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Can I have a closed revision to correct a high bumpy bridge on my nose without negative consequences?

Q:

~~3 1/2 years after revision rhinoplasty, I still have lack of blood flow on tip of my nose due to grafting, it's actually cold to the touch. Caffeine or alcohol, especially makes it throb. Grafting done to rebuild a week bridge also left me with a bump on the bridge of my nose. Can I have a closed revision to correct the high bumpy bridge without negative consequences to the blood flow issue on my tip? I don't want to end up with necrosis.

A:

Rose, 

 

 It sounds like you have been through allot. To answer your questions a surgeon most likely would require your previous records ( Operative Notes/ History & Physicals/ Pathology Reports/ etc. ) and an examination. Consider getting your records together and seeking a consult with an ASAPS Member in your area for an evaluation. 

Best,

 

Gary R Culbertson, MD, FACS

A:

The change of sensation in your nasal tip is from the dissection--nerve changes--which also affects how the blood vessels react to cold.  That type of change is common after all types of rhinoplasty but varies with the aggressiveness of the technique, and it is usually permanent.. 

Closed rhinoplasty is very safe if done correctly.  That is one of its great advantages.  Most secondary patients need more shape, but with a closed approach it is never necessary to close an incision under tension, which is where the risk of tissue necrosis occurs.

Further, most graft problems are under the surgeon's control--that is, they depend on technique--so you should be able to your bump improved safely with a closed technique.  You need to see a surgeon experienced in rhinoplasty and like his or her results with cases like yours.   I would expect improved shape but probably not a change in tip sensation.

A:

Thank you for your question.  You have a complicated situation with grafting both on the nasal tip and dorsum.  The dorsum has been over built.   To reduce the dorsum with precision a closed approach would be difficult.  If the dorsal material is your own cartilage it is integrated into the tissue and will tend to fall apart very easily, even, with an open approach.  If, however,  the material is silicone a well trained nasal specialist may be able to remove it, reduce it , maintain the tight pocket and replace it with some type of fixation.  The nasal skin will shrink down without an issue.  If it can be achieve with a closed  technique, then the vascularity to the nasal tip will be minimally affected.  I would suggest to look up plastic surgeons  in the  rhinoplasty society which is a sub-division of this Society.  Your records are very important to share with your doctor.  These plastic surgeons specialize and perform complicated nasal surgeries every day.  New Jersey and New York you have great option.  If you need help let us know.  Good luck

A:

You have the right idea.  I believe that the closed approach is safer than the open approach for a situation like yours, and I teach this principle constantly.  The surgeon can make corrections with less insult to the circulation and more precision.  If done carefully by an experienced surgeon, skin loss or necrosis should almost never occur.  No surgery is ever without risks, but your best insurance is to find a surgeon whom you trust and who specializes in this type of corrective surgery.

A:

Can I Have A Closed Revision To Correct Bumpy Bridge Without Negative Consequences- Revision Rhinoplasty is one of the most complicated procedures that is perform in plastic surgery. This should be done in the hands of a Board Certified Plastic Surgeon or Otolaryngologist, who is an expert in secondary Rhinoplasty. I generally recommend that Revision Rhinoplasty are optimal done with an open approach to fully visualize the nasal deformity better.  

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