17-year-old female student from Laguna Niguel 8 months following open rhinoplasty resulting in improved nasal appearance and facial balance. The 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 withering 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 (sponges) that create compromise of the overlying 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. The suboptimal nasal tip shape is characterized as a shapeless tip, in contrast to a refined nasal tip shape, and the result from improperly performed nasal tip cartilage stitching (intradermal 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 camouflaging 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 sidewall due to a weak upper lateral cartilage canopy, or from pinching of the nares entryway at the alar rim (external nasal valve constriction).
Correction of the internal nasal valve constriction requires the placement of spreader grafts. The collapse of the middle third nasal sidewall can be corrected with the placement of alar batten grafts which are placed in the nasal sidewall 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 entryway.
Book a Consultation for a Rhinoplasty Revision
In order to appreciate the exact nasal techniques required to complete your rhinoplasty revision surgery, a consultation is required.
Following your consultation, you will know exactly what maneuvers will be required to improve both the appearance and functionality of your nose. This evaluation will also affect the cost of your revision rhinoplasty.
For example, if you only need defatting of your nasal tip, you can perform this for only a few thousand dollars in the office setting without the need for general anesthesia. In contrast, if you will need rib grafting for more aggressive structural reinforcement, then you may need general anesthesia.
In any case, your rhinoplasty revision will be done to the highest standards for exceptional results. Your consult will include a quote for Dr. Mowlavi’s services.
23-year-old female student from Irvine 6 months following open rhinoplasty as well as submucous resection of a deviated septum and enlarged turbinates. The patient had a correction of severe nasal deformity with significant nasal dorsal deviation and nasal tip droop resulting in difficulty breathing. Upward rotation of the 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.
The patient now enjoys a more balanced nasal tip and nasal dorsum aesthetics following upward rotation and support of nasal tip.