Revision Rhinoplasty

This type of nasal deformity is characterized by an inverted V-shaped shadow in the area of the middle vault of the nose.

Overresection of the upper lateral cartilage, the cartilage that forms the sides of the nose’s bridge. It often occurs when the surgeon who performed the original procedure made a mistake during the removal of a nasal bump and during the fracturing of the nasal bones (this destabilizes the upper lateral cartilage).

Dr. Rizk prefers surgery to fillers because fillers do not fix the deformity permanently. The volume gained through hyaluronic acid-based fillers, for instance, lasts for about six months. Fillers are also less precise than surgery and can make the nose look larger. Moreover, they can cause inflammation and scar tissue, which makes a later surgery more difficult to perform. Finally, fillers can move around inside the nose. Therefore, he favors surgery to fillers when correcting an inverted V deformity. The surgery often involves the placement of dorsal cartilage above the nasal bridge to narrow the nose and widen the middle nasal vault.

The columella is the strip of skin between the nostrils. A hanging columella, or “alar-columellar disproportion,” is one that is visible from the profile and hangs lower than desired, typically about 4mm or more.

There are many potential causes of hanging columellae. Some people are born with it, in which case it is often the result of either a long septum and/or the columella cartilages pushing down on the columella. Other people end up with deformities due to a mistake made during their primary procedure.

This depends on the cause of the deformity. Excess tissue may be removed after making an incision, and a portion of the septum may be removed. Other cartilage may be removed or shaved. In rare cases, the nasal spine may be reduced.

A saddle-like formation in the area of the septum. This type of deformity is sometimes referred to as a “scooped nose.”

Typically, some type of trauma to the nose, like a blow to the face, causes the septum to lower.

The septum can be raised or a cartilage graft can be added to the depression, to fill it in.

External nasal valve collapse is caused by weakness or narrowness in the nasal valve, the thinnest portion of the nasal airway.

Trauma to the nose or mistakes made during the original procedure.

In some cases, it is possible to treat by lifting the cheek tissue on the side of the nose that is blocked. In other cases, surgery may be needed. There are several different surgical approaches that may be employed. For example, alar batten grafts may be grafted as appropriate if the collapse was caused by weakness in the nasal sidewall. The surgeon performing the revision procedure will need to assess the cause prior to choosing which approach to adopt.

A nasal tip that appears too narrow, or “pinched.”

Some patients are born with a pinched tip, but this type of deformity is often the result of over-resection of the tip cartilages during the original procedure.

Usually, a “tip-plasty” is performed to reshape the tip with ear or other cartilage.

A nasal tip that appears pointy essentially means that the alar cartilages are too prominent and appear too pointy, or stick out too much.

Many patients are born with pointy nasal tips. This deformity is more common in individuals with thin skin.

It depends on the patient’s unique anatomy. The endonasal (internal incisions) approach is used on some patients, while an open approach is used on others. The cartilage may be shaved or trimmed. In thin-skinned patients, a soft tissue graft or fascia may be placed over the tip cartilage. Repairing a pointy nasal tip, or another deformity of the tip, is one of the most challenging of all rhinoplasty procedure

A space is formed when the nasal bones do not come together near the top of the nose. An open roof deformity makes the nose appear excessively wide. Typically, the nasal skin grows or droops, and vertical lines or depressions start to appear

Open roof deformity occurs when a hump reduction has taken place, but the nasal bones have not been narrowed or brought back together to close the remaining gap – resulting in the appearance of a wide or flat nose.

It depends on how low or high the nasal bones are positioned. Osteotomies (fractures) may be necessary, and on-lay grafts may be used to close the gap between the nasal bones.

Cleft lip nose deformity is a common birth defect that can severely impact a person’s appearance. In the United States, nearly all cleft lip nose deformities are corrected in infanthood, as failure to correct this deformity can result in developmental impairment, infection, and even death. Cleft lip nose patients commonly require additional surgery later in life to fully correct the deformity.

Cleft lip nose occurs when the upper lip does not form completely in utero, leaving a separation or “cleft” in the lip. About half of all children born with a cleft lip will also suffer from a cleft palate, which is a separation on the roof of the mouth and the most serious manifestation of the disorder. Cleft lip causes the lip and nose to develop asymmetrically, resulting in obvious deformities that can cause feeding issues, breathing difficulty, and speech problems, all of which contribute to developmental delays in the child.

Most often, the surgery will be performed to correct obvious asymmetries in the upper lip and nose. The surgery must be performed by a doctor who has received specific training in correcting cleft lip nose deformity. Cheiloplasty, the surgery performed to correct cleft lip nose, typically produces positive results and allows the child to enjoy a normal childhood after surgery. In most cases, the child will not remember the surgery or the difficulties they experienced as a result of the condition.