African American Rhinoplasty Revision Case Study #3

Before Revision Rhinoplasty with Dr. Slupchynskyj.

The above patient is a 23 year old Ethnic male who had his primary rhinoplasty with another surgeon. In the first procedure, his surgeon used an open rhinoplasty approach. While Dr. Slupchynskyj agrees that the open rhinoplasty technique was the best choice for this patient because of his complex nasal anatomy and desired augmentation to the nasal tip, this advanced approach requires superior skill and extensive experience to be performed correctly. Unfortunately, his first surgeon did not possess the proficiency or skill to execute this complicated rhinoplasty technique. Ethnic and African American Rhinoplasty patients must be especially cautious when selecting a facial plastic surgeon due to the differences in their nasal anatomy and the difficulty those differences present. Some tips on what all patients should look for in facial plastic surgeon can be found here.

After an unsuccessful primary rhinoplasty, this patient was left with undesirable results: he exhibited a Pollybeak Deformity and a Bulbous and Ptotic (Drooping) Nasal Tip. After doing the research he wished he had done the first time around, he decided to have his final Ethnic Revision Rhinoplasty with Dr. Slupchynskyj.

Pollybeak Deformity and Ptotic Nasal Tip, Before
Revision Rhinoplasty with Dr. Slupchynskyj.

In the figure above, the patient is shown before and during his procedure. The profile image clearly displays his Pollybeak Deformity. A Pollybeak Deformity occurs when the area above the nasal tip protrudes from the nasal bridge, resembling a parrot's beak. There are two main types of Pollybeak Deformity: the hard tissue and the soft tissue. This patient exhibited both types. The hard tissue Pollybeak Deformity is that which is caused by hard cartilaginous tissue. As illustrated above, this patient's caudal septum (the cartilaginous component of the partition that divides the nose into right and left halves, shown in blue) was under-resected (or under-removed) in his previous surgery. This contributed to the overprojection above his nasal tip. He also had a soft tissue Pollybeak Deformity. His previous procedure resulted in a buildup of scar tissue in the nasal tip (shown in pink in the profile image). This scar tissue was made visible during his Revision Rhinoplasty with Dr. Slupchynskyj and is seen in the photo at right in the illustration above. This scar tissue further emphasized the parrot-like shape. In addition to the Pollybeak Deformity, this patient also had a Ptotic or Drooping Nasal Tip. In his first procedure, the Lower Lateral Cartilages (that comprise the lower, outside portion of the nose, shown in yellow), were poorly reconstructed. This added to an overall lack of tip support and led to the Ptotic Nasal Tip.

Bulbous Nasal Tip, Before Revision Rhinoplasty with Dr. Slupchynskyj.

When viewed from the front, as in the illustration above, this patient's Bulbous Nasal Tip is quite visible. A Bulbous Nose is one that is rounded, swollen looking and lacks definition. This patient had several factors that contributed to his Bulbous Tip, some of which likely existed before his first rhinoplasty and some that resulted from it. When one has a bulbous nose from birth, it is typically the result of structural differences in the nose. Excess fatty tissue in the nasal tip and droopy, flimsy nasal cartilage can lead to a rounded nose that lacks definition. These features can be more common in African American and Ethnic patients. This patient likely had these features prior to his first rhinoplasty. However, as a result of his first procedure, he developed scar tissue (shown in pink in the first illustration) that added to his already fatty nasal tip. In addition, his lower lateral cartilages (shown in yellow in the first illustration) were poorly reconstructed, essentially doing nothing to help refine his tip. With all of these factors at play, this patient was left with an especially bulbous nasal tip.

In 2004, this patient decided to have his final Ethnic Revision Rhinoplasty procedure with Dr. Slupchynskyj. Using an open rhinoplasty approach, Dr. Slupchynskyj resected (or removed) the caudal septal cartilage contributing to the patient's Pollybeak Deformity. Dr. S. bolstered the nasal tip using strut and shield grafts carved from the patient's septal cartilage. He further refined the tip by excising the scar tissue left from his previous procedure and removing a 2mm strip of the cephalic lower lateral cartilages (the part of the cartilages nearest to the top of the head). See this patient's miraculous transformation in his before and after photos below.

Before and After Revision Rhinoplasty with Dr. Slupchynskyj.

Before and After Revision Rhinoplasty with Dr. Slupchynskyj.

Before and After Revision Rhinoplasty with Dr. Slupchynskyj.