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 Dr. Bustillo on WPLG Channel10 discussing Medical Roll-CIT |
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 Dr. Bustillo on Univision Primer Impacto for Medical Roll-CIT |
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 Baptist Hospital patients given chance to smile |
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Revision rhinoplasty, or reconstructive cosmetic nasal surgery, has been performed since rhinoplasty first became popular in the late 1800’s. Revision rhinoplasty can take two forms. It can be performed to enhance previous rhinoplasty result or to reconstruct a previous result back to a normal appearing nose. While they may sound similar, they are not. One is directed at improving a acceptable rhinoplasty result. The other is usually a more involved procedure, in which the nose was left with a significant deformity and the goal is a return to normalcy. Dr. Bustillo is an expert in the area of revision rhinoplasty. He understands the emotional distress that patients undergoing through this process feel and enjoys helping them.
IS REVISION RHINOPLASTY SURGERY FOR YOU?
The ideal candidate for revision rhinoplasty is any person who is not content with their previous rhinoplasty result.
Dr. Bustillo’s consultation process begins with a discussion about specific issues and concerns regarding nasal aesthetics. Occasionally, patients with previous nasal surgeries may suffer from severe nasal obstruction, due to an aggressive removal of cartilage. This should also be discussed, as Dr. Bustillo can also help to correct this problem during the revision rhinoplasty.
Dr. Bustillo then performs a physical examination. The nasal cavities are examined. The external nose is then carefully examined and palpated. The dorsum, or bridge of the nose, is examined for any humps that may have to be reduced. The nasal bones are then palpated for irregularities, asymmetries, or curvatures. The nasal tip is then examined and palpated. Occasionally, the tip cartilages are asymmetric, or pointing different directions. Other times, the tip may droopy. The tip projection, which is the length of the tip from the base of the nose to the end of the tip, is examined. Tips that are too projected, or long, need to be reduced and those that are to short, may need to be lengthened. Tip rotation, which is the angle of the tip in relation to an imaginary vertical line drawn at the base of the nose is analyzed. Tips that are under-rotated, or “droopy“ need to be rotated up, while tips that are over-rotated like “Mrs. Piggy“ need to be de-rotated or brought down. Certain nasal tips that move when the patient talks or smiles may require strengthening.
Dr. Bustillo then takes pre-operative pictures. These are then reviewed with the patient. This is another opportunity to discuss particular concerns regarding the aesthetic goals with Dr. Bustillo.
UNDERSTANDING THE SURGERY
Dr. Bustillo performs the revision rhinoplasty surgery on an outpatient basis at the South Miami Medical Arts Surgery Center, located in South Miami. The center is part of the Baptist Health System and is outfitted with the newest surgical technology. All surgeries are staffed by board certified anesthesiologists, which are part of the South Miami Hospital Anesthesiology Department.
Dr. Bustillo requires that all patients undergoing the revision rhinoplasty operation have a medical examination and medical clearance before the surgery by their primary care physician. All aspirin, anti-inflammatory products (naproxen, ibuprofen), and vitamins such as A, ginko biloba, and St. John’s wart should be discontinued ten days before surgery because they may interfere with blood clotting and cause bruising. Alcohol should also be avoided for five days before surgery to avoid swelling. Dr. Bustillo starts patients on high dose vitamin C two weeks before and two weeks after to help with the healing and to reduce bruising.
The revision rhinoplasty operation can be performed with either IV sedation or general anesthesia. Dr. Bustillo will help you decide which option is best for you.
Dr. Bustillo performs the revision rhinoplasty operation with either of two approaches. They are called approaches because they are simply the method the surgeon uses to assess the areas of the nose that need to be altered. They are not techniques. Techniques are what the surgeon uses to change or alter the specific anatomic areas of
the nose. These two approaches are the external approach and the endonasal approach. The external approach involves an incision in the columella, or the area under the tip of the nose. The endonasal approach involves a series of incisions inside the nose. One approach is not better than the other. They are different and each one is used for different types of revision surgery.
Occasionally, grafts may be required to achieve the desired result. Grafts are structural elements, typically made from cartilage. For example, they can be used to define a tip or to fill in depressions. They can easily be acquired from the cartilage in the septum, which is inside the nose. If the patient has had a previous septoplasty with his previous rhinoplasty, then Dr. Bustillo may take the cartilage from the ear. If this is the case, the graft is taken from the bowl of the ear. This is a relatively simple procedure that does not change the look or feel of the ear. No one will ever know that cartilage was taken from the ear. Occasionally, Dr. Bustillo will take cartilage from the rib if the nose has a significant structural deficiency.
In the past, the nasal tip was usually sculpted by cutting the nasal tip cartilages. However, experience has taught rhinoplasty surgeons that simply cutting away the nasal
tip cartilages can lead to functional and aesthetic complications. For example, the weakness caused by the absence of cartilage can lead to severe nasal obstruction as well as pointy “pinched-looking” nasal tips. Instead of cutting the cartilages, Dr. Bustillo uses small sutures to change the shape of the cartilages. This not only allows the preservation of nasal function, but also allows better accuracy when shaping the cartilages.
Like every surgical procedure, there are some possible complications that can follow the rhinoplasty operation. Bleeding after the surgery is rare, but if it occurs, it can be controlled with measures such as cauterization or packing. The risk of post-operative bleeding is about 1%. There is also the risk of infection, which extremely rare, and occurs less than 1% of the time.
WHAT TO EXPECT AFTER THE SURGERY
The night of the surgery should be spent relaxed. Activity should be kept to a minimum. A liquid diet is best for the first eighteen hours after anesthesia. The head should be kept elevated using two pillows to help reduce swelling. Dr. Bustillo recommends placing small zip lock bags with frozen peas on the eyes 10 minutes, for every hour spent awake for the first 48 hours. This is done to help reduce swelling around the eyes, which typically resolves in five days.
The post-operative period after rhinoplasty is not painful. Tylenol is usually enough to control any minor discomfort. Dr. Bustillo will provide you with additional pain medication, in the event that you need it. Occasionally, Dr. Bustillo places a small gauze in the nose, which is removed on the first day after the surgery. There is a small cast that is applied to the bridge of the nose. This is removed in the sixth or seventh post-operative day.
There is a variable amount of swelling that occurs on the nose after the revision rhinoplasty operation. About seventy percent of the swelling resolves in the first four to five weeks. It is recommended that physical activity, such as running or lifting be resumed only after the fourth week. The remainder of the swelling can take up to four to six months to completely resolve. However, the nose should look better than before surgery once the cast comes off.
While the final results of the surgery may not be completely evident until several months after the surgery, most patients look better than before surgery right when the cast comes off. Patients that undergo revision rhinoplasty are, by enlarge, extremely happy.
Rhinoplasty
