Prior to your surgery, you will have the opportunity to speak with Dr Motykie about any part of your surgical procedure and/or recovery process. You will be asked to change into a surgical gown and Dr Motykie will place surgical markings on your face. Lastly, wear loose fitting clothing the day of your surgery that is easy to get in and out of such as sweat pants and a shirt that zippers in the front.
Anesthesia and Operating Facility
For almost all revision rhinoplasty techniques you most likely receive general anesthesia (you are asleep) for your own personal comfort, safety and surgical ease. It is Dr Motykie’s opinion that the safest and most effective way to perform revision rhinoplasty surgery is under general anesthesia since it allows for control of your airway and improved visibility of your nasal shape since less local medication needs to be injected in to the nose which can obscure visualization and surgical precision. It is therefore not always in your best interest to undergo surgery using awake anesthesia.
Dr. Motykie uses only Board Certified Anesthesiologists to administer anesthesia and monitor your safety during your surgery. You may be given medication before reaching the operating room so you will feel relaxed before surgery. The surgery takes approximately two to three hours to perform in its entirety. Every surgery is performed in a fully accredited, state of the art (AAAASF) surgical facility where your safety, comfort and privacy are of the utmost importance. Deep vein thrombosis (blood clots) precautions are taken with every patient and include a minimum of anti-embolic stockings and sequential compression devices (SCDs) on the lower extremities during the entire length of your procedure.
In general there are only two major techniques used to perform a revision rhinoplasty by most plastic surgeons today. One approach is called a closed rhinoplasty and the other is termed an open rhinoplasty. Dr Motykie is able to perform your rhinoplasty using either technique and he can therefore customize your revision rhinoplasty surgery by choosing the best technique to perform in your own, unique individual case.
In the open approach to rhinoplasty, an incision is made on the outside of your nose along the base of the columella (the hanging lower, middle portion of your nose that separates the nostrils). The skin of the nose is then separated from the underlying supportive framework of bone and cartilage. This framework is then reshaped to achieve the desired contour of the nose. Once the nose has been sculpted and remodeled to its final shape, the skin is re-draped over the new framework. When the surgery is complete, a splint will be applied to help the nose maintain its new shape during the healing process. This approach to surgery is typically used in more complicated revision surgery cases. However, an open approach to revision rhinoplasty surgery may often be ill-advised because the tissues of the nose have already been traumatized by prior surgery and further disruption of any remaining normal anatomy and healing pathways in the nose can lead to more long-term warping and scarring of nose. The placement of the unnecessary columellar incision may also force closure of the nasal tissues under tension which can further distort the final aesthetic result from surgery. The open approach also contributes to a loss of tip support by disrupting normal ligamentous attachments between supporting structures of the nose which can lead to decreased tip projection after surgery. Some data shows that revision rhinoplasty patients who have undergone open rhinoplasty have more numerous and more severe deformities than those who were previously treated with a closed approach. Therefore, I only perform an open rhinoplasty procedure in the most complex revision rhinoplasty cases wherein the benefit outweighs the risks.
Dr Motykie prefers to perform his revision rhinoplasty surgeries utilizing the more advanced closed technique since it delivers superior results, no visible scarring on the nose and quicker overall healing. In the closed approach to revision rhinoplasty, all of the incisions used to perform the surgery are confined to the inside of the nose. This is often referred to as an “invisible” rhinoplasty because it results in no visible scarring on the nose. During this technique the skin of the nose is also separated from its supporting framework of bone and cartilage in order to sculpt it into its final desired shape. At the end of the surgery the skin is gently laid over the new nasal framework since it was never entirely lifted in the first place. This is important because an experienced plastic surgeon realizes that it is better not to destroy and/or distort as much of the natural architecture of the nose as possible so that there is less room for swelling, scarring and complications after surgery. In addition, there is less interruption of the nerves and blood vessels of the nose that allows for a safer procedure, quicker healing and faster return of normal sensation of the nose. The predictability of the surgical result also increases significantly since there is less room for error and less post-operatives swelling that can lead to warping, deformities, asymmetries and crookedness of the final nose that are more often seen as a result of a prior open rhinoplasty procedure.
Another common misconception that is propagated by many websites is that revision rhinoplasty is better performed using an open technique because there is better visualization afforded to the surgeon during the procedure. Such thinking is flawed and backward, however, because it is during the closed technique that there is visualization of the actual new nasal contour at the conclusion of the procedure which is obscured by distorted anatomy and increased swelling during the open technique. In revision rhinoplasty, where there has already been scarring and damage from prior surgery, the aim should be to limit further tissue trauma and violation of normal anatomy as well as avoiding incisions that cut the lifeline of healing to the tip of the nose. In revision cases, a closed technique affords more precision, preservation of remaining healthy tissue and increased predictability of long term results. Unfortunately, less experienced surgeons who see a badly deformed nose with altered anatomy often try to do too much which can result in further damage to the remaining healthy tissue, development of more scar tissue and an extended recovery process. It is far better and much wiser to approach these noses with a closed technique in order to increase precision, predictability and limit further tissue trauma and risk of complications.
One of the main differences between primary and revision rhinoplasty procedures is that cartilage grafting is less readily available in revision procedures. This can make revision rhinoplasty more difficult because the plastic surgeon is left with missing parts of the nose and/or poor remaining natural cartilage. Somehow the surgeon must use his experience, skills and aesthetic sense to modify the existing nasal cartilages to create a more attractive, natural shape of the nose. These existing cartilages are frequently inadequate, deformed, mangled, fixed in scar or simply missing entirely. Yet since they are the natural framework of the nasal tip, they are always preferable to bringing in a foreign piece of cartilage form an ear or rib that is already unnatural and alien to the nose. These types of grafts simply do not match the thin, elegant nature of the original soft nasal cartilages since they are often, too thick, too large and too hard. When a patient’s natural cartilages are covered by “on lay” grafts the nose will naturally increase in size which is often the exact opposite of what a patient desires aesthetically from a rhinoplasty surgery. In fact, patients that have undergone an open approach with multiple grafts frequently complain that their nose actually got bigger with surgery and looks more unnatural and unattractive than before surgery. There is often no need to fill the tip of the nose with multiple grafts and sutures that simply create the risk of more lumps, bumps and asymmetries. If it is absolutely necessary to borrow cartilage from somewhere on the body, ear cartilage is the most readily available and it is naturally contoured and curved to match the shape of the nasal tip when harvested and carved properly for use in grafting. After all cartilage and bone has been re-sculpted, grafted and/or removed, the incisions inside of e nose will be closed with dissolvable sutures and a nasal splint will be placed on the outside of your nose along with a dressing that is to be left in place over night. Nasal packing is rarely used and if it is placed it will be removed the morning following surgery.
After surgery you will be brought to the recovery area where you will be allowed to rest and completely recover from anesthesia. Nurses will be on staff by your bedside to make sure you are recovering properly as well as being able to provide you with pain medications and small amounts of water and/or ice chips while you are becoming more awake and alert. After you have fully recovered from anesthesia, you may be released to home with a responsible adult or you may choose to stay overnight in an outpatient recovery retreat where there are nurses on staff 24hrs to assist you with post-operative care and medications.
The most comfortable position to recover in after surgery is a reclining chair with your head elevated. Over the first night you will most likely find yourself having to use the bathroom frequently. This is normal and is due to the intravenous fluids you received during your surgical procedure. Leave all dressings intact until the next morning when you will return to Dr Motykie’s office to have your dressings changed and receive further instruction for the rest of the week. The night following your surgery, you may experience some pain and discomfort that can be controlled with your prescribed pain medication. The majority of the sutures used during your surgery will be dissolvable and they will be covered by surgical tape that should be left in place for the first week after your surgery.
- Day Of Surgery
- Post Operative 1 day | 1 week | 1 Month | Long Term
- Alternative Procedures
- Combined Procedures