Revision Rhinoplasty Surgery

BENEFITS

The goal of revision or secondary rhinoplasty surgery is to correct the problems that appear following a previous rhinoplasty. Usually, the unintended outcomes are related partly to the nose appearance (contour and shape) and partly to the nose function (breathing difficulty).

The most common deformity across studies is polly beak, with other common deformities being saddling, mid nasal asymmetry, bossa and columellar retraction.

Other abnormalities that can be corrected by a second surgery are: over-reduction, under-reduction, and asymmetry.

Revision rhinoplasty is always more difficult and requires more surgical experience than the primary surgery, but does significant improvement and sometimes astonishing results can be achieved.

The psychological benefit is very important to pursue as well. An honest rapport needs to be established between surgeon and patient in order to avoid unrealistic expectations. The psychological relief sought by the patient after primary surgery should be the surgeon's concern as well.

PERFORMANCE

Many consider that revision rhinoplasty is more challenging to perform than primary rhinoplasty. This is because the initial nose anatomy has changed and complications or side effects have occurred including the build up of scar tissue etc.

Depending on the problems developed after rhinoplasty, on the patient's preferences and on the surgeon's recommendations there are various surgical techniques. This diversity is related both to the repair procedure and to the types of implant material for grafting.

Generally speaking, revision rhinoplasty deals with adjusting the cartilage or bone tissues trying to achieve what was not in the first rhinoplasty.

If the complications are more serious, a small incision sometimes needs to be made on the column of the skin (on the underneath surface of the nose) between the nostrils. This incision heals very well and is hardly visible.

If the base of the nose is too wide, it is narrowed by making incisions in the creases on both sides where the nostrils and cheeks join. The resulting scars are concealed in the creases.

Usually, the patient's own tissues are used to rebuild the nasal framework. These grafts may be harvested from septal, ear or rib cartilage, depending on what nasal part needs to be reconstructed. For example, if the bridge has to be rebuilt, rib cartilage is used often.

Generally, packing the nose is avoided. Instead, most surgeons use small soft plastic splints which have a built-in airway to support the nose structure. However, if packing is needed, the best type is the dissolving one that does not have to be removed.

The nose revision surgery is performed under a general anesthetic. This allows the anaesthetist to have complete control of the airway and keep any drainage from getting into your lungs.

RISKS

First, patients should be aware of the complications associated with primary rhinoplasty. This will help them better understand what can be corrected with the secondary surgery.

Generally, there are two basic types of complications: functional (related to breathing) and aesthetic (related to appearance).

Please see below a list of the risks that may appear after revision rhinoplasty.

Most of them are common with those developed after primary rhinoplasty, but occur much more rarely.

These problems that may arise are much the same as with any rhinoplasty surgery.

Infection

It happens in less than one percent of the cases. If the patient experiences pain or redness following the surgery, the surgeon should be notified immediately. However, after the operation, the patient is given antibiotics in order to heal this.

Bleeding and haematoma

This occurs usually immediately after the operation and is expected to stop in a few hours. This is normal bleeding. However, a blood clot (known as a haematoma) may accumulate under the skin or between the skin and cartilage. A return visit to the surgery is necessary then. If the patient experiences serious pain after the surgery, the surgeon should be notified as soon as possible.

Eye injury

This may occur because of the damage to the tear drainage apparatus during the operation performance. Eye injury can be avoided by carefully protecting the eyes during the surgery.

Asymmetry

Since the operation is performed on both nasal sides ( a left and a right side), the surgeon must pay great attention to symmetry. For example, asymmetries can be caused surgically by unequal treatment of the lower tip cartilages or by unequal scarring.

Skin problems

This complication is minor and temporary. The skin may be affected by the tape that is applied to the nose beneath the splint. Pustules or allergic dermatitis may occur, but can be treated.

Broken capillaries

This condition may already exist on the nose and can be treated with laser.

Scarring

The small incisions on the columella and nostrils will heal very well, so the scars will be hardly visible. They are almost unnoticeable after one month.

Bone irregularities

These may occur because of the nasal bone reshaping. If they are only palpable and not visible, then they can be disregarded. However, another minor procedure can be performed to solve this problem. It is recommended to wait at least one year.

Decreased sense of smell

This is rather a theoretical possibility and may be a potential source of irritation.

Questions

For the first consultation with the surgeon, the patient is advised to prepare a set of questions that might help them better understand the benefits, risks and performance of the procedure.

For the first consultation with the surgeon, you are advised to prepare a set of questions that might help you better understand the benefits, risks and performance of the procedure.

• How can over resection cause a droopy nose in some cases and an over shortened nose in others?
• If you need to use implant materials to rebuild the nasal framework, what kind of materials are used in revision rhinoplasty?
• If the skin is very thin, do you take any special measures?
• What is a polly beak?
• What is the meaning of "bossae" and how can it be treated?
• What are the alternatives to using the patient's own tissues for reconstruction?
• If you need to take ear cartilage, can the hearing be affected?
• I have little pointy knobs on my nasal tip. What are they, and can they be fixed?
• The insides of my nostrils show too much now, and it looks unattractive. What caused this, and can you fix it?
• I have small irregular bumps on my nose since my rhinoplasty. What are they, and can you fix them?
• Can persistent deviation of the nose be fixed?
• I am still dissatisfied with the outcome of the secondary rhinoplasty. Can a tertiary operation be performed?