Revision Rhinoplasty in Dallas, TX

A significant percentage of Dr. Toledo’s rhinoplasty cases at the Highland Park Plastic Surgery Center are seeking intervention to correct deformities from a previous primary surgery. A primary rhinoplasty is one of the most difficult plastic surgery procedures to perform. Therefore, a revision rhinoplasty is even more complex due to the fact that the patient’s anatomy has been altered, tissue has been removed, and scar tissue is present. The chances of achieving a desirable result diminish with each subsequent procedure—even for the best, most experienced plastic surgeons.

The most common deformities seen are over- or under-resection of the dorsum, which sometimes collapses to form a “saddle deformity.” Surgeons also frequently encounter a pinched, asymmetrical tip that is either turned up or down. Often, the lateral walls collapse causing the “inverted V deformity,” which may require reconstruction with cartilage from the septum, ear, rib, or even synthetic implants. Choosing your surgeon carefully is crucial in striving for successful rhinoplasty the first time. Experience matters!

You may be an ideal candidate for revision rhinoplasty if you want to amend or repair the results of your previous rhinoplasty. The revision surgery is often done to restore the form and function of your nose. You should have realistic expectations before seeking a revision procedure and understand that this procedure can be much more complicated than the original rhinoplasty. The degree of your nasal deformity should outweigh the risk and expense of the surgery, and Dr. Toledo will help you make that determination.

We at the Highland Park Plastic Surgery Center do our best to select patients who have realistic expectations. I will not attempt surgery unless I feel I can get a significant improvement. A photo of your nose will be uploaded to our imaging software, and I will do a computer rendering of what you may look like. The vast majority of the time I will achieve 80-90% of the changes I show you on the computer. Again, if I do not feel like I can get an 80-90% improvement on a primary rhinoplasty, I will not operate. Revision rhinoplasties are much more difficult and sometimes an improvement of only 50% is considered a satisfactory result. 

The majority of my patients present for cosmetic rhinoplasty and not because of nasal airway obstruction. Rhinoplasties usually involve making the nose smaller, less projected, and narrower. Smaller noses do not breathe as well as larger noses. An exception is when a nose is broken and very deviated, therefore significantly blocking the airway. I will do everything possible to straighten the inside and outside of your nose, so hopefully the rhinoplasty will not negatively affect the airway. Having a smaller nose that also breathes better is not always possible, so if a better airway is more important, leave your nose big and wide.

On a final note, plastic surgery is not an exact science. No matter how hard I have tried, I have never created a “perfect” nose in over 3,000 attempts.  If you stare at any nose long enough, especially in a magnifying mirror, you will find some slight asymmetries. All faces are asymmetrical to begin with. If you are a “perfectionist” and expect a “perfect result”, you may be disappointed. Patients with Body Dysmorphic Disorder (BDD) will never be happy. So please consider this information before scheduling your rhinoplasty surgery.

For this procedure, Dr. Toledo will either use an open or closed approach. During the open approach, which is the most common, Dr. Toledo will separate the skin from the cartilage and bone, which allows him more visibility during the procedure. Dr. Toledo will then reshape the nose to the desired frame. The closed technique is less invasive and is used for less complicated revisions. In some cases of revision rhinoplasty, a bone or cartilage graft or synthetic implant may be needed to help with the reconstruction process and strengthen the architecture of the nose.

Prior to performing nose revision surgery, Dr. Toledo will meet with you during a consultation in order to determine your unique needs and goals before creating a customized treatment plan. Revision rhinoplasty is performed under general anesthesia at our state-of-the-art facility. The duration of your surgery depends on the amount of reconstruction required to achieve your desired results. Following the procedure, you will wear a nose cast for 5-6 days and will attend a follow-up appointment to remove both the cast and stitches. This will also allow Dr. Toledo to assess your recovery progress. Due to the fact that revision surgery can most often be more complex than the primary surgery, the recovery may be somewhat longer. You may experience a little more bruising and swelling.

Surgery Instructions

How long should I wait after my original rhinoplasty?
It is important to give your nose time to heal after a rhinoplasty. In many cases, it can take a year for the inflammation and swelling to fully subside and the final shape of your nose to be visible. Once your nose has completely recovered from rhinoplasty, you should take time to assess how you feel about the appearance before scheduling a consultation at the Highland Park Plastic Surgery Center for revision rhinoplasty.

How common are revision rhinoplasty procedures?
Rhinoplasty is one of the most popular cosmetic surgeries, and most patients are happy with their results. However, rhinoplasties are also one of the most difficult of all cosmetic procedures to perform, and, therefore, have a high revision rate – approximately 5 to 15% – even among experienced, board-certified surgeons. Poorly trained, inexperienced surgeons will have a much higher revision rate.

How can I ensure that I will receive better results with a revision procedure?
It is extremely important to do your research when looking for a plastic surgeon to perform your revision rhinoplasty. Dr. Toledo is a skilled plastic surgeon with a special interest in revision rhinoplasty who understands the advanced techniques and expertise required to perform revision rhinoplasty. Despite this, there are no guarantees in cosmetic plastic surgery. Dr. Toledo will not accept you as a patient unless he is confident that he can improve your appearance, as well as that your expectations are reasonable.

Will I need cartilage grafting?
For some revision rhinoplasty procedures, cartilage grafting may be necessary. This is performed by taking bone and/or cartilage from a part of the body—such as your septum, ears, or ribs—and using it to restructure your nose. Typically, this is only required in severe cases, or if your cartilage was jeopardized during the initial rhinoplasty procedure. Cartilage grafting may be used to help support the structure of your nose. Dr. Toledo will discuss the possibility of cartilage grafting during your consultation.

Highland Park Plastic Surgery Center is committed to ensuring that you receive the results you want, especially if you have had a negative experience with your initial rhinoplasty performed elsewhere. During your consultation, we will work with you to understand your concerns and goals before discussing your options in order to give you the best possible outcome. If you are interested in revision rhinoplasty and wish to schedule a consultation with Dr. Toledo, contact our Dallas, Texas office today.