Revision Rhinoplasty Beverly Hills

It is very discouraging to undergo nose reshaping surgery only to find that the final result falls far short of expectations. People in this position are understandably hesitant to undergo surgery a second time and may be despondent of ever having the result they had hoped for. Dr. Kevin Brenner is a prominent revision rhinoplasty surgeon in Beverly Hills. In addition to over 7 years of plastic surgery training, he has completed uniquely specialized training in nose reconstruction techniques.

He completely understands the frustration felt by revision rhinoplasty patients and realizes that trust may need to be rebuilt. Revision nose surgery is considered by most plastic surgeons as the most challenging of all cosmetic procedures. Patients can need revision surgery even when the original procedure was performed by a skilled surgeon. The healing process is unpredictable. In some patients, erratic healing will result in cosmetic imperfections or functional

Secondary rhinoplasty is the term used for nasal corrective surgery performed on a patient who has had a previous nasal operation. Revision nose surgery may have already been attempted several times. This makes the revision process far more complex as surgery causes trauma each time, weakening the internal structure.

Some patients only require a very small correction in revision rhinoplasty. After healing it may be necessary to remove a small amount of residual bone or cartilage. There may be a small ridge that formed during healing or some scarring that must be revised. In these cases the revision surgery is usually done by the original surgeon.

Patients with unsatisfactory results seek a second opinion for several reasons. Usually they have lost confidence in their original surgeon and want to seek the opinion of a more qualified rhinoplasty surgeon.

Second opinions are sought for several reasons:

• A persistent defect which was never addressed during primary rhinoplasty
• A defect that has formed as a result of primary surgery such as a drooping tip
• Depressions in the nose or asymmetric appearance
• Displaced implants or cartilage grafts
• Healing variations that have caused cosmetic or functional defects
• Collapse of the nasal airway from primary surgery causing breathing difficulties
• Unsightly scarring
• Trauma to the nose after primary surgery

Revision rhinoplasty is among the most complex and demanding procedures in plastic surgery. As the nose is a complex three dimensional structure, the skill of the surgeon must be equal to the challenge. In some cases it may take multiple surgeries to restore function and repair defects in appearance.

The first step for your rhinoplasty revision in Beverly Hills is the examination and evaluation of the previous revision rhinoplasty surgery and the defects that must be corrected. This is followed by an in-depth conversation with the patient to discuss aesthetic goals, the challenges to be overcome, the method of surgery and whether grafts will be needed. Dr. Brenner recommends that the primary nose job be at least 6 months old before revision surgery is attempted.

Surgery is performed at Dr. Brenner’s state-of-the-art surgical facility in Beverly Hills on an outpatient basis. This facility is fully accredited by the AAAASF and the Centers for Medicare Services (CMS) and meets all guidelines.

Dr. Brenner prefers the open rhinoplasty method over the closed method in most revision cases as it provides greater access to the structures that need revision. The small scar that results from the open method is difficult to see and fades over time. There may be more swelling when using the open technique, but Dr. Brenner finds the final results are considerably better using this method. Very simple revision rhinoplasty may be done using the closed technique which avoids an external scar.

• Open approach, revision rhinoplasty. The correction of the internal airway and complex nasal tip reconstruction required an open approach using a transcolumellar incision.
• Correction of alar malposition & nasal tip reconstruction. The orientation of the nasal tip cartilages was incorrect and resulted in a very unnatural appearance of the tip. Further, the cartilages had been asymmetrically trimmed and actually over-reduced during the primary operation. Reconstruction then required alar extension grafts that were made from septal cartilage. The native weakness of the left alar required placement of a small PDS rhinoplasty plate.
• Correction of alar retraction. The nostril rims were lowered by placement of composite ear cartilage grafts on both sides.

• Correction of tip position. The nasal tip lacked support and its orientation had an unnatural appearance. This was corrected with placement of an angled columellar strut between the medial crura (tip cartilages).
• Correction of nasal airway obstruction. The patient had internal valve collapse as a result of her primary operation. This was corrected by reconstructing the middle vault with placement of spreader grafts.
• Correction of dorsal inclination and irregularities. The patient’s bridge was lowered and then the visible and palpable bony irregularity was removed.
• Correction of nasal skin scarring. The patient had an incredibly thin skin envelope that was scarred down to the underlying bones. This was corrected by placing a lining graft along the nasal bridge of deep temporal fascia.