Redoing a Nose

Correcting deficiencies after a rhinoplasty (secondary rhinoplasty) can be difficult. Depending on what was done in the first surgery correction can require simple rearranging of misshaped cartilage to a complete redo where cartilage is harvested from the nasal septum or the external ear and grafted in to place. Bones may even need to be reset. In some extreme cases where there is little cartilage to harvest or the nose is markedly depressed rib and even synthetic bone may be needed to achieve an acceptable result. All of this is done through an open approach where a small incision is made in the columella (little column) between the nostrils and then carried in to the inside of the nose to allow adequate exposure of the internal structures of the nose. The resulting scar is minimal and the results that can be achieved are more predictable than doing the procedure "closed" where the only incisions are on the inside of the nose.

One of the more interesting cases I've had through the years involved a young man who might be described as a 'street pugilist'. His nose had been hit several times and the last altercation had resulted in the nose being very crooked and pushed to the right side of his face. I started the operation and after opening the nose and seeing how badly the septum (the wall that separates the nostril passages internally and supplies the support for the nose) was twisted I knew something more than the standard scoring and suturing would have to be done. I elected to separate the mucosa from the wall from above and completely remove the septum. I cut is out and put it on the sterile surgical table to try to straighten it. It allowed me access to parts of the septum that I otherwise couldn't get to and allowed me to reshape it with incisions and stitches. When I was done I put it back in place but it still wasn't good enough. I noticed the bottom half was much straighter than the top so I flipped it over and put it in upside down. The nose looked great. I sewed it in to position with the other cartilage and closed the soft tissue over it holding the mucosa (and blood supply) to it with sutures. The patient healed uneventfully and the nose was markedly improved with better function (he could breath) and a straight appearance.

If you have a nose that needs redoing I would be happy to see you.

All the Best,

Dr. J