Dr. Buckingham’s Q&A

Question:
I’ve heard revision rhinoplasty is most often performed as an open procedure. Is this true? Is it possible to undergo a closed procedure and minimize scarring?

Answer:
Which procedure is used more often is surgeon dependent.  Some utilize nearly all open and some closed.  We used to perform about 50% open and 50% closed, but by following our results over time came to the conclusion that the open procedure delivered superior results because of the ability to precisely mold cartilage and place grafts.  We now perform about 90% of our procedures open.  However, in the appropriate patient, we will perform a closed approach.  Scarring should not be a concern that dictates which procedure is performed. 

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Question:
My surgeon recommended that an osteotomy be performed to fix my wide nasal bridge. How is this done?

Answer:
An osteotomy is performed by going inside the nose and using a small chisel to make fine cuts in the nasal bones allowing them to be mobilized and moved closer together.  The bones are then splinted with an external “cast” for one week to hold them in the new position. 

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Question:
The very tip of my nose looks droops down. I am 64 years old, very conscious of my appearance, and never noticed this before.  Does this sort of thing happen with aging? I want to have it lifted.  Does this require rhinoplasty?

Answer:
A drooping nasal tip happens often with age. It is a result of weakening ligaments and support in the tip of the nose which allows it to fall. It can be corrected reliably, but requires a rhinoplasty.

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Question:
How is an overly long nose fixed with rhinoplasty?

Answer:
A nose can look overly long when it is associated with a droopy, under-rotated tip; when the columella is too long or a combination of both.  These forms of a long nose can be treated with rhinoplasty.  A nose can also appear long when the entire mid-facial bony structure is long and this cannot be dealt with utilizing rhinoplasty alone.  A bony shortening of the mid-face would also be required.  For a long nose associated with under-rotation or a hanging columella, rhinoplasty can be used to rotate and shorten the nose and/or tuck up the columella.  We utilize cartilage grafts and sutures to achieve these goals.

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Question:
Are there any additional risks to revision rhinoplasty compared to primary rhinoplasty?

Answer:
Absolutely! A primary rhinoplasty does not possess any scarring usually and the native cartilages are available to be shaped in the desired way. Revision surgery contains a variable amount of scarring that makes dissection more difficult, cartilage may have been over-resected and need to be replaced, and donor cartilage sites may have been violated necessitating obtaining cartilage from other areas. We have significant experience with revision rhinoplasty surgery and can achieve acceptable results in most cases, but it is definitely more challenging than primary surgery.

Posted by Dr. Buckingham