Rhinoplasty Revision - Dr. Young Award Winning Facial Plastic Surgeon of Seattle / Bellevue, WA Specializes and Discusses Before and After Images, Case Presentations, and Learning Videos on Revision Rhinoplasty:

Before and After Revision Rhinoplasty for a procedure that was originally done in Korea. This patient had an extrusion of her implant through her nasal tip and we reconstructed through 2 stages. The first entailed taking the implant out. The second comprised of using both her ear cartilages to reconstruct her tip and nasal bridge

Below is a live video demonstration of an Asian Rhinoplasty Revision Surgery, although not related to the pictures shown on this page. We would like to warn you that the images in this video are graphic. But from the request of our patients and clients, we are showing this to better educate them and also answer some questions they have had in the past:

Rhinoplasty, to begin with, is the hardest and most technically demanding procedure that a plastic surgeon encounters in his career. With revision rhinoplasty, the level of difficulty is even greater. In revisions, you have scar tissue that can hinder the procedure from start to finish. Also the amount of material left to work with is usually much less. Hence, the possibility of needing cartilage tissue from your ears or ribs is greater during revisions. Implants such as silicone, medpor, cadaveric cartilage, polyethylene are some more popular alternatives over your own tissues. These alternatives are more attractive to some people who do not wish to have cartilage taken from their ears or ribs.

Sometimes the best way to illustrate your ideas are through case presentations / studies. Below is a lady who had an implant placed in Korea. This implant began to fight with the body and began to extrude from the tip of the nose.

This case was extremely difficult. The implant had eroded through her skin and had severly damaged her underlying cartilages. With Asian noses inherently, many times, having weaker cartilages and structure, we knew that this rhionplasty would require a "reconstructive effort". We would have to totally put the nose back together and also build it up in the process. The options included using a rib graft by itself, or using a combination of ear cartilage / temple fascia (tissue covering the temporalis muscle) / and medpor implant for the tip, or using solely medpor / silicone implants. Given that she had problems with the silicone implant, the option of all implants was not a great idea for her. Harvesting rib was also not on the top of her list and neither was this opttion top of mine. The option of using a combination of ear cartilage (likely both sides), temporalis fascia, and medpor sheets to present the natural tip cartilages was planned. The use of Medpor in Asian Rhinoplasty is explained in this link. Our plan was to take out the implant first and give the nose some time to rest. This 2 step process would allow us to avoid infections by placing cartilage or another implant in the nose in the setting of the implant extrusion, which is considered an infection prone nose. After waiting 2 weeks, we would then carry out the definitive revision. Our plan was to take both ear cartilages and mince most of this cartilage into small pieces and then place them in a fascial blanket shaped into a nasal bridge. This natural implant was then placed in the dorsum. The tip cartilages would be advanced as explained on this Asian Rhinoplasty page. We would further need to place some more cartilage on the sides of the tip and on the tip itself to increase the height

The above pictures were taken at one month. We will have more pictures in the near future when she comes back. Her swelling will go down more and her tip and bridge will become more refined with time. The scar on the tip of her nose will also get better with time. We will consider a scar revision procedure in the future as a possibility of further improving the tip area where the implant came out through the skin. The patient was extremely happy at this point of the recovery. We were also thrilled with the results! Again these after pictures were taken only just a month after the procedure. We will continue to update this for you to follow.

The next case involves a lady that had a rhinoplasty before. She was not happy that her nostrils showed a "snarling" type of appearance. Her nostrils flared upwards. She also felt that her nostrils on the sides were too high and wanted them lowered. We mentioned the different options of lowering the nostrils on the sides. Most of the time, it entails using tissue from somewhere else to make the nostril rim come down. You can advance tissue, add some cartilage and skin from the ear to the inside, add cartilage along the rim of the nostril to pull it down.

In this next 2 photos the blue shape in the one on the left indicates where you would put a cartilage graft within the nostril, hidden through an incision inside the nose. This cartilage graft can come from the septum or ear cartilage. This is good for less severe cases. When the retraction of the nostril rim is more severe, you can use composite grafts, or grafts that have skin and cartilage. We usually take these composite grafts from the ear in a well hidden incision. In the photo on the right the blue shape indicates where you would advance tissue from within the nose to lower the nostril rim. This is called a V-Y advancement.

In this next photo the blue arrow show our plan to advance the nostril rim to lower the whole nose on the side. This will help the retraction even more. Thie was caused by liberal resection of tissue on the side of the nostril which is often used to narrow the width of the nose in this area. The procedure to narrow the nose in this area is often called a wier excision. We are reversing the wier excision to a degree by advancing the nostril rim completely downward.

The below pictures are some before and afters to show the results from doing the composite grafts to the nostril rim and the advancing / lowering of the nostril side tissue inferiorly to help decrease the retraction.

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