Your question: Having 2nd surgery to improve breathing droopy tip.I would appreciate anyone who can offer suggestions helpful advice?
I've had a septoplasty and spreader graft back in 2012 and since then developed a septal perforation to big to fix , I've been to 3 reputable Drs who say they can't fix it. They think the hole was caused by trauma and possible infection. I'm concerned about the structural integrity of the nose,And another surgery . Today I had my first consultation with DrSwenson. I had a good overall consultation , this is what he would perform functional nasal septal graft as well as a vestibular repair.
Dr. Denenberg's answer: You probably have to decide whether the hole should even be repaired
Concerning the droopy tip, see the Web reference link just below my answer I made a computer morph, and an animation, showing the kind of change that should be possible with a revision rhinoplasty.
I know I haven't had the chance to examine you in person, but here are my thoughts from past experience with patients in similar situations
It's probably not a good idea to try to close the hole AND change what your nose looks like in the same operation. Closing a hole as large as you describe is very difficult in itself, and combining that procedure with a difficult revision is just too much it could compromise the results of each component of the operation.
In evaluating whether the cosmetic revision can be done, I look to see how much septum is remaining. We would want a strong nose even after the revision. It's quite rare for the septum to be too damaged to allow for a cosmetic revision you only need a small amount. If your nose is stable now, it should be okay to raise the tip.
The reasons to close the hole are if it bleeds, if it whistles and drives you crazy, if it crusts up all the time, if it causes a LOT of airway obstruction, if it's been confirmed that it keeps getting bigger and your nose is at risk. We DON'T close holes just 'cause they're there, especially if they are so large that the operation has a fair likelihood of failing. It'd be a shame to try to close the hole just because it's there, and have the operation fail, and now you can no longer have the cosmetic portion done because the attempt at perforation closure changed things too much on the inside.
Any of this make sense?
You should also understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle. Be sure to read the section in the Web reference link on how to stay out of trouble while searching for a rhinoplasty surgeon.
1) Proposed before and after:
Here's an animation of those changes. Give it a couple seconds to load:
Does this fit with what you have in mind for yourself?
2) Click here to comment on those changes, or to ask Dr. Denenberg a follow-up question.
3) Click here to see more rhinoplasty before and afters of patients who had revision rhinoplasty.
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Plain talk about picking a plastic surgeon for your first-time or revision rhinoplasty.
I do lots and lots of revision rhinoplasties; I'll try to give you some advice here, to maximize the chances that you'll be happy after surgery, and to minimize the chances you'll need a revision.
Important!! How to tell whether your consultation was acceptable:
Photos. If a surgeon doesn't show you before and after photographs, scratch him off of your list. Period. No exceptions. Deal-breaker.
You pick a surgeon primarily from his before and after photos. Diplomas, board certifications, hospital affiliations, academic appointment, and even reputation tell you nothing: a surgeon is never tested for his skill, his artistic eye, the quality of his outcomes, or even whether he cares that his patients are happy.
You must see photos of other patients who had some features similar to your nose. For example, if your nose has a wide and drooping tip, don't accept profile-only photos of patients who had a hump carved down. You can't see the width of the tip on a profile photo.
Revision nose operations are much more difficult than first-time operations, so if you are consulting a surgeon about a revision operation, you must see photos of his revision patients.
If you do see the surgeon's photos, but you don't love them, scratch him off your list. You want to use a surgeon whose work you like. Don't assume that he'll do great on you when he didn't do great on the other people.
Thought experiment: you are going to hire a portrait painter to paint your portrait. Would you really hire the painter if he wouldn't show you any of his other portraits?! No, it would never occur to you to hire him. Well, now you're going to hire a surgeon to change your nose, in the middle of your face, and you aren't going to insist on seeing examples of his work, proof that he knows what he's doing? Think about it. Teach your friends.
Communication. If the doctor treats you disrespectfully, scratch him off your list. If he won't patiently listen to what you want for your nose, same thing. How will he know how to make you happy if he won't hear what you want for your nose?
If he conducts the consultation from behind his desk and doesn't examine your nose, deal-breaker. If it's the nurse and not the surgeon who conducts the consultation, run away fastest. All due respect to the nurse, she doesn't know what's possible and what isn't. If the plan is to see the surgeon for the first time on the morning of surgery, deal-breaker. For sure.
Computer morphing. If the surgeon doesn't do computer morphing of your nose, scratch him off your list. The morphing is crucial, so the surgeon can prove to you that he understands exactly what your goals are. Also, if the surgeon recommends some changes that you hadn't thought of, you need to see the morphs, so you can see whether you like those changes.
Your intuition. If your gut tells you "no," don't use the surgeon. Don't ever use a surgeon only because you know him, or your kids know him, or he lives on your street, or your primary care doctor referred you to him, or he did your breasts, or your tonsils, or your wisdom teeth, or you saw his advertisement, or his awards.
I hear these stories all the time from my revision rhinoplasty patients. You must do your own evaluation of any surgeon you visit. And by "evaluation," again, we're talking mostly about seeing his photos and seeing how well he communicates with you. Don't bother checking the surgeon's licensure and board certification and hospital affiliations and all that; it'll just distract you from what's important.
Conclusion. The fact is, the great majority of plastic surgeons who perform rhinoplasty shouldn't be doing the operation. It's an incredibly difficult procedure, technically demanding, requiring experience, skill, judgment, an artistic eye, an exceptional level of communication and thoughtfulness, and a rare level of empathy and caring for the patient. No hospital board protects you by judging the quality of a surgeon's rhinoplasties and prohibiting him from operating if he's terrible. It's the wild, wild west out there, folks.
More plain talk: should you let your primary surgeon perform your revision?
First, you need to consider whether things didn't turn out great on your first operation because of some unusual circumstance with the surgery or the healing, or whether things went wrong because your doctor was not expert in rhinoplasty in the first place.
Evaluate your surgeon again. Read the section above, on how to evaluate a surgeon for a rhinoplasty. If you saw lots of before and after photos of your surgeon's other patients who got excellent results, in noses at least somewhat similar to yours, then your surgeon probably knows what he is doing, and you can consider letting him perform your revision. Even the very best surgeon has the occasional disappointing result.
However, if, on looking back, you decide that you did not do excellent research on your original surgeon -- perhaps you relied on a referral, or on his board certification, without being able to see his photos -- then you probably should not have him perform the revision. If he couldn't get you close to your goal the first time because of a lack of skill, he will have no chance at all on the second try, and then you'll be in the tough position of looking for a third operation.
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