Dr. Robert Troell - Las Vegas, NV
Las Vegas, NV & Irvine, CA
Cosmetic and Facial Plastic Surgeon
Revision Rhinoplasty (*) is one of the most challenging procedures in cosmetic surgery today. Previous “nose job” or rhinoplasty either did not achieve the desired outcome, the surgeon was overly aggressive with nose cartilage manipulation or a complication occurred, all of which have produced a less than optimal result.
Approximately, one third of Dr. Robert J Troell, FACS, FAAFPRS, FAACS, FAAOHNS, FAASM’s nasal beautification surgeries are revisions from his colleagues. All patients have photographs taken and photo morphing with Dr. Troell to identify the exact appearance the patient is striving to achieve. He will educate you on the possibility reaching this aesthetic goaI. Preparation for surgery is essential. Acquiring your previous description of the surgery or “operative report”, provides valuable information of the anatomy that may be present at the time of your revision procedure.
Nearly all of these cases require the soft tissue structure between the nostrils to be lifted (open approach) for maximum visualization of the nasal anatomy. Nearly all of the revision procedures require cartilage from somewhere in your body: nasal septum, ear conchal or rib cartilage. Occasionally, bone may be needed from the top of your head, skin and cartilage combined graft from the ear or irradiated cartilage from a cadaver specimen.
The usually deficiency in revision surgery is the previous removal of either the bony or cartilaginous support structure of the nose. This structural framework needs to be rebuilt, preferably using your own tissue. The addition of skin or a composite graft (skin and cartilage) is required to resurface scarring inside your nostrils or vestibule skin.
RealSelf Q&A with Robert J. Troell, MD, FACS
In Some Patients, Only Minimal Treatments Are Necessary
Sometimes, only one or a few direct skin injections to an area of fullness (usually the supratip area above the tip) of a steroid called triamcinolone or Kenalog in low dose resolves the problem. Rarely, injected of a dermal filler can fill in an area of deficiency, however, this is only a temporary solution.
Some patients can undergo a closed approach with an incision inside the nostril, which produces less post-treatment nasal tip swelling than the open approach. Directly cutting an area of excess cartilage or placing a cartilage graft in an area of weakness or area of volume deficiency may be necessary.
The most common presentation is a nose that has had one to four previous surgeries with excess cartilage manipulation that requires multiple cartilage grafts for both functional (improved breathing) and aesthetic structural support. A knowledge of the anatomy, engineering, artistic eye and understanding the limitations are essential qualities of the surgeon to achieve the optimal outcome.
Dr. Robert Troell has superior education and training to ensure he’s adequately qualified to treat these challenging revision rhinoplasty procedures with the following board certifications:
- American Board of Otolaryngology-Head & Neck Surgery
- American Board of Facial Plastic & Reconstructive Surgery
- American Board of Cosmetic Surgery- Facial Plastic Surgery
The later two board oral examinations Dr. Troell received the highest score on the certifying board examination. With his colleagues from his private practice at Stanford University in Palo Alto, CA has designed two surgical procedures for the nose for improved function (nasal breathing) and aesthetic appearance.
Nasal Alar Rim Reconstruction Ch.27 (*)
Contact Dr. Troell’s Office for Your Free Consultation:
Dr. Troell and his staff are happy to discuss Reconstructive Plastic Surgery procedures with you and answer your questions. Please feel free to call our offices in Las Vegas, Nevada (702) 242-6488 and Irvine, California (949) 220-0532.
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Photographs of people used on the following pages are before and after photos of patients who have undergone surgical and non-surgical cosmetic procedures described herein and that provide a reasonable indication of typical results of the advertised procedure. Results may vary and this may not be typical of every user. In the event that this Website uses the image of a non-patient model, we will make reasonably attempts to state that the photo used is of a non-patient model.