A rhinoplasty has one of the highest levels of difficulty in the world of cosmetic surgeries. It is a challenging facial procedure that calls for a highly customized approach that includes several consultations and close attention to how the nose fits with the face as a whole. Proper functionality of the nose is extremely important as well as it is where oxygen comes into the body and its proximity to the brain.
If the first surgery is not performed properly, it can result in undesirable characteristics related to cosmetic appearance or physical functionality such as problems breathing, chronic inflammation, or unresolved drainage.
In all of these types of cases and others, a revision rhinoplasty may be needed to correct the primary surgery. Working closely with your doctor and consulting other professionals will help you assess the situation and make an educated decision if needed.
What is Involved in a Revision Rhinoplasty?
Revisions to any surgery are complex, but the nose has an added level of challenging factors. This particular nose surgery is done under general anesthesia, but can also be performed under local anesthesia or sedation depending on the patient’s circumstances. In almost every case, revision rhinoplasty is performed as an open procedure, which allows the medical team to access delicate tissue. The bones and cartilage that compose the cosmetic structure of the nose have to be treated extremely carefully because they are hard to regain.
The procedure requires a small incision on the outer part of the nose to allow the skin to be lifted but can heal without much scarring, hidden in the contour of the nose. This makes this type of surgery one that does not leave visible scars.
In other simpler cases of a rhinoplasty revision, the surgeon may remove cartilage or other tissue that was not completely removed during the original procedure. There are also cases where a deviated nasal bridge has to be straightened by a controlled fracture to the bone.
In complex cases where the patient lost too much structure in the first surgery, complete construction of the nose may be necessary. This is done by inserting a cartilage or bone graft taken from the ribs, ear, or temple. The patient must be in excellent health to avoid complications.
Some circumstances don’t allow a revision to happen so easily or at all. Such as when scar tissue develops from the first surgery or the skin of the nose is insufficient to work with. Cases such as these require careful consideration by a team of professionals that have a long history of complex cases involving the nasal structure.
Revisions without grafts may last approximately one to three hours in the operation room. The patient usually goes home the same day and can expect a similar recovery as the primary surgery.
What Are Common Reasons for a Revision Rhinoplasty
Sometimes the appearance of the nose is the problem, but for others breathing problems have to be corrected. Either one is very important to correct. Here are some reason why a revision surgery may be necessary:
- Change the size.
- Modify the nose’s angle.
- Straighten the bridge.
- Reshape the tip of the nose.
- Change the structure of the nostrils.
In due time, after you heal completely and your nose has time to settle, you must examine your initial results well and try to detect any mistakes your doctor may have done. You don’t want to just go back to the same doctor for a revision. The surgeon that performs the revision must be highly skilled as it is a more complex procedure than the first one.
Why is a Revision Rhinoplasty a Difficult Surgery?
There are many reasons why revision rhinoplasty is more challenging than the first procedure. The primary reason is that the structure inside the nose has already been restructured. Before any surgeries, the nose has layers of tissue that the doctor can easily separate during the first rhinoplasty and access different structures. This is not the case for the revision procedures that follow. After the first procedure, these layered structures no longer exist making the surgery much more difficult. This is because the skin is now glued to cartilage and bone.
Other Difficult Scenarios
Some patients experience difficult rhinoplasty circumstances such as a nose that has been overworked. For instance, if too much cartilage is removed or the nose healed improperly, it will result in an obviously “operated-on” appearance.
Other cases result in a misshaped nose because too much cartilage is taken off, the nose is too pinched, it is left too long or too short, and other complications. The solution is to take grafts from other parts of the body and literally rebuild the nasal structure.
It is difficult to know the results of a plastic surgery procedure until all healing is complete. The surgeon, depending on skill, can guess what the nose will look like, which is why it is so important to choose a doctor with vast experience performing revision rhinoplasties.
As the nose heals during the postoperative phase, some changes in the structure of the nose can result. A common problem is known as “dropped tip” characterized by a rounded tip that looks like a bump from the profile view. In most cases, this problem can be avoided if the physician anticipates this drop and adjusts accordingly. Other instances are due because the cartilage is not strong enough to keep the tip in place.
How to Achieve the Best Results
A rhinoplasty revision is a very challenging operation that requires a surgeon that has the creativity and skills to anticipate possible outcomes. The doctor has to know exactly what the consequence will be at each step of the procedure and how to maneuver unexpected events on the operation table.
Find a surgeon that specializes in complex reconstruction procedures. They are more likely to navigate through a difficult situation and have a better probability of achieving the desired outcome.
