Revision Rhinoplasty

Answer: It is always better to have fewer surgeries. However, in well-trained hands, it is not as important how many surgeries you have had before; what is more important is what your nose looks like now, and can a skilled revision rhinoplasty surgeon improve it. 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.

Revision surgery is different from primary rhinoplasty. Revision surgery requires specialized training and expertise. It is important to find a surgeon who specializes in revision rhinoplasty.

Answer: We hear this from many patients. While scar tissue in noses that have had prior surgery can complicate matters, improvements are usually still possible. It is true that sometimes, a nose may be beyond repair. However, in Dr. Becker’s experience this is uncommon.

Answer: Yes, if a patient’s nose has been over-operated and now looks too small, Dr. Becker can generally improve it. He also can generally fix noses that are too short, too long, too narrow, too wide, twisted, and so forth.

Answer: No, this is outpatient surgery. Dr. Becker’s patients typically go home after surgery; or, when they are from out-of-town, they stay at one of a number of fine hotels in the area.

Answer: Not typically. Time after time, Dr. Becker’s patients are surprised at how little pain and how little nausea there is. 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.

Answer: We suggest that patients take a week off from work. Patients tell us that recovery is uneventful. There is little pain and little nausea. Your main job after surgery is just to rest.

Most surgeons provide their patients with detailed after-surgery instructions.

Answer: The “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 by 1 week. Patients wear a small nasal bandage for 6 days.

After removal of the small nasal bandage (or “splint”), most patients are presentable in public. Most of Dr. Becker’s patients return to work the very next day after nasal splint removal. As noted in the patient instructions, there are restrictions on activity for a few more weeks after that. And of course, there is continued healing and reduction of swelling that continues to take place, quickly at first and then gradually for at least a year.

Answer: 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.

Answer: Yes, it has been Dr. Becker’s experience that significant improvements are possible in this relatively common problem.

Answer: Yes. Unfortunately, this is a common complaint. Fortunately we are usually able to substantially improve nasal breathing. A number of the patients in the Photo Album had this problem. Many times, patients request improvement in breathing and appearance

Answer: Yes. Computer imaging is a very helpful way to communicate surgical goals. It is important for the surgeon 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 extremely useful to communicate this information, and we therefore perform computer imaging on virtually all patients prior to surgery.

Answer: 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 a happy outcome.

Answer: 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.

Answer: If you have had a rhinoplasty and do not like the way your nose looks, and if you are in good health, then you are eligible for a revision rhinoplasty consultation. The next step is to meet with a skilled surgeon to see if surgery can meet your expectations. In Dr. Becker’s practice, Dr. Becker talks to you in detail and examines you. Then, he explains his realistic expectations for your surgery and will let you know if he thinks you are a good candidate.

Answer: Yes. Please see the Photo Album for examples.

Answer: 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 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.

Answer: 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!

Dr. Becker performs both endonasal (closed) and external (open) rhinoplasty. In his experience, the closed approach is more suitable for some noses, while the open technique is more suitable for others. The approach Dr. Becker picks is based on what he thinks will provide the best outcome for you, and based upon a detailed discussion about the technical aspects of your 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.

Answer: The incisions are just inside your nostrils, where they are hidden from view. The exception is the open rhinoplasty, where an additional small (3 to 4mm) incision is made across the tissue between the nostrils.

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 will not discuss our fees over the Web or over the phone, but in general patients have found our fees to be reasonable and fair.

Answer: YES. Rhinoplasty comprises approximately 50% of Dr. Becker’s surgical practice.

Answer: Dr. Becker is the 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.

Answer: YES

Answer: No, Dr. Becker does not use nasal packing.

Answer: Dr. Becker has designed a number of specialty instruments for rhinoplasty. These instruments are smaller to allow him to perform more exact surgery.

For example, 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.