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Secondary Rhinoplasty CASE STUDIES

Secondary Rhinoplasty

Secondary Rhinoplasty by: Arian Mowlavi M.D.

Secondary rhinoplasty is indicated for patients who desire a revision rhinoplasty. Patients who had prior rhinoplasty are frequenly referred to Dr. Mowlavi for various reasons including nasal dorsum contour irregularities, suboptimal nasal tip shape or malpositioning and compromise of nasal structural support infrastructure leading to difficulty breathing.

Irregularities in nasal dorsum contour can result from wither nasal dorsal bony irregularities of the upper third of the nose or from poorly supported upper lateral cartilages which results in "an inverted V" deformity of the middle third of the nose. Irregularity in nasal dorsal bony contour can arise either from prominent bony spicules that create compromise of the overlaying nasal skin or from asymmetric infrastructure and medialization of the nasal bones causing a crooked nose deformity. Either deformity can be corrected by revising the previously performed osteotomies. The correction of the inverted V deformity requires reinforcement of the upper lateral cartilage to the dorsal septum utilizing a spreader graft.

Suboptimal nasal tip shape is characterised as an amorphous tip, in contrast to a refines nasal tip shape, and result from improperly performed nasal tip cartilage stitching (intradomal and interdomal stitches). This deformity can be corrected by revising the nasal tip cartilage stitches and infrequently introducing onlay cartilage grafts. Since onlay cartilage grafts are vulnerable to resulting in an operated look, Dr. Mowlavi advocated softening all onlay graft edges and camoflauging th grafts with a temporalis fascia. Suboptimal nasal tip positioning is frequently observed and results from poorly reinforced nasal tip cartilage structures resulting in a tip that is lower than the nasal dorsum. When the nasal tip does not lead the nasal dorsum, the tip appears droopy as characterized by the parrot beak deformity. Correction of this deformity required reinforcement of the nasal tip cartilages as described in the "Nasal Tip Rhinoplasy" page.

Patients who develop difficulty breathing following rhinoplasty demonstrate constriction of their internal nares due to poorly supported upper lateral cartilage and nasal dorsal septum junction resulting in constriction (internal nasal valve constriction), concavity of the middle third nasal side wall due to a weak upper lateral cartilage canopy, or from pinching of the nares entry way at the alar rim (external nasal valve constriction). Correction of the internal nasal valve constriction requires placement of spreader grafts. Collapse of the middle third nasal side wall can be corrected with placement of alar batten grafts which are placed in the nasal side wall and which stent up the middle nose soft tissue. Finally, correction of a pinched external nasal valve requires placement of alar contour graft that is placed directly into the alar rim and help stent open the entry way.

Frequently Asked Questions:

Revision rhinoplasty on just tip of nose 4-5 months after closed rhinoplasty? Is it safe?

You should definitely wait six months for swelling to subside, otherwise you are operating on something that has not settled down and would be guessing as to the final results. It is ideal to wait one year so that you are assured not to have it move again.

Can a secondary rhinoplasty ever be done closed?

Narrowed nostrils require alar rim contour grafts that can be done in the office and really not considered a formal closed or open rhinoplasty. Concern is that usually there is not enough cartilage following prirmary rhino in the septum; you may want to consider using your ear cartilage (conchal bowl). An alternative to the above, is to use a cadaveric cartilage graft.

I’m wondering if I would most likely get a surgery to my nose? Cosmetic or to fix the broken bone?

I’m wondering if I would most likely get a surgery to my nose? Cosmetic or to fix the broken bone?

Patient Specific Questions:

My nose is too thin after rhinoplasty, is it possible to make my tip bigger?

Unfortunately, trying to fix your nose surgically is only going to make it thinner. I would recommend using a filler to cushion your nasal cartilages and to help fix any irregularities. This is safe and some of the filling will create scar tissue which will make your nose look more bulbous as you desire.

Columella strut; can you visualize the strut and make sure it is at the appropriate height via a closed Rhinoplasty?

If your columellar strut is too long, this is the only exception I would make to revising it using a closed approach; otherwise an open rhinoplasty provides more visualizatoin and more accurate adjustment.

How soon can I reverse a rhinoplasty? Will there be any sagging of the skin?

You can't really reverse you rhinoplasty but you can have a revision rhinoplasty in order to get rid of the silicone (this is no longer the ideal dorsal onlay as it will eventually become unstable and fail) and to have it replaced with diced rib graft (remember that this can be obtained from an organ donor) as well as deprojecting your tip at the same time

Can fascia grafts and contouring tip cartilages be done through a closed approach?

Tip grafts using the closed approach is a crap shoot because you cannot see how the shape will look in its final position; with the closed you can deliver the tip out the side, change it, and then hope that it looks good when you pop it back. The open is the GOLD STANDARD for altering the tip.

HOW OUR PATIENTS FEEL ABOUT US:

I Had a Great Experience!

Dr. Mowlavi is amazing!!!!! After a triplet pregnancy plus 2 other single pregnancies this mommy needed help with her breasts and tummy! After having consultations with 5 different well know surgeons in OC, my consultation with Dr. Mowlavi was a breath of fresh air! He listened and took his time explaining everything to me. My mommy makeover was what we decided on. We decided on a full tummy tuck as well as a breast lift and reduction. My breast reduction was tricky, due to the fact I only had one implant that was done 15 years ago. Dr. Mowlavi was confident he would remove the implant and make both breasts the same size. Natural look and something that would look proportioned to my body and Dr. Mowlavi was confident that he would do the best to fit what I wanted. The morning of surgery was also great! The surgical staff were very comforting and after surgery James was always available to answer our questions. The front office staff is very helpful and friendly on my followup visits. My breast are still setting in and I already love them. My tummy is so nice and flat, looking forward to wearing a bikini again after all these years. I have recommended Dr. Mowlavi to my family and friends already. 
A huge thanks to Dr. Mowlavi for giving me my confidence back!

Dream Body

This review is past due, but I wanted to make sure that I said exactly what I thought of my experience with VASER Liposuction. My first experience with liposuction (with another Dr.) did not go well. I had compromised and I deeply regretted it. Long story short, it was a botched job, so as soon as I could, I started my search for a doctor who could fix me. This time, I was careful to look for someone who not only was a great doctor, but also a true artist who could make my dream a reality. I went on real self and went through dozens of doctors and finally came across Dr. Mowlavi. I was sold upon the initial consultation. He made me feel heard and at ease, but most importantly, he shared my vision and I was confident he could give me my dream body. My self esteem had taken a hit from having to walk around with a lumpy abdomen but Dr. Mowlavi assured me that he could fix it. Not only did he fix me, the end result well exceeded my expectations! I now have a beautifully sculpted hourglass figure.  Dr. Mowlavi not only is a top notch doctor, he has a great and supportive staff who were always friendly and helpful from beginning to end. I had no trouble scheduling follow up appointments and they were available to take my call if I had post op problems. At one point, I had a bit of excess fluid (which is a common thing) and with one quick, painless adjustment from James, I was out the door in less than a half an hour.  Dr. Mowlavi is a visionary. He is a very precise surgeon and talented artist who is amazing at his craft. Whether it’s your first procedure or you’ve had your fair share, I would highly recommend choosing Dr. Mowlavi as your doctor.

He is a great doctor

Dr. Mowlavi is easy to talk to and he is great at his job. He is professional and ensures that all your needs are met. I had the gynecomastia surgery and the procedure was quick and I had minimal pain after the surgery. I would definitely recommend Dr. Mowlavi to anyone interested in getting plastic surgery.

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