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Ethnic Rhinoplasty Revision Case Study #2

Before Ethnic Revision Rhinoplasty with Dr. Slupchynskyj.

The above patient is a 22 year old African-American female who had two previous Rhinoplasty procedures with another surgeon in 2004 and then in 2006. This patient experienced four complications as a result of these surgeries. In the two previous procedures, the surgeon used a Closed Rhinoplasty approach. This traditional technique is best reserved for minor cases, such as bridge hump removal as it is performed through the nostrils, which limits the access to and visibility of the nasal structures and tip. The advanced open surgical approach would have been advisable with this patient in order to precisely address her nose the first and definitely the second time around. Many surgeons choose to perform a Closed Rhinoplasty, due to their lack of training, experience and/or surgical skill with this advanced Rhinoplasty technique, even though complex cases involving the nasal tip (like this patient presents), are better addressed using the Open Rhinoplasty approach. Regrettably, her surgeon's subsequent use of the Closed Rhinoplasty technique in both procedures was one of the factors leading to less than desirable results. The Pollybeak, Open Roof, Hanging Columella and Retracted Nostril deformities are all exhibited in this Revision Rhinoplasty patient and are discussed in detail below.

This patient's first surgeon over-resected (or over-removed) the bony nasal bridge while under-resecting (under-removing) the nasal dorsal septal cartilage. See the labeled photo below. This led to an overprojection or hump just above the tip of her nose, creating a parrot-like, Pollybeak Deformity. In other words, the surgeon was too aggressive in augmenting her nasal bridge, but also failed to properly refine her nasal tip. More information about the Pollybeak Deformity and its specific causes can be found here.

Pollybeak Deformity, Hanging Columella and Retracted Nostril,
Before Revision Rhinoplasty with Dr. Slupchynskyj.

This patient exhibits two additional deformities as a result of her Primary Rhinoplasty and her Secondary or Revision Rhinoplasty with another surgeon. In the figure above, the yellow arch over her nostril illustrates her Retracted Nostrils. When viewed in profile, as in the patient's photo, the nostril appears pulled back and reveals part of the nasal septum. The profile view also exposes the Hanging Columella, also known as Columellar show. The columella is the thin strip of tissue between the nostrils. Here, you can see that her columella hangs or protrudes below the nose. In this case, both the Retracted Nostrils and Hanging Columella resulted from the removal of too much lower lateral cartilage, also known as the cartilage that comprises the side of the lower nose.

In addition to the Pollybeak Deformity, Hanging Columella and Retracted Nostrils, Dr. Slupchynskyj found this patient was also left with an Open Roof deformity. If we imagine the nose as the roof on a house, the nasal bones typically meet in the middle, forming the bridge of the nose or the peak of the roof. When this patient's surgeon over-resected her bony nasal bridge, he or she also took the "roof" off of the nose. Essentially, this created a hole in the bridge of the nose that is covered by mucosa and skin, but there is an absence of bone. Removing the "roof" of the nasal bridge is a relatively common part of bridge augmentation and only becomes problematic when the operating surgeon fails to close the "hole" in an appropriate manner. Usually after the "roof" has been opened, the surgeon uses lateral (side of the nose) osteotomies (changing the shape or alignment of bones) to bring the nasal bones back together, thus closing the hole in the roof. However, this patient was left with an Open Roof deformity that contributes to the boxy, flat nose that can be seen in her "before" photo and illustration below.

Open Roof Deformity, Before Ethnic Revision Rhinoplasty with Dr. Slupchynskyj.

In 2007, this patient sought out and decided to have her final African-American Revision Rhinoplasty procedure with Dr. Slupchynskyj. Using an Open Rhinoplasty approach, Dr. S. added height to her nasal bridge with his custom-carved SLUPimplant™ and removed excess fat and scar tissue (caused by the previous procedures) from her boxy, nasal tip, which corrected the Pollybeak Deformity. Dr. Slupchynskyj performed lateral osteotomies to correct the alignment of her nasal bones and eliminate her Open Roof Deformity. In her before and after photos below, you can see how Dr. Slupchynskyj's tip refinement also corrected the Hanging Columella and Retracted Nostrils. Both the aesthetic and functional aspects of this patient's nose were greatly improved.

Before and After Ethnic Revision Rhinoplasty with Dr. Slupchynskyj.

Before and After Ethnic Revision Rhinoplasty with Dr. Slupchynskyj.

Before and After Ethnic Revision Rhinoplasty with Dr. Slupchynskyj.

 
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  • I am so thankful to have come across Dr. Oleh Slupchynskyj of The Aesthetic Institute of New York & New Jersey. "Dr. S." (as I like to call him for obvious reasons, haha) is a Double Board Certified Facial Plastic Surgeon, and it turns out he has an entire website dedicated to his work with African American patients: www.africanamericanrhinoplasty.com. I was immediately impressed with the wealth of information that he has on his site, including information about his practice, his stellar credentials, his surgical inventions (i.e., the SLUPimpla...

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  • As a 74 year old African American woman, I was apprehensive regarding the SLUPlift™ Surgery. In the past, when I discussed plastic surgery with family and friends they spoke negatively about the surgery. Eventually I decided it was something I wanted to do for myself. I found Dr. Slupchynskyj while surfing the Internet and reviewing several of his before and after photos. After meeting the Dr. he assured me that I would be OK — and he was correct. After the surgery I did not have to take any pain medication and I was out shopping within 4 d...
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    I am a 27 year old, African-American female from the Midwest and I just recently had a Rhinoplasty procedure performed on February 9, 2012. I had known for a long time that I wanted to have the procedure done to correct a bump in the bridge of my nose, reduce the width of my nose, as well as to refine my down-turned nasal tip. This was an operation that I was not going to trust to just anybody, so I spent countless hours researching and looking for a surgeon who had significant experience working with African-American patients. Because I liv...
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