Working in one of the top otolaryngology–head and neck surgery departments in the United States, Johns Hopkins’ chief of facial cosmetic surgery Shaun Desai treats a number of patients who require complex rhinoplasty revision — a  specialty for his practice.

In one recent case, a female patient was experiencing the results of a prior rhinoplasty: a deviated septum, collapsed nostrils and twisted nasal tip. The concerns were not only cosmetic but also functional, with her breathing significantly obstructed. “Everybody told her no in terms of surgery,” Desai says, due to the significant complexity of the job.

But Desai —  who is often sought for advanced work, and has performed hundreds of rhinoplasties in his nine years at Johns Hopkins — took on the procedure. To reconstruct the patient’s nose during the five-hour operation, Desai used grafts of cartilage from her ears as well as from the ribs of a cadaver. “We got her to a place where she was breathing normally again, and felt more confident being in public with her appearance,” he says.

Improving functionality and cosmetics is the priority for Desai, who is board certified as a facial plastic surgeon and otolaryngologist. He is one of four facial plastic and reconstructive surgeons in the department, which also includes Kofi Boahene, Lisa Ishii and Jason Nellis. “We look at it from a breathing perspective and from an aesthetic perspective, and we don’t sacrifice one for the other,” he says.

The team members are based out of Bethesda; Green Spring Station in Baltimore County; the Levi Watkins, Jr., M.D., Outpatient Center in Baltimore; and Sibley Memorial Hospital in Washington, D.C.

While skilled in rhinoplasty revisions, Desai says his own practice has established a low rate for surgeries requiring them — under 3% in a field where the average rate is 5% to 7%, according to a study he co-authored. 

Desai and colleagues also make a point of following patients through long-term healing as their noses take final shape, a nuanced and personalized process that may involve taping, massaging or steroid injections, among other steps. “What makes rhinoplasty such a challenging surgery is the outcome isn’t judged a week after — it’s judged almost one-and-a-half to two years later,” he says. “You really have to follow things over time, and having that patient-physician relationship, knowing we trust each other, is important.”

To make a referral, call 301-896-3332 or learn more at hopkinsmedicine.org/facialplastics.