Revision rhinoplasty involves several factors to ensure a successful outcome and overall satisfaction. It’s important to note that revision rhinoplasty might not always achieve the desired results, and some patients may require additional surgeries.
While most patients only undergo rhinoplasty once, there are instances where a touch-up or revision surgery is necessary. Some patients may experience functional issues with breathing or the sinuses, while others seek revision rhinoplasty to improve the appearance of their nose. Some may need both functional and cosmetic improvements.
Primary rhinoplasty is already a complex procedure for plastic surgeons due to the intricate structure of the nose, which includes skin, cartilage, bone, and mucosa, all of which significantly impact one’s appearance and sinus function. There isn’t a one-size-fits-all method or technique to address the various aspects of the nose.
Revision rhinoplasty is even more challenging. Modified tissues and existing scar tissue can affect the outcomes, making final results more variable.
If you haven’t already, please read Part 1 of Factors to Consider in Revision Rhinoplasty.
Timing of Surgery
It is generally recommended to wait at least a year after the initial rhinoplasty before considering revision surgery. The “final” healing for all plastic surgery, face or nose, takes about a year. This allows sufficient time for the tissue to fully heal and for the final results of the first surgery to become apparent. Nose swelling, especially the tip, normally takes a long time to resolve. Depending on each case, some plastic surgeons waiting even longer for revision surgery.
Read more about rhinoplasty swelling.
Condition of Skin and Cartilage
The quality and condition of the nasal skin and underlying tissues can significantly impact the success of revision surgery. Existing nasal cartilage was likely reduced or modified from prior surgery.
Scar tissue from the previous surgery makes the procedure more complex, and the surgeon needs to assess the skin’s elasticity and overall health. Patients with thicker skin tend to create more scar tissue, while those with thinner skin tend to have more irregularities of the tip and bridge.
Surgical Technique and Approach
The specific surgical techniques and approaches used in revision rhinoplasty can differ from those in the primary procedure. Discussing these with the surgeon, including whether an open or closed approach will be used, can help in understanding the intricacies involved and the potential for achieving the desired results. Generally, many plastic surgeons perform revision nose surgery via an open approach and make an incision between the nostrils.
Dr. Chaboki specializes in closed rhinoplasty, including revision cases, and avoids making external scars if possible.
Use of Grafts
In many revision rhinoplasty cases, cartilage grafts from the ear, rib, or septum may be required to provide structural support or to rebuild areas of the nose. Understanding the need for and implications of grafts is an important part of pre-surgical planning. Cartilage from the septum may not be available for revision surgery due to it being used from the first operation. As a result, some revision cases may elect to use cadaveric or donor rib cartilage.
Recovery Process
The recovery from revision rhinoplasty may be more extended and complex than the initial surgery. Knowing the expected recovery timeline, potential for swelling and bruising, and post-operative care requirements can help in preparing adequately for the period following surgery.
Potential Risks and Complications
Revision rhinoplasty carries its own set of risks, including infection, bleeding, poor wound healing, nasal congestion, and the possibility of dissatisfaction with the results. In addition, risks such as saddle nose deformity and septal perforation are higher in revision cases. Discussing these risks thoroughly with the rhinoplasty surgeon and understanding the steps taken to mitigate them is crucial.
Consultation and Second Opinions
Seeking consultations with multiple surgeons can provide different perspectives and approaches to addressing the issues from the first surgery. This can be invaluable in making an informed decision and choosing the best surgeon for the revision procedure.
Non-Surgical Alternatives
In some cases, non-surgical options might be considered to address minor aesthetic concerns. Minor tweaks may be performed in the office via local anesthesia. Steroid injections can help reduce scar tissue. Dermal fillers can help contour the nose. Understanding the scope and limitations of non-surgical alternatives can help in making a well-rounded decision.
Read more about nonsurgical rhinoplasty.
By carefully evaluating these additional factors, one considering revision rhinoplasty can better prepare for the procedure and increase the likelihood of a successful outcome. Are you considering revision rhinoplasty? Contact us to schedule a consultation.
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