What is Revision Rhinoplasty
Revision rhinoplasty (sometimes called secondary or tertiary rhinoplasty) is a surgery designed to repair both form and function of a nose that has previously been operated on. Most commonly corrections are needed to because of poor techniques in the original surgery, poor or unexpected healing, complications, or misjudgment on the surgeon’s part. Revision surgery can be necessary to address cosmetic and appearance issues or functional problems that affect breathing. Revision rhinoplasty tends to be more complicated than primary rhinoplasty, or those procedures performed for the first time. For example, patients may need cartilage grafting to help recreate natural structures and create nasal shape and prior scar formation can make the operation technically more difficult. As such it requires a Board Certified Plastic Surgeon with extensive experience. Insurance companies do not usually cover revision rhinoplasty.
Revision Rhinoplasty – Diagnosis
Good candidates for revision rhinoplasty include physically healthy men and women who are realistic in their expectations and are unhappy with the results of a prior rhinoplasty procedure.
The first step in the revision nose surgery process is a consultation with your surgeon to discuss your past rhinoplasty procedure or procedures. It’s not uncommon for patients to have undergone several unsuccessful nasal surgeries from several different surgeons. You will be asked detailed questions about your concerns and goals. Common goals include:
- Correcting asymmetry or crookedness often from uneven post-operative scarring that distorts the shape of the nose.
- Smoothing out bumps or a dorsal hump that can appear up to 12 months after rhinoplasty. These can often be corrected with a minor procedure.
- Altering the tip and bridge of the nose. If too much cartilage was originally removed from the tip of the nose it can create a pinched appearance. Cartilage is typically added back to the nasal tip in a revision procedure. After a hump is reduced in the original procedure the middle section of the nose occasionally collapses inward which can be corrected with grafts. If not enough was removed just behind the tip of the nose a build-up of scar tissue can create a beak-like appearance.
Revision Rhinoplasty – Treatment
Once the incisions are made, the skin of the nose is separated from the underlying bone and cartilage. What occurs next will depend upon the particular case. The difference, in many cases, is the presence of scar tissue or the lack of cartilage and other structures. In the case of excess scarring, the surgeon may need to remove some of this tissue to ensure results are not distorted. For many revision patients, the surgeon rebuilds the structural framework of the nose because some of it was removed in the previous procedure. Cartilage may be harvested from the ear or ribs and grafts of fascia (fibrous, connective tissue) from the temple area to build the nose back up before readjusting the overlying tissues and skin. This ensures the nose remains strong and reduces any risk of collapse. However, in many cases of revision rhinoplasty, the surgeon is able to use residual nasal cartilages, including from the septum, even if the patient has had a previous septoplasty.
When the desired result is achieved, the skin is then re-draped over the new framework and the incisions are closed.
Revision rhinoplasty procedures tend to involve less pain and bruising than primary rhinoplasty. Any discomfort that patients do experience can be controlled with pain medication. Patients wear a nasal splint during the initial days of their recovery, and they are encouraged to sleep upright to minimize swelling. Patients usually do not require nasal packing, and any bruising should fade quickly. Each patient receives detailed aftercare instructions.