Dr. Warwick Nettle specialises in facial rejuvenation surgery and nose surgery and is one of the most experienced rhinoplasty surgeons in Australia. He frequently performs primary rhinoplasty and revision rhinoplasty and is often referred the most difficult cases to fix. With strong training in ear, nose and throat (ENT) surgery and plastic and reconstructive surgery, Dr. Nettle is highly qualified to perform both primary and revision rhinoplasty.
Dr. Nettle trained in rhinoplasty surgery in the USA with some of the most respected names in rhinoplasty surgery. Dr. Nettle regularly visits leading surgeons in the USA to update techniques and share knowledge about rhinoplasty.
With his extensive experience in revision rhinoplasty, Dr Nettle is aware of the disappointment patients feel when primary rhinoplasty is unsuccessful and revision is necessary.
Most revision rhinoplasty is performed by an open approach. This involves a small incision on the columella (the skin on the central underside of the nose) that joins with incisions inside the nose to allow the skin to be lifted off of the underlying cartilage and bone. This allows complete visualisation of the underlying structural problems and scar tissue. In almost all cases of revision rhinoplasty, extra material is needed for reconstructing elements that have been removed too aggressively or are not in the right place. Extra cartilage may be taken from the septum (the midline cartilage of the inside of the nose) or if this is not available, cartilage may be removed from the ear or rib. If ear cartilage is used, this does not leave a visible defect on the ear as it is approached from behind.
Occasionally implants are used and these implants may be silicone, MEDPOR® or in unusual situations, GORE-TEX®, however we prefer to use your own biologic material for nose surgery unless this is simply unavailable. Temporalis fascia, which is a membrane overlying the temporalis muscle in the temple, is sometimes used as an overlay or to help build up areas of the nose as it is soft, pliable and easily obtained without any visible sign or functional deficit.
In modern revision rhinoplasty packing is very rarely used but as with primary rhinoplasty, it may be used on very rare occasions. After surgery, a thermoplastic (fibreglass) nasal cast is used and kept in position for approximately five to six days. All stitches are dissolving.
Recovery from Revision Rhinoplasty Surgery
Revision rhinoplasty has a similar recovery to primary nose surgery. The nasal cast is removed after five or six days, and you should generally be able to return to work after approximately 10 days. Usually, the most obvious sign of nose surgery is bruising around the eyes. It may take a few months before swelling subsides and breathing is at its maximum.
Although you can see changes instantaneously, until the bones have healed and the swelling has completely subsided, you will not be able to determine the end result, which can take more than 12 months, although relatively uncommon, even revisions of previous nose surgery sometimes need touch-ups to ensure the best possible result.
Revision rhinoplasty surgery is performed in a private, accredited hospital under general anaesthetic with a qualified anaesthetist. The time required for surgery is very variable and depends on the extent of the surgery required. Complicated revision rhinoplasty surgery can take 5 or more hours. You can usually go home the same day but will require someone to pick you up to care for you at least overnight and take you to Silkwood for your post-op appointments.
The cost of revision rhinoplasty surgery is determined by the expected complexity and duration of your operation and will be estimated following your first consultation. Dr Nettle’s surgeons fee is approximately $17,000. This does not include the assistant fee, Anaesthetist, or hospital cost.
If you are unhappy with your new nose, the first step is to schedule a consultation at Silkwood Medical in Sydney to discuss further rhinoplasty surgery. At your revision rhinoplasty consultation, we will discuss your medical history and evaluate your nose to determine what can be done. Rhinoplasty often involves modifying or removing parts of the natural cartilage, and certain goals may be unrealistic because they would compromise the structure of the nose. Each case is unique, and should be evaluated individually.
After rhinoplasty, it is important to be patient. If you are dissatisfied with your nose a few months into recovery, it is important to remember that it can take many months, and sometimes more than a year, for all swelling to disappear and the final shape to be revealed. A new surgery should not be performed until you have fully recovered from the original procedure. The amount of time required will differ from patient to patient, and anyone interested in revision rhinoplasty should be evaluated individually.