Candidates for Revision Rhinoplasty
Any patient in good health who has had a previous rhinoplasty (one or multiple) and is dissatisfied with their results is a potential candidate for revision rhinoplasty. Patients should be fully healed before seeking a consultation for revision rhinoplasty, since residual swelling could be impacting the final results or affect a new surgical plan. It is important that patients maintain realistic expectations and understand that improvement, not perfection, is the goal. Minimizing the number of surgeries while making significant improvements and having a happy patient is the goal of revision rhinoplasty.
Individual candidacy must be assessed in person, during a one-on-one consultation with Dr. Becker. He reviews each patient’s case to ensure the procedure is a good fit for their needs.
Consulting with Revision Rhinoplasty Specialists
For patients who are interested in revision rhinoplasty, the next step in the process is to meet with a skilled facial plastic surgeon to see if the surgery is an appropriate treatment option for meeting their specific goals. Dr. Becker conducts consultations with patients in New Jersey to ensure that they are good candidates for the procedure and to discuss patient goals and expectations.
During the consultation, Dr. Becker talks to patients in detail and performs an examination. He will explain the possibilities for the surgery and discuss the details with you. Then, he explains his realistic expectations for your surgery and will let you know if he thinks you are a good candidate. He will provide information on the procedure, the risks, and recovery, and give you an opportunity to ask questions. He will also go over your health history and ensure that you are healthy enough to undergo elective surgery.
Dr. Becker also offers patients computer imaging at the time of the visit to assist in the planning and decision-making process. Computer imaging is a very helpful way to communicate surgical goals. It is important for Dr. Becker to know what the patient wants to accomplish, and the patient must know what the surgeon envisions as a goal for the surgical result. Computer imaging is an extremely useful tool for communicating this information, and weperform computer imaging on virtually all patients prior to surgery.
*Each patient is unique and individual results may vary.
The Revision Rhinoplasty Procedure
Since every nose is different and has unique surgical requirements, Dr. Becker discusses the options with each patient and is happy to describe his surgical plan in detail.
Before the procedure begins, patients are given anesthesia. Typically, this will either be general anesthesia or local anesthesia with IV sedation. Once the patient feels no pain, Dr. Becker will begin by making the incisions.
The two approaches are the endonasal or “closed” rhinoplasty (all incisions hidden inside the nose) and the external or “open” rhinoplasty (all incisions EXCEPT one small incision are inside the nose. In open rhinoplasty there is one small incision across the columella (the skin between the nostrils). This incision is generally extremely difficult to see, and is only 3 or 4mm long. The approach Dr. Becker picks is based on what he thinks will provide the best outcome for you, based upon a detailed discussion about the technical aspects of your procedure.
During the procedure, Dr. Becker will use advanced techniques based on the specific goals for the procedure and the current condition of the patient’s nose. This may include breaking or cutting and resetting the nasal bones, removing scar tissue, and repositioning cartilage. Once all the concerns have been addressed, sutures will be placed and the patient moves into recovery.
Revision rhinoplasty is an outpatient surgery. Dr. Becker’s patients typically go home after surgery to recover. When they are from out of town, they may stay at one of the fine hotels in the area. The initial recovery period is approximately one week. It takes just a few days to recover from anesthesia. There is typically some swelling and some slight bruising that is dramatically reduced after a week. Patients wear a small nasal bandage for 4 to 6 days. Dr. Becker does not use nasal packing.
We suggest that patients take a week off from work. Patients tell us that recovery is uneventful. There is little pain and little nausea, which can mostly be controlled with prescribed medication. A patient’s main job after surgery is just to rest. Most surgeons, including Dr. Becker, provide their patients with detailed after-surgery instructions. These should be followed closely for optimal results.
Shortly after removal of the small nasal bandage (or “splint”), most patients are presentable in public. Most of Dr. Becker’s patients return to work within a few days after nasal splint removal. As noted in the patient instructions, there are restrictions on activity for a few more weeks after that. There will be continued healing and reduction of swelling that continues to take place, quickly at first and then gradually for at least a year.
Dear Dr. Becker, I hope this email finds you well. It is a long overdue email that should have landed in your mail box many weeks ago. Just want to send you greetings from Hong Kong and let you know that I’m doing really well with my new nose. As you have told me before, now that much of the swelling has subsided, I am breathing much better and am loving the feeling of being able to breathe like a normal person. I also love the fact that I have a straight and smooth humpless nose. Thank you so much for doing such a wonderful job (I can’t even find the scar anymore!). Although it was a big trip to come all the way from Hong Kong, but it was so worth it and I’m so glad we found you. Thank you so much! Hope you had a wonderful Christmas. My fiance and I send you our warm wishes to you and your family for a Happy New Year! Regards, N
Revision Rhinoplasty FAQ
I have had four revision rhinoplasties. My doctor said that I can’t have any more and I just have to live with my nose the way it is. Is this true? How many revisions can I have?
It is always better to have fewer surgeries. However, in well-trained hands, the number of surgeries you have had before is not as important is what your nose looks like now. A skilled revision rhinoplasty surgeon may or may not be able to improve a nose, but they will need to evaluate the patient before making that determination. Some of Dr. Becker’s patients had as many as 7 or more revisions elsewhere before they went to see him. Dr. Becker was still able to make improvements for these patients. Sometimes a nose may be virtually beyond repair. However, this is relatively rare.
A doctor told me there is too much scarring in my nose, and that he or she can’t do anything more for me. Is this true?
We hear this from many patients. While scar tissue from a prior surgery can complicate matters, improvements are usually still possible. In Dr. Becker’s experience, it is uncommon that a nose isbeyond repair.
Is there a lot of pain or nausea after revision rhinoplasty?
Not typically. Time after time, Dr. Becker’s patients are surprised at how little pain and nausea there is during recovery. After-surgery pain is usually well-controlled with a mild narcotic. We are especially proud of our anesthesia team, who provide expert anesthesia that keeps after-surgery nausea to a minimum.
I live far away, how do I arrange to see you and to have surgery?
You can contact Dr. Becker’s office and arrange an appointment. Many patients come for an initial visit and schedule surgery at the end of this initial visit. They then return for their surgery. Occasionally a patient may wish to come into town for consultation followed by surgery the next day. This is possible, but obviously must be arranged in advance.
*Each patient is unique and individual results may vary.
Ever since my rhinoplasty, I can’t breathe well through my nose. Can you fix this?
Yes. Unfortunately, this is a common complaint. Dr. Becker isusually able to substantially improve nasal breathing. A number of the patients in the Photo Album had this problem. Many times, patients request improvement in both breathing and nasal cosmetics.
I’m not sure what I need to have done, I just know I don’t like it!Can you help me?
We understand! Some patients know how they want their nose to look, but other revision rhinoplasty patients are frustrated, angry, and even a little scared. They know they don’t like their nose, but they are upset and confused and just want someone to help them! We understand this and will take the time to work with you to help you have an outcome that makes you happy.
I am scared! How will you help me feel at ease before my surgery?
We understand! You have had a bad experience, so it is okay to feel that way. It is important for you to be confident in the surgeon you choose to perform your revision rhinoplasty. Dr. Becker is proud of his surgical results, but he also wants his patients to feel at ease. Dr. Becker’s staff plays an important role in helping his revision rhinoplasty patients feel more at ease before and after surgery.
Do you do surgery on all ethnic groups Caucasian, African-American, Asian, and other ethnic noses?
Yes. Please see the Photo Album for examples.
How does the surgeon go about figuring out what is wrong and then how to fix it?
There is both a science and an art to revision rhinoplasty. There are certain approaches, techniques, and so forth that are important. Then, just like artists, and athletes, and virtually all professions in life, some surgeons are simply more experienced and/or better at revision rhinoplasty than others.
Skillful, experienced surgeons understand the underlying causes of the various problems occurring in revision surgery. Understanding the anatomic cause of each complication provides a guide to the correct approach to repair. Often there is more than one concern and these can relate to each other in a complex fashion.
Sometimes if a problem is focused and limited, a targeted, limited approach can fix the problem. Other times, a more comprehensive reconstruction is needed. This depends on the nature and severity of the problem. Dr. Becker customizes each procedure carefully in order to create the best result possible.
*Each patient is unique and individual results may vary.
Will insurance cover my surgery?
Answer: If your requests are of a functional nature (for example, you cannot breathe through your nose), many insurance companies will cover the part of the surgery that is required to correct these problems. However, any requests that relate simply to change of appearance are generally not covered by insurance companies, and do require a cosmetic surgery fee. We do not discuss our fees over the Web or over the phone, but in general, patients have found our fees to be reasonable and fair.
I have heard that Dr. Becker teaches rhinoplasty to other board-certified doctors. Where do they come from?
Dr. Becker is the co-director of the University of Pennsylvania Aesthetic & Functional Rhinoplasty Course. This course has attracted surgeons from over 38 states and 11 countries.
Dr. Becker has also published a textbook on the subject of rhinoplasty. Surgeons have come from as far away as Sweden and Japan to study rhinoplasty from him and to observe his techniques.
What kind of advanced technology and modern techniques does Dr. Becker use to achieve faster healing and more precise surgery?
Dr. Becker has designed a number of specialty instruments for rhinoplasty. These instruments are smaller than standard tools, andallow him to perform more precise surgery.
The “standard” osteotome (bone knife) for cutting the nasal bones is relatively large — too large in Dr. Becker’s opinion. Dr. Becker’s research team measured the thickness of the nasal bones (only 2.5 to 3 mm) and have introduced a 2.5 mm and 3.0 mm guarded osteotome (manufactured by Microfrance), that we now use exclusively. We find that there is the least amount of trauma when these small instruments are used, and subjectively patients seem to have less bruising and heal faster.
In the operating room, Dr. Becker uses the Becker/ToriumiRhinoplasty Instrument Set, manufactured by Medtronic Corporation and especially designed for minimally traumatic rhinoplasty surgery.
About Dr. Becker
Dr. Daniel G. Becker is a double board-certified facial plastic surgeon who is renowned all over the world for his work in the field of rhinoplasty. Repairing a bad rhinoplasty outcome can be a life-changing experience, and Dr. Becker has dedicated his career to becoming an expert in the field. Dr. Becker has written 4 surgical textbooks and over 100 scientific publications on rhinoplasty and instructs other surgeons on the intricacies of rhinoplasty and revision rhinoplasty.
Dr. Becker sees patients from throughout New Jersey and the tri-state area, from all over the country, and from around the world who are seeking improvement after a rhinoplasty elsewhere. Sometimes the problem that a patient has with their result is minor, and sometimes it is dramatic. Whatever your situation, you should know that you are in the right place – Dr. Becker will listen to your concerns, examine your nose, and then, with the help of computer imaging, he will work with you to design the ideal surgery. You will find Dr. Becker to be kind, caring and exceedingly skillful at his craft.