Revision Sinus Surgery

Revision Sinus Surgery in Los Angeles with Dr. Cohen

Revision Sinus Surgery in Los Angeles with Dr. Cohen

Revision Sinus Surgery is an important aspect of Dr. Alen Cohen’s practice that he specializes in. Many of his patients come from various parts of California and other parts of the United States for revision sinus surgery with expert nose and sinus surgeon, Dr. Alen Cohen. Revision sinus surgery is quite different than primary sinus surgery. Most often the issues are either recurrent severe polyps, scar or synechiae formation along the sinus openings, an advanced infection that has set in the sinuses and is recalcitrant to medical management, or inadequate primary surgery.

Dr. Cohen has a revision surgery rate that is minuscule compared to most surgeons across the country and is usually limited to advanced polyp patients who are not adherent with their postoperative medical regimen. He utilizes advanced in-office techniques with nasal/sinus endoscopy and a CT scan to recognize the source of the problem/recurrence and then address it appropriately.

He utilizes various techniques such as in-office endoscopic lysis of synechiae, revision balloon dilation or Propel™ stent placement to address the particular issues as noted. Furthermore, most patients are amazed at how little discomfort there is with Dr. Cohen’s surgical techniques with no or minimal/dissolvable packing and what an entirely different experience Revision Sinus Surgery in Los Angeles with Dr. Cohen is.


FAQ’s for Outpatient Minimally Invasive Image-Guided Endoscopic Sinus Surgery with or without Septoplasty, Turbinate Reduction and/or Vestibular Stenosis Repair:

Is the procedure covered by insurance?
Yes. 95% of insured patients will have this procedure approved by their insurance carrier. Your doctor will get prior-authorization from your insurance carrier to verify your benefits. You may have deductibles and copays that you’re responsible for depending on your insurance benefits. Bills will be generated to your insurance by your physician, the surgical center, the anesthesiologist and any pathology that may be sent from your surgery. Furthermore if any cosmetic changes are being made to the nose that would reflect the outside appearance of the nose, then those fees are separate and there will be a separate “cosmetic fee” associated with your procedure that reimburses the surgery center as well as the surgeon and anesthesiologist for those components of the procedure.
Does it hurt?
You will experience facial pressure, a moderate headache and some soreness along the tip of your nose, which is normal, but pain overall should be minimal. Most of the discomfort is usually in the first 24-72 hours at which time patients will take narcotic pain medications or Tylenol extra strength to alleviate the discomfort.
Will I be put to sleep?
Yes, general anesthesia is administered by an anesthesiologist so you do not feel or remember the procedure. You will just remember the pre-operative holding area and waking up in the recovery room and nothing in between.
What are most common post-op side effects?

Most patients experience a mild to moderate headache, nasal congestion, mild blood/mucus drainage, and facial pressure for the first 24 to 48 hours. Beginning 72 hours after the procedure patients will begin to feel some improvement as the tissues begin to heal and their congestion and headache begins to slowly improve. The congestion and headache is 50% improved at one week, 75% at 2 weeks, 90% at 3 weeks and usually 100% at 4 weeks in most cases. Thus be patient!

How long will I miss work/school?

In most cases, patients can return to work/school usually 4-5 days after surgery usually if your job does not involve any lifting.  If your job does involve physical labor then we usually suggest a week off of work.  

How effective is Sinus Surgery?

Very effective and over 95% of patients experience significant improvement in their breathing, sinus pain/pressure, nasal congestion, smell/taste issues, and significant reduction in their frequency and severity of sinus infections. 

How long will results last?

There is sufficient data showing long term efficacy and indefinite results (beyond 5 years).  Your outcomes will typically depend on the severity of your sinus disease.  There is a very low revision rate for this procedure (less than 10%) in most non-polyp cases in Dr. Cohen’s hands. 

Is any tissue removed?

Yes along the sinus openings small amounts of tissues are removed in order to open the sinuses so they can drain properly.  The septal bone and cartilage is often reshaped so as to not obstruct your nasal passages.  The turbinates are shrunken to prevent congestion and the nasal valves are supported to prevent collapse, if warranted. 

How long does the procedure take?

Total start to finish time is typically around 1-1.5 hours.  Usually 15-20 minutes of this time are to put you to sleep and wake you up.   

Will this cure my sinus disease?

Unfortunately, there is no absolute ‘cure’ for sinus disease, however this procedure should greatly improve your quality of life by decreasing the likelihood that you will get future sinus infections and significantly improve your breathing and facial pressure issues.  This procedure changes your anatomy, which addresses the underlying problem, rather than just treating symptoms, like with antibiotics. Dr. Cohen will have you continue with rinses, allergy medications, such as sprays or antihistamines, to control your allergies.  Dr. Cohen may also have you see an allergist to identify what causes inflammation of your sinuses and whether allergy shots or allergy drops would help you minimize your need for ongoing medications.   

What is the follow-up after the surgery?

Dr. Cohen will often see you 4-7 days after your surgery as well as 14-21 days after to do regular debridements (cleanings) to make sure that the tissues in your nose and sinuses are healing properly without signs of infection or scar tissue.  These follow-up visits are separate from the surgery and are vital to make sure the tissues heal properly and may incur additional charges to your surgery depending on your particular insurance.   

How important are the Neilmed Sinus Rinses during the recovery?

We ask that you start on your rinses the day after your surgery and this is the single most important thing to make sure you heal properly without scar tissue and also to prevent infection.  We often ask you to rinse 3-5x per day the first 3 days and then 3x per day starting day 4 until day 14. This helps all of the dried blood, mucus, infection and dissolvable packing come out and helps the tissues heal properly. 

Will my nose be packed?

Dr. Cohen never packs the nose in any case in order to make the recovery for patients as comfortable as possible.  As such he often uses small amounts of dissolvable gel in various parts of the nose and sinuses which simply helps to minimize bleeding and prevent scar tissue.  As such patients can breathe through their nose right after surgery but there is mild to moderate congestion during the first 1-7 days similar to a cold.  If a septoplasty is performed, Dr. Cohen will often place plastic straw-like splints inside the nose which are removed 3-4 days after surgery and one can breathe and rinse through.   

Why do I have a sore throat after surgery?

This is because of the anesthesia often and usually resolves after 24-48 hours.  Lozenges and cold liquids or popsicles are often helpful with this.   

Does icing the nose or face help?

It does provide some relief from discomfort but is not necessary unless you’ve had a cosmetic rhinoplasty or nasal fracture repair.  

Will I have bruising?

There is absolutely no bruising on your face unless you’ve had a cosmetic rhinoplasty or nasal fracture repair. 

Will I have stitches?

 Yes you will have dissolvable internal stitches in your nose if you have a septoplasty or nasal valve repair and they dissolve on their own over 7-14 days.  If you have a cosmetic rhinoplasty, you may have a few stitches that may need to be removed 5-7 days after surgery when the cast is also removed.  

When will I notice the final results?

Most patients see full results between 3-6 weeks after surgery and they say that the quality of life improvement they experience is immense compared to previous.  They often notice increased energy, improved quality of sleep and even and are able to focus better on daily activities. Our patients routinely say that if they knew the results were this good and that the procedure was so easy, they would have done it decades ago.  That’s why we routinely get many referrals from friends and family!