REVISION RHINOPLASTY LOS ANGELS, BEVERLY HILLS


REVISION RHINOPLASTY


It is not possible for every plastic surgeon to be an expert in all procedures. This is particularly true for Rhinoplasty and even more so in revision and corrective nasal procedures. The nose is an extremely complex breathing organ, as well as being the most obvious anatomic focal point of the face. Maintaining or improving its function, while simultaneously creating a natural shape is vitally important for patients’ physical and psychological well-being and takes an experienced and highly skilled surgeon.

Dr. Binder has been performing revision rhinoplasty procedures for almost three decades. It is well known in plastic surgery that a surgeon’s knowledge and mastery of the Rhinoplasty procedure is limited until he has been performing it consistently for at least ten to fifteen years. This is an unfortunate but undeniable fact. Rhinoplasty procedures are said to be in a completely different class. Only after a qualified surgeon has endured the long process of learning and understanding this procedure, as well as endeavored to refine it, does he realize that rhinoplasty is the most challenging procedure in plastic surgery. My confidence in performing the procedure, based on an extremely high rate of success, enables me to say to my patients – "I can, with confidence, obtain a successful result even in the most extreme cases". The nuances of the finished effect and attention to the smallest detail are what define a positive outcome and a happy patient.

Dr. Binder has strived to specialize in Rhinoplasty and Revision Rhinoplasty. He became interested in this field in the mid 1980’s when it was recognized that the nasal procedures performed in the 1960’s and 1970’s did not hold up over time and started to collapse, causing problems in breathing. This evolution in the thinking of Rhinoplasty as "reinforcing and restructuring the weaknesses in the nose" versus the removal of structure and weakening the nose reflects the progress made in this procedure over the past twenty years. Today, the techniques discussed in the plastic surgical literature include terms such as "cartilage repositioning", structural grafting and suturing techniques, spreader grafts, nasal valve reconstruction with alar batton grafts and supporting rim strips, and many more. Dr. Binder understands that although these procedures are now becoming commonplace amongst those skilled in Rhinoplasty, they are only mastered through extensive experience over a long period of time.

Understanding this evolutionary process within your own practice and being part of the transformation of Rhinoplasty provide the experienced surgeon a huge advantage over the novice surgeon (no matter how well trained) in treating the most challenging cases. Equally important from this perspective, the experienced surgeon must have knowledge and understanding of what cannot be accomplished. Thus, the surgeon is able to empower the prospective patient with a sense of confidence and equip him or her with realistic expectations of what is, and what is not possible.

Dr. Binder’s office in Beverly Hills is often considered the final destination for correcting the most difficult problems in revision Rhinoplasty. His referrals are often from other doctors and other plastic surgeons who recognize Dr. Binder’s expertise within this highly specialized field of plastic surgery. Many patients seeking Dr. Binder’s consultation have already undergone one or more cosmetic nose surgeries and have been left with functional breathing problems, collapsed noses, or unacceptable cosmetic results. Dr. Binder explains, "Everybody’s nose is different, requiring different surgical techniques to be carefully selected and appropriately applied to each individual case."

Dr. Binder believes that the optimal techniques required for mastering the difficult revision Rhinoplasty procedure are so demanding that relatively few surgeons have, in fact, mastered them at all. Those cases often require revision nasal surgery are "conspicuously artificial-looking" or have "altered noses" that also have serious structural damage or deficiencies, such as collapsed nasal valves and simultaneous breathing problems.

Patients frequently wonder, "Why did my nose look okay at first, but after a year or even 2 years later, is now collapsed, pinched or what has now become known as "skeletonized" and artificial looking." Unfortunately, this problem is not rare. It is estimated that between 5 – 15% of patients who undergo Rhinoplasty will need revision surgery, some needing minor and others more major procedures. Although not every surgeon can guarantee perfect results every time, additional procedures after a primary or secondary revision surgery should be no more than a "minor adjustment" that, in most instances, can be performed under a local anesthetic. However, only in the most complex cases, a secondary or two-stage procedure is not uncommon.

WHY ARE THERE SO MANY "BOTCHED NOSE JOBS"? Dr. Binder attributes an overabundance of surgeons with limited experience or limited training in rhinoplasty to the alarming percentage of botched nose-jobs that are neither functionally efficient nor aesthetically satisfactory. The end-products of less-than-masterful rhinoplasties include cases where the tip of the nose appears snubbed or "cut off", or what we refer to as lacking tip projection. Surgeons often attempt to solve this problem and lengthen the short or "bobbed" nose with the use of only a tip graft procedure. This is commonly performed in the open rhinoplasty approach. However, this technique, by itself, yields results which often look and feel equally unnatural. Dr. Binder’s unique methods include grafting procedures to reinforce the natural cartilages which will actually form the shape of the nasal tip. This is a major difference in conceptual thinking between the two techniques.

"FORM FOLLOWS FUNCTION"
The definition of revision Rhinoplasty embraces the concept of "reinforcing noses" that have been structurally weakened by previous surgeries, or require further aesthetic correction. In most cases, a good part of this procedure demands a clear understanding of the functional or breathing problems that are often simultaneously associated with these revision cases. This is where my training in both specialties of Otolaryngology and Facial Plastic Surgery becomes so important in understanding and being able to diagnose and correct the problems contributing to the functional breathing problems associated with many of the revision surgical cases. The goal is to restore to normal the anatomical components of the nose using the patient’s own cartilage either obtained from the septum or ear. In extreme cases where there is no available septal or ear cartilage, rib cartilage may then be used as an alternative.

SPECIAL CIRCUMSTANCES AND– NEW PROBLEMS IN REVISION RHINOPLASTY: Very often problems do not appear until years later. After open rhinoplasties have failed and the nose cannot be "opened" for the 3rd or 4th time, who will now revise the open Rhinoplasty complications which now must be addressed through a closed approach? With the collaboration of several surgeons from across the country, Dr. Binder and his colleagues have developed a solution to this problem. Revision of the open Rhinoplasty complications using a closed approach - a novel method of reconstructing and performing revision Rhinoplasty.

There are sections on this website that will answer many questions regarding revision Rhinoplasty. In addition, the section on FAQ’s will also serve to answer most of the questions patients ask during their consultation.

YOUR CONSULTATION FOR REVISION RHINOPLASTY:
Our office is dedicated to establishing proper communication with prospective patients. Since revision rhinoplasty is complex and so difficult for patients particularly with the prospect of having to redo the first surgery, our out of town patients, can start out with a brief history of the problems as well as the aesthetic concerns. Photographs sent via the internet or mail are helpful in this process. We will gladly review this information and promptly reply with relevant information pertaining to your surgery. We will not make a complete diagnosis until the time of your actual consultation.

During the consultation, a thorough review of your history and a physical examination, including any problems in breathing, will be completed. Dr. Binder will provide a step by step explanation of the problem and the procedures that will attempt to correct the problem. Our supportive staff, who have worked with Dr. Binder for over 14 years, will also explain the details of postoperative care, as well as address any insurance matters.

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