Revision Rhinoplasty

Dr. Robert Troell, M.D., F.A.C.S.
Beauty By Design
Irvine, California

Revision Rhinoplasty is now available by a Stanford University Medical Center trained Facial Plastic Surgeon and Head & Neck Surgeon, Robert J Troell, MD, FACS with significant experience with probably the most difficult cosmetic surgery today!

This is one of the most challenging procedures in cosmetic surgery today. Previous “nose job” or rhinoplasty procedures either did not achieve the desired outcome, the surgeon was overly aggressive with nose cartilage manipulation or a complication occurred, all of which have produced a less than optimal result.

About one third of Dr. Troell’s cosmetic nasal surgeries are revisions from his colleagues. All patients have photographs taken and photo morphing with Dr. Troell to identify the exact appearance the patient is striving to achieve. He will educate you on the possibility reaching this aesthetic goal. Preparation for surgery is paramount. Acquiring your previous description of the surgery or “operative report”, provides valuable information of the anatomy that may be present at the time of your revision procedure.

Nearly all of the revision procedures require cartilage from somewhere in your body

Nearly all of these cases require the soft tissue structure between the nostrils to be lifted (open approach) for maximum visualization of the nasal anatomy. Nearly all of the revision procedures require cartilage from somewhere in your body: nasal septum, ear conchal or rib cartilage. Occasionally, bone may be needed from the top of your head, skin and cartilage combined graft from the ear or irradiated cartilage from a cadaver specimen.

The usually deficiency in revision surgery is the previous removal of either the bony or cartilaginous support structure of the nose. This structural framework needs to be rebuilt, preferably using your own tissue. The addition of skin or a composite graft (skin and cartilage) is required to resurface scarring inside your nostrils or vestibule skin.

In some patients, only minimal noninvasive treatments are necessary to create the desired aesthetic appearance. A steroid called triamcinolone or Kenalog is injected in one or a few direct skin areas of fullness (usually the supratip area above the tip) of in low dose resolves the problem. Rarely, injection of a dermal filler, such as Restylane Lyft or Bellafill can fill in an area of deficiency, however, this often needs to be repeated.

Some patients can undergo a closed approach with an incision inside the nostril, which produces less post-treatment nasal tip swelling than the open approach. Directly cutting an area of excess cartilage or placing a cartilage graft in an area of weakness or area of volume deficiency may be necessary.

The most common presentation to Dr Troell's revision rhinoplasty practice is a nose that has had one to four previous surgeries with excess cartilage excision or manipulation. Patients with this presentation often require multiple cartilage grafts for both functional (improved breathing) and aesthetic structural support. A knowledge of the anatomy, engineering, artistic eye and understanding the limitations are essential qualities of the surgeon to achieve the optimal outcome.

Improving nasal aesthetics and function

Dr. Troell has been involved in inventing two procedures for improving nasal aesthetics and function. Radiofrequency tissue reduction using a radiofrequency probe to reduce the size of the inferior turbinate to improve nasal breathing, also known as Somnoplasty. This procedure can be preformed on the palate for snoring and in the tongue musculature for patient's that have obstructive sleep apnea syndrome. He and his colleagues at Palo Alto Ca got the radiofrequency device approved by the FDA and completed all the initial studies, including in the pig model and in humans for the nose, palate and tongue anatomical areas.

The other nasal procedure developed was a cartilage grafting technique to the internal and external nasal valve that revolutionized the physical and architectural thinking of nasal support associated with nasal aesthetics. This technique was first presented in a Facial Plastic Surgery conference in Rome Italy in September 1997 at the 1st Roma OSAS: Advances on Snoring and Obstructive Sleep Syndrome, Rome, Italy. Nasal Rim Reconstruction: Evaluation of a New Procedure.

This novel procedure was published in 2000: Troell RJ, Powell NB, Riley RW, Li KK. evaluation of a new procedure for nasal rim and valve collapse: Nasal alar rim reconstruction in Otolaryngology/Head & Neck Surgery. 2000;122:204-211.

The procedure has revolutionized the way nasal reconstruction and cosmetic rhinoplasty is performed to optimize cartilaginous support to limit the need for revision surgery. A book chapter on this surgical technique was requested and published in an Advanced Aesthetic Rhinoplasty textbook:

Troell RJ: Nasal Alar Rim Reconstruction for Nasal Rim and Valve Collapse, In: Melvin A. Shiffman, M.D., J.D., Alberto Di Giuseppe, M.D., editors. Advanced Rhinoplasty: Art, Science, and New Clinical Techniques, Springer Verlag, Berlin, 2013.

Dr. Robert Troell has superior education and training to ensure he’s adequately qualified to treat these challenging revision rhinoplasty procedures with the following  expertise: He is a diplomate of the following medical subspecialty boards:

  • American Board of Otolaryngology-Head & Neck Surgery
  • American Board of Facial Plastic & Reconstructive Surgery
  • American Board of Cosmetic Surgery- Facial Plastic Surgery
  • American Board of Facial Cosmetic Surgery

The later two board oral examinations Dr. Troell received the highest score on the certifying board examination. Dr Troell is currently a board examiner for the American Board of Cosmetic Surgery. With his colleagues from his private practice at Stanford University in Palo Alto, CA has designed two surgical procedures for the nose for improved function (nasal breathing) and aesthetic appearance.

Please contact us at Beauty By Design in Irvine, CA.

Nasal Alar Rim Reconstruction Ch.27

Please feel free to call us at Beauty By Design in Irvine, CA (949) 220-0532.


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