Rhinoplasty Revision

17 year old female student from Laguna Niguel 8 months following open rhinoplasty resulting in improved nasal appearance and facial balance. Patient had correction of nasal dorsal hump, narrowed nasal bridge, and a more refined tip. Following rhinoplasty, this patient now enjoys a more petite nasal contour that is aesthetically pleasing in appearance and she has avoided an operated look.

Secondary rhinoplasty is indicated for patients who desire a revision rhinoplasty. Patients who had prior rhinoplasty are frequently referred to Dr. Mowlavi for various reasons including nasal dorsum contour irregularities, suboptimal nasal tip shape or malpositioning and compromise of nasal structural support infrastructure leading to difficulty breathing.

Irregularities in nasal dorsum contour can result from wither nasal dorsal bony irregularities of the upper third of the nose or from poorly supported upper lateral cartilages which results in "an inverted V" deformity of the middle third of the nose. Irregularity in nasal dorsal bony contour can arise either from prominent bony spicules that create compromise of the overlaying nasal skin or from asymmetric infrastructure and medialization of the nasal bones causing a crooked nose deformity. Either deformity can be corrected by revising the previously performed osteotomies. The correction of the inverted V deformity requires reinforcement of the upper lateral cartilage to the dorsal septum utilizing a spreader graft. Suboptimal nasal tip shape is characterised as an amorphous tip, in contrast to a refines nasal tip shape, and result from improperly performed nasal tip cartilage stitching (intradomal and interdomal stitches). This deformity can be corrected by revising the nasal tip cartilage stitches and infrequently introducing onlay cartilage grafts. Since onlay cartilage grafts are vulnerable to resulting in an operated look, Dr. Mowlavi advocated softening all onlay graft edges and camoflauging the grafts with a temporalis fascia. Suboptimal nasal tip positioning is frequently observed and results from poorly reinforced nasal tip cartilage structures resulting in a tip that is lower than the nasal dorsum. When the nasal tip does not lead the nasal dorsum, the tip appears droopy as characterized by the parrot beak deformity.

 Patients who develop difficulty breathing following rhinoplasty demonstrate constriction of their internal nares due to poorly supported upper lateral cartilage and nasal dorsal septum junction resulting in constriction (internal nasal valve constriction), concavity of the middle third nasal side wall due to a weak upper lateral cartilage canopy, or from pinching of the nares entry way at the alar rim (external nasal valve constriction). Correction of the internal nasal valve constriction requires placement of spreader grafts. Collapse of the middle third nasal side wall can be corrected with placement of alar batten grafts which are placed in the nasal side wall and which stent up the middle nose soft tissue. Finally, correction of a pinched external nasal valve requires placement of alar contour graft that is placed directly into the alar rim and help stent open the entry way.

How Much Does Breast Augmentation Cost?

The all-inclusive cost starts at $5,000 when performed by expert board-certified plastic surgeons. This fee includes the surgeon’s fees, operating room fees, anesthesia fees, implant fees, breast band/garment, and all of your postoperative visits. Above all, Dr. Mowlavi is Orange County's top breast augmentation surgeon and will ensure that the results meet all of your expectations.

Book a Free Consultation

The only way to really know and understand the cost of any cosmetic procedure is to book a consultation. 

When Dr. Mowlavi can talk with you to learn about your needs and desires and can see you and determine what needs to be undertaken can he really determine the cost of your procedure.

 23 year old female student from Irvine 6 months following open rhinoplasty as well as submucous resection of deviated septum and enlarged turbinates.  Patient had correction of severe nasal deformity with significant nasal dorsal deviation and nasal tip droop resulting in difficulty breathing. Upward rotation of patient’s nasal tip has allowed for correction of her nasal tip droop which has improved not only her appearance but also breathing.

29 year old Hispanic female 6 months following open Rhinoplasty to correct bulbous nasal tip, constricted nasal dorsum, and nasal imbalance. Patient now enjoys a more balanced nasal tip and nasal dorsum aesthetics following upward rotation and support of nasal tip.

Breast Augmentation FAQs

During your breast augmentation consultation we will discuss:

  • The ideal implant size, shape, and form
  • Breast sizing
  • Discussion of various approaches for implant placement’
  • Preoperative management and planning
  • Postoperative care

There are many reasons why you might feel that one of your breasts is firmer than the other. This can be caused by early capsule formation or it may be that the implant was malpositioned. You will need to follow up with your plastic surgeon for this as this diagnosis is more accurate when made by feel during an examination.

Capsular contracture prophylaxis exercises can be initiated as early as one week following surgery but you have to make sure that you don’t push your breasts up; I recommend using a breast band over the first two weeks that minimizes the risk of malposition. When messaging your breasts, it is very important to keep one hand over the top of the implant while the other hand messages your breasts so that you don’t inadvertently push the implants up.

A radiated breast will always feel firmer and sit higher but this is not capsular contracture.  This is caused by fibrosis of your skin, underlying fatty, and fibro septal network. The capsule, in fact, might be absolutely normal assuming that you placed your implant after the radiation. Fat grafting has been recommended as a treatment to soften your breasts.

The only way to ensure that your chosen implants are going to provide you your desired breast size augmentation is to complete breast sizing during your consultation. During this visit, you are provided the opportunity to try out amongst a variety of breast implant sizers in order to hone in on your desired breast size. 

Also, when the implants are placed inside you, they will be actually 5% smaller in size. As a result, you must take this into account. A final reason why you may feel that your breasts are smaller at two months is that you have gotten used to your swollen breasts over the first six weeks that is now resolving.

You can side sleep immediately after breast augmentation. The idea is to not allow your implants to move from the dissected breast pocket until the pockets have scarred down (creation of a capsule). 

This occurs by 4 weeks following surgery. Regardless, as long as you wear a breastband (my favorite is the Mermaid band), you should have no problems with any activities that don’t require heavy weight lifting with your arms. The only exception is sleeping on your tummy in the early postoperative period which can push the implants out of their pocket.

Universally patients are not allergic to silicone. In fact, silicone is found in your diet as it is present in a potato skin. It is also used in your acrylic nails! Finally, it can be found in our cartilaginous structures such as the knees and ears. There has not been a single case of a true allergic reaction to silicone to date.

 

Whether or not you will need a lift is dependent on your nipple position. If your nipple is below or at your inframammary crease, then you will need a simultaneous lift at the time of your breast augmentation. 

The amount of lift is based on your chosen implant. The reason for this is to allow your nipple to be centered on your implant. This follows the fact that the implant must sit on your inframammary crease and such that the radius of your implant will be centered on your nipple. This is the most important consideration. 

The breast lift can only raise your nipple approximately 5 cm so it can only be performed for minimal to moderate nipple sagging. A virtual consultation with a breast specialist is recommended to make sure you appreciate what needs to be done to get you an excellent outcome.

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