Revision Rhinoplasty Surgery Procedures

Revision rhinoplasty is any further surgery following a primary rhinoplasty. Revision or secondary rhinoplasty is not commonly performed until a year has gone by following the first rhinoplasty. This is to allow the tissues to settle and all the inflammation, swelling and wound remodeling to resolve. At this point the surgeon can usually finally assess the nose and further rhinoplasty can occurs in as stable as possible a surgical field.  The patient and surgeon then know what they are starting with. Revision rhinoplasty can vary from a minor procedure done under local anaesthetic to a complex reconstructive rhinoplasty lasting all day. The goal of the procedure is to correct problems arising from previous rhinoplasty surgery and/or those problems which failed to be corrected during the primary Rhinoplasty. There are many reasons for revision rhinoplasty, all can be classified as either functional or aesthetic. Sometimes both reasons are combined. The causes are also many. At times too much tissue was removed, other times but less frequently too little. A post operative complication may have resulted in the nasal deformity or impaired function. Overall, most problems for patients are minor and can be dealt with by the original surgeon. The revision rate for rhinoplasty even for experienced rhinoplasty surgeons is around 5 %. If there is a major deformity it may be better to pursue your second surgery with someone experienced in revision rhinoplasty.

The second (or third or fourth) surgery is usually much more challenging for the surgeon. The normal anatomy of the nose has been altered, cartilage has been removed and breathing maybe compromised. The revision rhinoplasty surgeon must carve out the normal structures which are usually encased in scar tissue. Rhinoplasty is acknowledged to be the most difficult operation on the face. Revision rhinoplasty is acknowledged to be more difficult than primary rhinoplasty. This means unfortunately the achievable goals are frequently reduced or limited.  Revision Rhinoplasty and primary Rhinoplasty are really two different operations that share the same name and location. It almost always takes longer for a revision rhinoplasty, there is usually more bleeding and more frequent need for additional grafting.

There is often a need to rebuild the underlying structures of the nose and therefore grafts (pieces of cartilage either from the nasal septum, ear or rib) are sometimes required. Some surgeons prefer to use implants (synthetic materials) for this purpose. Some of the more common materials used are gortex, medpore and hard silicone. Recently injectable fillers (Restylane®, Artecoll®, Radiesse®) have been used to fill in small defects remaining after rhinoplasty. Most surgeons prefer using the patient’s own cartilage; if it is available. There are however situations where an implant or injectable is the preferred option.

Patients are never happy about the prospect of further surgery. It is unexpected and unwanted. There is also the additional unplanned expense and usually this cost is greater than the initial surgery. Patients are always disappointed, sometimes angry at their first surgeon, sometimes depressed with themselves. Some patients want further surgery immediately, even before the swelling has resolved and the tissues have healed. Although this is understandable, it’s clearly not advisable. Others have waited years, even decades because of their initial experience was so psychologically traumatic. These patients are afraid of further failure and are cautious and careful. Sometimes they have lost trust in not just their former surgeon. At times people will travel long distances as they feel a larger city will have better doctors. They usually have tried to educate themselves regarding rhinoplasty and searched carefully for their surgeon. Their decision to proceed is usually made after long thought and deliberation.

Expectations are lower for further surgery. The best opportunity for the greatest improvement is the first time the nose is operated on. Success rates are less and the degree of improvement is reduced unfortunately with each additional surgery. The initial surgery has eliminated the clean surgical planes and introduced scaring. The need for grafting is common, natural tissues have been resected and are now missing, The surgical time is often greatly increased, the healing process is longer and the surgical maneuvers are more technically difficult. These are the main reasons for the lower degree of  success in revision rhinoplasty.

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