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Revision Rhinoplasty is much different and more difficult than performing a primary Rhinoplasty (first time nasal surgery). The surgeon has to be much more experienced in the techniques of nasal surgery in order to accomplish a good result on patients who have had previous rhinoplastic surgery.
It is because the tissues of the nose are often scared and the smooth natural surgical planes are not as easily identifiable. Thus a perfect understanding of the anatomy of the nose has to be second nature to the revision rhinoplastic surgeon. Also nasal breathing problems such as obstruction often accompany the nasal deformity that has to be addressed at the same time. So not only does the revision rhinoplastic surgeon have to be able to correct the external deformity that have resulted from the surgery but also be able to understand the breathing problems that may have either not been corrected at the time of the original surgery or resulted from the problems of the healing from the original surgery. In order to correct those types of breathing problems Dr. Silver, not only has training and expertise in Facial Plastic Surgery, but also training in Otolaryngology (ENT) as well, where he spent many years treating and diagnosing nasal obstruction problems. Because of Dr. Silver’s vast experience both in performing complicated revision rhinoplastic surgeries and his extensive lecturing and writing on the subject, over half of the patients referred to him to perform rhioplastic surgery have been referred to him in order to obtain his expert advice and skill to perform a revision rhinoplsty.
Besides having to know the anatomy so extremely well, very often there is a need for grafts to be applied to the nose in order to substitute for tissue that has been removed or injured at the time of the initial nasal surgery. Knowing what types of grafts, whether to use the patient’s own cartilage from other parts of the body such as the ear, the nasal septum, or the rib without creating additional deformities has to be performed quite delicately and with experience. Also there are times when other materials that do not come from the patient can be substituted for the patient’s own tissues. The handling of these materials takes many years of experience to perfect.
At Dr. Silver has been performing rhinoplastic surgery for over 30 years. His vast experience in the field of nasal surgery has enabled him to be one of the leading Board Certified Facial Plastic Surgeons in the country to have patients referred to him for revision rhinoplastic surgery.
On the initial consultation with Dr. Silver a careful history and complete nasal exam is performed. If available, the previous operative notes are reviewed. Also every patient is computer imaged by Dr. Silver prior to making any final recommendations. In very complicated cases the patient is often seen on more that one or two visits in order to make sure the patient fully understands the entire procedure. These extra visits are part of the original consultation, but are utilized for the patient as well as Dr. Silver to be better prepared to reach a good conclusion.
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