REVISION RHINOPLASTY IN CHICAGO, IL
Many advances have been made in revision rhinoplasty over the past five years. Many persons with nasal deformities thought to be “inoperable” in years past by surgeons from other decades may be able to be addressed by newer techniques and a better understanding of nasal dynamics.
Revision rhinoplasty is probably the most difficult procedure in all plastic surgery. While rhinoplasty is a difficult procedure by itself, revision rhinoplasty makes this procedure even more challenging. Oftentimes, patients need cartilage grafting to help recreate natural structures and create a nasal shape.
Before and After
Philosophy
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 buildings 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 skyscraper 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.
Revision Rhinoplasty Spectrum
Revision rhinoplasty can often be frustrating to patients, but not all revision rhinoplasties are the same. Revision rhinoplasty can be seen through this spectrum. Some patients may only need some minor changes that can be done in an in-office setting. Other patients may require hours or multiple stages of surgery to get their nose where they want it to be.
Non-Surgical Rhinoplasty
Nonsurgical rhinoplasty or the use of filler is an option for some patients who desire minor changes to the nose. These changes can include adding filler or threads to the bridge of the nose to help make the nose like straight or smoother. Small shadow issues along the nasal tip and middle portion of the nose can also be treated. Non-surgical rhinoplasty is not designed to reduce the nose or make large changes to the nose. For many patients, adding filler such as a longer lasting hyaluronic acid can help patients solve their issues with little to no downtime procedure.
Beware that nonsurgical revision rhinoplasty should ONLY be performed by an expert rhinoplasty surgeon and injector of filler. The anatomy of the nose is altered after surgery and injections must be in proper anatomical plane or issues such as vascular compromise can occur.
Micro Revisions
Dr. Shah studied under 2 of the most prolific endonasal (closed) rhinoplasty surgeons in the world. There are very few closed rhinoplasty surgeons left in the world and these valuable techniques, along with advances in nasal bridge contouring, can benefit some patients with specific issues. Small elevations along the bridge often times can be sanded down using an instrument called a rasp, Rather than use a standard handheld rasp, Dr. Shah prefers the uses of a micromotor rasp which can allow for improved changes and control of the nasal bridge appearance. Small issues with the columella, nasal tip can also be addressed. Some of these techniques can even be performed in an “in office” setting allowing for patients to have less downtime and risk in their final outcome. The benefit of these techniques is that for other surgeons, there rhinoplasty arsenal may be limited to larger procedures requiring extensive grafting. While these techniques are important, they may not be for every revision rhinoplasty patient with minor issues.
Is Cartilage Grafting neccesary in Revision Rhinoplasty?
Standard Revision
Most patients thinking of revision rhinoplasty think of a procedure in the operating room setting requiring time to restructure the nose. Revision rhinoplasty is becoming more common as more and more patients are seeking changes to the nose. For some patients, revision rhinoplasty represents a setback for their goals not being realized. For patients seeking revision rhinoplasty, setting realistic goals is a big step.
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).
Septal cartilage
Septal cartilage is often the desired choice for cartilage grafting. Septal cartilage grafting requires taking cartilage from the septum. For patients who have had prior nasal surgery, this valuable resource may no longer be present. Some septal cartilage is necessary for normal structure and form of the nose.
Rib Cartilage
Rib cartilage is often for patients with major deficiency of cartilage or seeking larger changes to the appearance of the nose. For patients desiring increasing nasal length and deficient in septal cartilage, rib cartilage may be their best option. Rib cartilage mimics septal cartilage in that both are hyaline cartilage. The advantage of rib cartilage is that it is strong and can allow for major changes in the appearance of the nose. The disadvantage of rib cartilage is that it is challenging to work with. Dr. Shah uses rib cartilage both in vertical and horizontal axis depending on goal (take intraop pic of sliced rib cartilage). One of the keys to using rib cartilage is to avoid making the nose overly bulky.
Rib cartilage is often for patients with major deficiency of cartilage or seeking larger changes to the appearance of the nose. For patients desiring increasing nasal length and deficient in septal cartilage, rib cartilage may be their best option. Rib cartilage mimics septal cartilage in that both are hyaline cartilage. The advantage of rib cartilage is that it is strong and can allow for major changes in the appearance of the nose. The disadvantage of rib cartilage is that it is challenging to work with. Dr. Shah uses rib cartilage both in vertical and horizontal axis depending on goal (take intraop pic of sliced rib cartilage). One of the keys to using rib cartilage is to avoid making the nose overly bulky,.
Ear Cartilage
Ear cartilage is great for non foundational support to the nose. Since ear cartilage is different from septal cartilage (elastic vs hyaline), it is not great for reconstructing septal shape and form. For small areas along the tip and middle portion of the nose, ear cartilage can be helpful. Ear cartilage can be challenging to work with due to the curved nature of the cartilage and its softer qualities.
Total Septal Perforation
The most advanced type of Revision Rhinoplasty would be the use of the pericranium flap for complete closure of total septal perforations along with grafting rib cartilage. This type of revision involves a variety of techniques who will probably have the most changes of the nose.
To read more about Septal Perforation and Dr. Shah’s technique to close it, Septal Perforation and Dr. Shah’s techniqueclick here.
Revision Rhinoplasty Approach
Consultation- determine function and residual cartilage
During the consultation Dr. Shah uses validated questionnaires to determine the function of the nose including the NOSE scale. He will also determine an estimate of how much residual cartilage is present to help patients understand their likelihood of needing grafting from ear and /or rib.
3D imaging and analysis – Dr. Shah prefers the use of 3D imaging (he uses the latest from Canfield called the H2 which is 99.9% accurate) to help patients understand both their face and nose. Often times their insights that the patient did not know was present.
Calculation- During the procedure dr shah will use the calculations and images as a guide to help him in the procedure. He performs detailed measurements to allow for as accurate as possible outcomes.
Instant Update- Many patients seeking revisions are nervous and anxious. He offers patients the option to see their nose on a disappearing story for immediate visualization of their nose. He first does this by taking a photograph of the nose without any anesthesia. He then injects the nose and operates and finally takes a photograph right before placing the cast. Dr. Shah does this even though the nose is swollen. It often gives patients peace of mind to know that there are already positive changes in the nose. This approach for instant followup is a combination of Dr. shah’s gentle approach, intraop anti swelling maneuvers and years of experience.
Follow Ups – rhinoplasty is akin to biologic sculpture. How our bodies react can influence our final outcome. Some patients will form scar tissue and swell despite dr shah’s technique and his anti swelling intraop maneuvers. Follow ups can influence a patient’s outcome and they must be willing to invest in their care.
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- Real Patient
Recovery Time after Revision Rhinoplasty Procedure
Recovery time varies from patient to patient and where they fall on the spectrum. Patients with filler often look good the same day or next day and can progress to normal activities. Patients with micro revisions often look good in days but their final result may take up to one year. Patients with standard revisions can often return to work in a week (case by care) but will often take longer to see their final results and may vary from case to case with some patients taking up to 2 years to see their final result. Dr. Shah uses a combination of supplements and specialized techniques to help minimize swelling and downtime.
Revision Rhinoplasty FAQ’s
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 “inoperable” 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.
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.
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.
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.
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.
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.
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.
“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.
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.
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.
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.
If you live near Chicago, IL, Anil Shah Facial Plastic Surgery offers revision rhinoplasty among its services and is conveniently located at 200 West Superior St., Suite 200 Chicago, IL 60654
About us
Dr. Shah is a double board certified facial plastic surgeon who has written over 50 scientific articles including three landmark articles about facial anatomy revolutionizing the way plastic surgery is performed. Dr. Shah specializes in Revision Rhinoplasty and takes an analytical approach to patient recovery after the procedure. Based in Chicago, IL; Dr. Shah is not only recognized as one of the top plastics surgeon not only in the city of Chicago, but in the world.
Related procedures: Septoplasty, Otoplasty.