Q: Dr. Eppley, I have a few questions after my rib graft rhinoplasty surgery. I’ve noticed that the very top of my nose bridge has started to warp to the right. It’s at the very top and it’s kind of hard to notice in person, it’s more apparent to me and then in pictures. Also a bump/hump has developed on the upper nasal bridge. I just didn’t know what possible things could be done about this if this indeed is a problem. Also, I know I’m jumping to conclusions, but if there had to be a revision surgery, how long would I have to wait? I’ve done research on revisional rhinoplasties and some doctors suggest waiting 6 to 12 months. But I saw that this was more for patients who thought their nose tip was too bulbous or the nose was too big, so the doctors suggested to wait for the swelling to go down. Another doctor suggested that he’s performed surgery as soon as two months on patients who’s revisions would be easier to fix sooner rather than later. How long would I have to wait to do a revisional rhinoplasty?
A: The timing of revisional surgery for any procedure fundamentally comes down to knowing that one has a stable target. This translates into three issues to consider: all swelling has resolved, the tissues have shrunken down and adapted to the new underlying framework and one has had enough time to accommodate to the new look. When all of these factors are considered, the timing of revisional surgery will vary based on the exact rhinoplasty procedure that was done. In general, most plastic surgeons would say that six to 12 months is when any type of revisional rhinoplasty can be done. This is, of course, a general statement and each nose and the concerns must be considered separately.
The key concept is that you don’t want to chase a ‘moving target’ when it comes to revisional surgery. Patience can be difficult but critical with secondary surgery. You don’t want to play ‘wack a mole’ with revisional surgery by jumping in too soon.
It is true that nasal dorsal issues are different then nasal tip issues because of the quicker resolution of swelling and tissue adaptation. Since your specific concern appears to be at the upper end of the rib graft in the radix, this type of revision might be considered sooner than other post rhinoplasty concerns. Some slight deviation and/or step-off of the upper end of the rib graft is not uncommon and can often be felt. How visibly significant that is will determine whether any revision is worth the effort.
The key concept is that you don’t want to chase a ‘moving target’ when it comes to revisional surgery. This is particularly true when one has had multiple procedures as one would like only undergo one revisional procedure. You don’t want to play ‘wack a mole’ with revisional surgery but jumping in too soon.
Dr. Barry Eppley