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Revision Rhinoplasty

Patients visit West End Plastic Surgery in Washington, D.C. for revision rhinoplasty for a variety of reasons. Some have cosmetic concerns, and others have functional problems where they are unable to breathe clearly through the nose. Regardless of the reason, Dr. Paul G. Ruff IV knows that this can be an emotional time. For that reason, he believes the consultation is of utmost importance so you can candidly discuss your concerns and get on the right track toward the results you want for your nose. Our plastic surgeons' expertise in rhinoplasty has led to many seeking them out to treat some of the most challenging cases.

If you are considering revision rhinoplasty for an unsatisfactory nose job in Washington, D.C., request a consultation online to meet with Dr. Ruff, or call our office at (202) 785-4187 to schedule an appointment.

Paul G. Ruff IV,
M.D. F.A.C.S.

Personalized, compassionate patient care is the foundation of West End Plastic Surgery's philosophy. Our board-certified surgeon, Dr. Paul G. Ruff IV embraces innovative techniques to ensure our patients get the best treatments available.

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Are You a Good Candidate for Revision Rhinoplasty?

The ideal candidates for revision rhinoplasty are men and women who are in good general health, are not happy with their rhinoplasty results, and have realistic expectations about the procedure.

Meeting With Your Plastic Surgeon

Prior to scheduling your nose surgery, you will have an extensive consultation with Dr. Ruff and our staff at West End Plastic Surgery. Your surgeon will use the initial consultation to understand your motivation and expectations for a revision rhinoplasty. It is also an opportunity to develop a mutual level of trust and understanding. Your surgeon will perform a detailed physical examination to determine the areas that will require correction to provide the best result.

During your consultation, we will:

  • Review the various nose surgery options with you
  • Clearly discuss the potential risks of the procedure
  • Outline in detail how the surgery will be performed and what you can expect before, during, and after the procedure
  • Provide detailed cost and payment information
  • Answer all your questions

You will be asked to provide:

  • Details about your medical history
  • A list of all medications you take, including over-the-counter medications such as aspirin, vitamins, and herbal supplements
  • Information regarding your tobacco and alcohol use

Photos will be taken, and with the help of sophisticated computer imaging we will create a realistic simulation of an outcome that is in line with your needs and desires. Dr. Ruff will explain the various structures in the nose, including bone and cartilage, and how sculpting these can alter the appearance of the nose. They believe that the use of computer imaging provides a realistic potential outcome for your individual anatomy and expectations. It is always beneficial for you to compile a list of questions in advance to ask your surgeon during the consultation, as this can clarify any concerns about the procedure and help better delineate if your expectations are in line with your doctor's aesthetic goals for your nose.

How the Procedure Is Performed

Your revision rhinoplasty will be performed at the state-of-the-art surgical suite in our Georgetown plastic surgery office or at one of the area hospitals where Dr. Ruff operates. The surgery is typically performed on an outpatient basis under general anesthesia so you will be completely asleep.

In cases of revision rhinoplasty, our surgeons frequently see that many of the elements that provide structure to the nose have been over-resected. This leads to breathing problems, as much of the support structure that keeps the airways clear has been altered. Our surgeons believe in re-creating the structure of the nose to restore the integrity and function for improved breathing.

Dr. Ruff uses cartilage grafts to rebuild the structure of the nose to give a new aesthetic shape that withstands the inevitable contraction of the nasal skin that can occur over the course of many years. There is typically an insufficient quantity of nasal septal cartilage to use in cases of revision rhinoplasty. Because of this, your surgeon has to get cartilage from either the ear or costal rib cartilage. The type of cartilage that your surgeon uses in each case depends on the deformity that needs to be corrected. These options will be discussed with you at the time of the consultation. Our surgeons doe not use artificial implants in the nose for revision rhinoplasty due to an increased risk of infection and extrusion of the artificial material.

Our surgeons use an open rhinoplasty approach in some cases. This involves making a small incision on the columella of the nose, which allows greater access to the nasal structures. This approach allows our surgeons to better identify the concerns that the patient has with his or her nose by directly visualizing the problem. By looking directly at the structures, our surgeons can create symmetric changes to the nose to maximize the likelihood of a good cosmetic outcome. As with any incision, if closed correctly, the columella incision will heal with very little evidence of a scar.

What to Expect After Your Surgery

Activity When
Out of Bed After 24 Hours
Packing and Gauze Dressings Removed One to Two Days After Surgery
Stitches Removed Five to Seven Days After Surgery
Splints Removed Seven to Ten Days After Surgery
Back to Work One Week After Surgery
Contact Lenses As Soon as You Feel Comfortable
Driving As Soon as You Feel Comfortable
Strenuous Activity Two to Three Weeks After Surgery
Wearing Your Glasses Six to Eight Weeks After Surgery
Contact Sports Six to Eight Weeks After Surgery

Immediately After Your Surgery

In most cases, revision rhinoplasty is performed on an outpatient basis so you will go home shortly after the surgery. You may be sleepy from the anesthesia and you will feel mild to moderate discomfort, so it is important to have someone drive you home after your surgery. You may also want to have someone stay with you for the first few days after surgery.

The First 24 to 48 Hours After Your Surgery

Your surgeon will see you the day after your surgery to clean the area around the nostrils and ensure that you are doing well. Your discomfort level will drop rapidly after the first 2 days. A little bleeding is common in the first day or so after surgery, and you may continue to feel some nasal stuffiness for the first few weeks. If nasal packing was placed in your nose, it will be removed within a day or so after your surgery, which will greatly improve your comfort level.

The First Few Weeks After Surgery

At your 1-week postoperative visit, Dr. Ruff will remove the nasal cast and fine sutures that he uses to close the incision. It is important to realize that your nose will be swollen when the cast is removed. Your surgeon will place tape on the nose if necessary to decrease the overall amount of swelling.

You will notice a marked improvement in your comfort level during the first few weeks after your surgery. You can most likely return to work about a week after your revision rhinoplasty, unless your work is strenuous. Here are some other things to take note of during the first few weeks after your surgery:

  • All dressings, splints, and stitches are usually removed 1 week after surgery; however, procedures that are extensive may require a 2-week wait.
  • Most of the swelling and bruising you experience will disappear within about 2 weeks of the surgery. In cases of revision rhinoplasty, it is not uncommon for the swelling to continue for a longer period of time due to the underlying changes that have occurred from previous surgery.
  • You can wear your contact lenses as soon as you feel comfortable doing so.
  • You should be extra careful and gentle when washing your face and hair and applying makeup for the first 2 to 3 weeks after the procedure.
  • Strenuous activity should be avoided for at least 3 weeks after your surgery.

Resuming Your Normal Routine

Everyone heals at different rates, and you are the best judge of when you are ready for certain activities, but the following are general guidelines:

  • You can most likely return to work within a week of your surgery.
  • You can resume driving as soon as you feel comfortable doing so.
  • You can most likely return to your physical exercise program within 3 weeks of your nose surgery. Our patients are encouraged to plan an exercise program and discuss it with the staff prior to resuming exercise.
  • You can wear your contact lenses as soon after surgery as it feels comfortable. Glasses, however, cannot be worn for at least 6 to 7 weeks after your surgery. Until then, they must be taped to your forehead or propped on your cheeks until your nose heals completely.
  • Your nose will feel stuffy for several weeks; talk to the doctor about using nasal sprays to help with this condition.

Things to Be Aware of After Your Surgery

It is imperative throughout the postoperative process that you follow the directions your surgeon provides. Guidelines may include:

  • You should not blow your nose for a week or so after surgery to give the tissue a chance to heal. You should make every effort to avoid rubbing, bumping, or hitting your nose for several weeks.
  • After surgery, small burst blood vessels may appear as tiny red spots on the skin's surface. These spots are usually minor but can be permanent in some cases.
  • Rhinoplasty performed from inside the nose leaves no visible scarring. When the incision is made across the top of the nose or when the procedure corrects flaring nostrils, the scars are minor and are usually not visible within a few weeks of surgery.
  • Stay out of the sun to avoid sunburn for at least 8 weeks.
  • Our surgeons encourage patients to follow up with them on a long-term postoperative schedule to ensure the best outcome. Your surgeon may recommend steroid injections, taping, or nasal exercises. If anything unusual or troubling develops between visits, call West End Plastic Surgery right away.
  • For months following your surgery, you will continue to see changes and a more refined appearance to the nose. Internal swelling subsides very gradually; therefore, the final results of your revision surgery may take a year or more to reach.

What Are Possible Side Effects or Risks?

All surgical procedures have some degree of risk; however, major complications from revision rhinoplasty are unusual. During your initial consultation, your individual risks will be assessed and discussed. As with any surgery, you can help reduce the risks by closely following the pre and post-surgery instructions provided to you. Your surgeon and his staff will be with you every step of the way to ensure a safe and pleasing outcome.

Most likely risks include the following:

  • Infection
  • Nosebleeds
  • Persistent swelling
  • Asymmetry
  • Need for further surgery

How Long Will the Results of Your Revision Rhinoplasty Last?

Revision rhinoplasty can reshape, resize, and enhance the appearance of your primary rhinoplasty results. In most cases, these results are permanent. Of course your face, including your nose, will continue to change as you age.

Questions You May Have

Will my insurance coverage pay for my revision rhinoplasty?

In some cases, your revision rhinoplasty may be covered by your insurance company. Please contact your insurance provider to confirm coverage. Be advised West End Plastic Surgery does not participate with any insurance provider and you are responsible for the full payment of the procedure. Cost and payment information will be fully discussed with you during your initial consultation.

How long after my rhinoplasty do I need to wait to have revision surgery?

The general guideline is to wait at least 12 months to allow swelling to fully subside. There are cases where concerns are unlikely to improve with time, such as if the structure of the nose is crooked or collapsed, and waiting may make corrective surgery even more difficult. As experienced revision rhinoplasty surgeons, Dr. Ruff will meet with you to determine what can be accomplished with revision surgery and give you his opinion about the best timing and approach.

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West End Plastic Surgery 2440 M Street Northwest #200
Washington, District of Columbia 20037 (202) 785-4187 Monday–Friday: 8 a.m.–4:30 p.m. Get Directions
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