Revision Rhinoplasty
Rhinoplasty, also known as nose job or nasal reconstruction, is a plastic surgical operation used to reshape and reconstruct the nose.
For a variety of reasons, most plastic surgeons think that rhinoplasty is one of the most complex cosmetic (aesthetic) plastic surgery operations.
- The nose is a complicated structure that sits prominently in the center of one’s face.
- Expert rhinoplasty necessitates treating nasal abnormalities while maintaining maximum nasal function. It is impossible to make a nose seem beautiful without addressing nasal airway function.
Revision rhinoplasty is a surgery performed on a nose that has already undergone surgical alterations. It is a procedure that entails surgically reshaping the nose as well as adjustments to the interior and exterior components in order to enhance the look and function of the nose.
Despite the best efforts of doctors, revision rhinoplasty has a greater revision rate than original rhinoplasty (no prior nasal surgery). Statistics vary, but it is estimated that around 15% of original rhinoplasty procedures require revisions for one cause or another.
Patients should be aware of this since no ethical plastic surgeon can guarantee the success of revision rhinoplasty or any other cosmetic plastic surgery operation.
Patients who want to get a revision rhinoplasty should wait until they have totally healed from their previous rhinoplasty. It is suggested that a patient wait at least a year after their prior operation. Returning for surgery too soon may result in further, more significant nose damage that is difficult to repair.
Why people seek Revision Rhinoplasty?
- Patients who have undergone previous procedures with poor results may need revision surgery.
- You may dislike the appearance of your nose and believe that more should have been done. This may occur frequently as a result of a breakdown in communication with your original surgeon.
- Some patients may experience nasal drooping, hooded nasal tip, nasal bone abnormalities, nasal asymmetry, infections, and excessive scar tissue formation as a result of their initial operation.
- Patients who have had implants inserted may get draining infections that are resistant to medications.
- At times, patients may have difficulties breathing. This might be due to internal nose weakness, asymmetrical nose settling, or excessive scar development from the initial operation. In such circumstances, the interior anatomy of the nose must be restructured and restored.
- Finally, people who have had nasal surgery more than ten years ago may experience subsequent weakening and abnormalities in nasal architecture that worsen as they age.
A retrospective study of primary (308 surgeries) versus revision (92 operations) rhinoplasty procedures revealed that the most prevalent problems for patients undergoing primary rhinoplasty were a dorsal hump (50 percent), a big nose (44 percent), a bulbous tip (44 percent), and nasal blockage (33 percent).
On the other hand, patients undergoing revision rhinoplasty, complain of persisting deviation (38%), nasal blockage (36%), bulbous tip (33%), and big nose (25 percent).
Tip asymmetry (22%) increased dramatically in revision procedures compared to first surgery, as did dorsal sloop (11%), large nostrils (19%), columellar show (11%), and alar retraction (4%). Prior rhinoplasty stigmata leading to unnatural outcomes, such as those stated previously, were frequently identified as causes for revision surgery.
Why Revision Rhinoplasty is difficult?
Rhinoplasties are among the most challenging cases that aesthetic plastic surgeons encounter for a variety of reasons, including:
- Patients are frequently dissatisfied with their previous surgery and may be unaware that further rhinoplasty may not be helpful in totally repairing cosmetic defects that were not repaired in the previous surgery or developed as a result of the operation.
- Scar tissue from previous rhinoplasty is frequently a concern in revision patients and can affect the ultimate result since it can return even after successful revision rhinoplasty.
- In revision rhinoplasty, cartilage is frequently used to repair damaged and/or inadequate cartilage removed during the previous procedure.
Because the nose has been affected by previous operations, the inside and exterior structures of the nose are frequently different. Parts of the nose may be absent or distorted in size or form.
Because of this disparity in anatomy, the surgeon must be able to replace, reshape, and reconstruct the nose in order to restore healthy anatomy, function, and cosmetics. Surgeons must often have the necessary experience and skill sets to reconstruct a nose. Such abilities include the utilization of rib and ear grafting, as well as free grafting, to integrate into the new nose. Surgeons must also be experienced in the art of local and regional reconstruction, depending on patient’s major complaint.
Preoperative assessment of patients for Revision Rhinoplasty
Every rhinoplasty surgery is conducted with the goal of enhancing the look and nose breathing and obtaining a desirable result.
Preoperatively analyzing a nose to avoid the need for revision necessitates a thorough study of the anatomy.
Surgical techniques should be designed to accomplish the intended benefits in a long-lasting manner that will be satisfying during the long healing phase and for many years after the first operation.
Surgeons should keep in mind that the subcutaneous fat of the nose thins with age, and grafts implanted in a teenager’s nose may show up in later adulthood.
Modern rhinoplasty procedures have turned away from reduction rhinoplasty and toward reshaping and supporting the nose. In reduction rhinoplasty, compromised cartilages collapse and twist under the powerful forces of scar contraction, possibly decades later; giving the nose an unpleasant external look and limiting respiration over time.
Support is especially crucial in revision rhinoplasty because of the presence of significant scar contractions. Experience will aid the rhinoplasty surgeon in making intraoperative judgments about the size and form of cartilages and grafts that will offer the desired result.
A recent retrospective study of an established rhinoplasty practice listed the risk factors for postoperative dissatisfaction and the need for revision rhinoplasty. Dissatisfaction was increased by:
- Postoperative complications.
- A history of nasal fracture.
- Lack of anatomic association.
Postoperative infections, dislodged nasal stents or casts, and scarring hampered recovery and worsened patients’ prognosis. Traumatic crooked noses are well known as a technically difficult rhinoplasty group.
To perform a successful surgery, the surgeon must first understand why patients desire revision. Specific nose changes, as well as issues with nasal blockage and nasal breathing, should be highlighted. Accurate and transparent communication will aid in the definition of the operational aim. Communication is essential for both the doctor and the patient to have a positive outcome. It is crucial to remember that patients and surgeons frequently differ in their assessment of the nose.
Studies have demonstrated that rhinoplasty surgeons will notice many more defects than people do; rhinoplasty specialists are trained to examine noses closely. In recent research, the surgeon discovered almost 40% more nasal abnormalities than the patients.
The surgeon must recognize the patients’ concerns and prioritize addressing them. Gaining the patients’ confidence requires the physician to understand their worries and expectations and to present realistic outcomes.
The use of a mirror or photography to evaluate the nose jointly enhances communication. your doctor may consider employing 2-dimensional or 3-dimensional computer simulations to better communication.
The anatomy of the individual nose and face may have restrictions that exclude a certain result. Each patient has a distinct face structure and nose, as well as characteristics such as cartilage contour, strength, and skin thickness and quality. Each feature has advantages and disadvantages that will necessitate distinct surgical approaches.
Patients with thick skin, for example, who require more grafting and more projection to enhance the shape, are generally hesitant to select this option for fear of having a large nose.
Preparing for Revision Rhinoplasty
Preparing for revision surgery necessitates a thorough assessment and the creation of a conceptual surgical plan. Surgeons should take the time to evaluate the images and design a strategy after discussing them with patients and examining historical photographs and surgical records.
In revision surgery, the options vary from less invasive filler augmentation for modest contour depressions to more substantial repair including rib cartilage transplantation.
When scheduling a revision surgery, keep in mind that a revision case will take longer than a primary case. Revision operations are sometimes more complicated because of the scar tissue and alterations to the anatomic components of the nose.
Nasal bones and cartilages are frequently folded, weak, deformed, or missing. The doctor must be prepared to spend the time necessary in surgery to repair and improve the nose’s complicated architecture. Commonly, septal cartilage and even auricular cartilage may be depleted. Autologous costal cartilage can be considered.
Consultation