As one of the most experienced, and busiest revision rhinoplasty surgeons in South Florida, Dr. Bustillo devotes half of his time to nasal reconstruction surgery. That means performing more than 300 nasal surgeries per year, many of them revisions, and many working with different ethnicities.
Ethnicity is very important when it comes to nasal surgery. The nose is part of the person’s ethnicity and it is important to maintain that certain “look” so as not to change the ethnicity. This requires a natural creative talent, a certain ability to observe nuances and skill. Dr. Bustillo is known for having that talent, as well as for passing it on through teaching his advanced techniques.
Dr. Bustillo divides revision rhinoplasty cases into two categories – the touch-up and the reconstruction. The former is a minor correction of a previous rhinoplasty that is structurally acceptable but has minor cosmetic flaws. These are often easily fixed and may even be completed by the original surgeon as they will have explained the possibility of minor inconsistencies in the result and how they could be corrected.
Given the nature of these “touch-up” procedures, there is usually no need for any reconstruction of the nasal structure. However, in serious cases, where the look of the new nose is worse than the original nose, Dr. Bustillo has a different challenge – to return the nose to what he calls “normalcy”.
In other words, these cases of revision rhinoplasty require that he correct the previous rhinoplasty so that the new nose does not attract attention or detract from the overall balance and symmetry of the patient’s facial appearance. Unfortunately, there’s often not much of the original nose left, in structural terms.
Nasal cartilage will likely have been removed during the original surgery, replaced in part by scar tissue. This may leave behind a lack of structural support for the tip, leading to an unnatural appearance that will need to be fixed by replacing the missing cartilage. In some cases, this cartilage my come from the ear.
Using Auricular Cartilage
Dr. Bustillo prefers to harvest septal cartilage to use as a graft to support the nasal tip and restore the look of the nose, but in cases where that material just isn’t available or has been depleted form the original surgery, auricular cartilage can take its place.
Auricular cartilage can be harvested from the ear by making an incision behind the ear. This doesn’t change the shape of the ear. While typically not a first choice, it is a good substitute when septal cartilage is unavailable.
Common uses for the cartilage are in tip grafts. Here, the cartilage is shaped and camouflaged so that when it is placed in the nose, it doesn’t show through the skin. This means carving it, rounding the edges, and smoothing off any rough corners. Often Dr. Bustillo will also cover the new cartilage with tissue. When the graft is put in place, it can either rotate or project the tip (a shield graft) or define the tip itself using a cap graft.
Other grafts used in revision rhinoplasty include columellar struts which provide underlying support to the nasal tip, counteracting any healing forces trying to pull the tip down, and spreader grafts which are used to help straighten the bridge.
So, even if you are not happy with your rhinoplasty, or if there has been a technical failure during the surgery which has led to a less than acceptable result, a revision rhinoplasty can be used to at least restore the nose to normalcy. The result should also restore your looks and self-confidence, remembering that there is always a margin for a result that while being as good as possible, may not be perfect.
Helping patients understand the limitations of both rhinoplasties and revision surgery is something that Dr. Bustillo takes very seriously, and he employs advanced computer imaging to help him communicate the likely scenarios to each patient.
To find out more about how Dr. Bustillo can help restore your nose with a revision rhinoplasty, and to set up an appointment in his Miami, Florida, based practice, simply fill out the contact form, or call 305.663.3380 for more information.