rhinoplasty
Dr. Shah often compares rhinoplasty to architecture. There are some parallels in building a nose and building a skyscraper (there are many in Chicago). It wouldn't be prudent to just jump into construction without a well-planned approach or a blueprint. There is science to ensure that the building will function is safe and not collapse. However, there is artistry in designing the building, creating the building, and interpretation of glass and light and space. There have been significant advances in bulidings over the time, with builders now able to buildings taller and with shapes and materials not possible in years past. Just as an architect for your house or company's skyskraper would welcome your input, so should your surgeon.
He is one of the few surgeons who use complex computational measures prior to every rhinoplasty to assess symmetry, projection, angles. Of course, these complex measures work in conjunction with Dr. Shah's artistic eye.
The idea is for Dr. Shah to guide you through this process and let you know what is and is not possible and what would look appropriate and function in balance and harmony with the rest of the face and body. He is using the most advanced rhinoplasty techniques available with state of the art planning and technical precision to help in creating your new nose.
In addition, Dr. Shah has a unique perspective on revision rhinoplasty. His goal is to use the least invasive approach to achieve the aesthetic goal. This means in some cases a revision rhinoplasty can actually be more straightforward than a primary rhinoplasty. On the other hand, some noses may require complete revisions.
Grafting and Revision Rhinoplasty
Many patients wonder whether cartilage grafting is necessary in revision rhinoplasty. It depends on the characteristics of the nose and how much cartilage or structure was preserved in the nose after the previous rhinoplasty. Dr. Shah utilizes only your existing cartilage in rhinoplasty. This cartilage can come from your existing nasal septum, ears (concha cymba and cavum), and rib (costal cartilage).
Dr. Shah is one of the few surgeons who utilizes costal cartilage. He has published two landmark articles on costal cartilage and is frequently referred complex cases by other prominent nationally known rhinoplasty surgeons. He harvests costal cartilage in a unique manner in which he does not cut any muscles surrounding the rib. He also utilizes a special technique in closing the donor site, making recovery from this procedure rapid and recovery expedient.
Auricular cartilage grafting is done with a postauricular incision, in order to hide the incision. He removes only the portion of the ear which will not effect the ear's shape. In fact, your ear will look the same except feel slightly softer in the portion where auricular cartilage has been removed.
How will I know if Dr. Shah knows what I want?
One of the key steps of performing revision rhinoplasty is a clear idea of what the patient wants and communication. Dr. Shah uses computer imaging to facilitate a clearer understanding between himself and the patient.
The computer imaging serves as a guide to create various noses and determine an aesthetic level of acceptance. For example, a patient may want her nose deprojected, and Dr. Shah will present multiple options to determine what the patient finds satisfactory or not. If the patient and Dr. Shah do not come to an understanding during his consultation, he will meet with them as many times as necessary to better understand and clarify each others aesthetic goals. If Dr. Shah does not feel like he "understands" the patient's aesthetic he will not operate on the patient.
Does Dr. Shah use open or closed techniques for revision rhinoplasty?
Dr. Shah uses both endonasal and external approaches in revision rhinoplasty depending on what your specific needs are.
Endonasal rhinoplasty is where all incisions are made within the nostril, while external rhinoplasty is where a small incision is made across the columella (skin area between the nostrils). There are pros and cons specific to each procedure. Dr. Shah feels strongly that every rhinoplasty surgeon should be able to use both techniques so that patients can have the best possible procedure for them.
I am coming from far away and am not sure if I am a candidate?
Dr. Shah sees patients from all over the country and world, including California, England, Netherlands, India, United Arab Emirates, Japan, China, and Canada. He and his staff help screen patients from afar to help make sure your visit to Chicago, IL is productive.
Where does Dr. Shah operate?
Dr. Shah operates only at accredited centers with board certified anesthesiologists. He prefers to operate at Gold Coast SurgiCenter for their level of care and excellent nursing for cosmetic surgery patients.
Does Dr. Shah understand ethnic patients concerns?
Dr. Shah is from a diverse racial background, with a dark haired father from Banglore, India and a blond haired mother from Italy. His wife is also of mixed background as well. He has worked extensively with patients from Asian, African-American, and Latin descent. Not only are there clear physical differences between noses from different backgrounds, but each patient has a unique set of cultural norms and ideas.
"Beauty does not know race or skin color." Anil R. Shah
Dr. Shah will work with patient to find an acceptable shape and contour of the nose. beauty is universal
Does Dr. Shah use K-wire?
Dr. Shah does not, except with rare exception. There are two instances when surgeons use K wire in rhinoplasty. First of all, some surgeons use K wire to help decrease the incidence of warping with the use of costal cartilage. Dr. Shah carves the costal cartilage in a way in which he does not need K-wire.
The second instance in which K wire is used is when the junction between the bony part and cartilage part of the nose is disrupted. This is also known as total nasal collapse. Some surgeons will drill K wire through the nasal bones through the cartilage and then through the other side (Reported on a series of six patients in Plastic and Reconstructive Surgery). Dr. Shah uses a different technique where he drills a hole through the nasal bone but resupports with a series of permanent sutures and grafts. He has performed this on a small series of patients (five patients) with success.
Will Dr. Shah give me the most fashionable nose available?
"Fashion passes, style remains." Coco Chanel
Dr. Shah does not believe in trends for the nose. His desire is to create a natural nose in appearance and shape specifically created for that patient. He does not have a preference to his nose (strong, projected, etc), but just creates nose which match a person's face in a natural appearance.
Will I have bruising after surgery?
Dr. Shah utilizes a series of preoperative and postoperative alternative medicines to help reduce bruising and swelling. He also performs special maneuvers to minimize trauma to the nasal mucosa and periosteum of the nasal bones (what is responsible for a key component to bruising and swelling postoperatively.) Some patients will still bruise despite these measures, however Dr. Shah will utilize targeted therapies to expedite the healing postoperatively.
Does Dr. Shah have experience in revision rhinoplasty?
Dr. Shah's has extensive background, training, and experience in revision rhinoplasty. 50% of his rhinoplasty practice is revision rhinoplasty work from other surgeons. He is a professor and teaches at a major university to other surgeons on how to perform rhinoplasty better.
He has performed revision rhinoplasty on a wide variety of noses including noses without septal or auricular cartilages, noses without lower lateral cartilages, upper lateral cartilages, severe deviations, noses which have been operated on five or more times, noses with extruded implants, retracted columellas, hanging columellas, pinched nasal tip, wide nasal tip, etc.
"The nose should fit the face"
A strong jawline would suggest a stronger nose.