Revision rhinoplasty – Dr Roth explains what is involved.
Why would I consider a revision rhinoplasty procedure?
Rhinoplasty surgery is often considered the most complicated cosmetic procedure and also the most complicated nose and sinus procedure. Often despite our best planning, rhinoplasty surgical techniques and post-operative care, over time things do not end up how we expect them. Even when surgery is performed in the best of hands, revision rhinoplasty is sometimes necessary.
Common reasons for revision rhinoplasty are
- Difficulty breathing on one or both sides
- A crooked nose
- A dorsum that has dropped too much and the nose is now too “scoopy”
- A dorsum that sites too high just above the tip
- Irregularities in the cartilage or bone can be seen or felt through the skin
- The original cosmetic concerns (e.g. hump, size of the tip, width of the nose) or functional concerns (e.g. breathing problems) were not all addressed adequately
Why is revision rhinoplasty more difficult than primary rhinoplasty?
Revision rhinoplasty requires a detailed knowledge of advanced reconstructive rhinoplasty techniques that are often not needed in primary rhinoplasty.
After a rhinoplasty procedure the natural tissue planes heal with scar tissue and can no longer be opened up in the usual manner. Dissection has to proceed more slowly and is more difficult. Commonly the first rhinoplasty disrupts the natural supports of the nose which then need to be reconstructed. The usual first source of cartilage for reconstructive rhinoplasty grafting is the nasal septum. In many patients this cartilage has already been used or removed in the first surgery and cartilage needs to be harvested from the ears or rib.
Revision rhinoplasty requires a detailed knowledge of advanced reconstructive rhinoplasty techniques that are often not needed or used in primary rhinoplasty. A whole different cookbook of techniques are needed to address some of the issues that can be encountered and to correct them.
What are the important things to cover in a revision rhinoplasty consultation?
It important to think carefully about how you would like your nose to look and function and have a very clear idea of this. Look at your nose carefully in the mirror and try and identify the specific things that you are not happy with. Although it can be helpful to bring in some photographs of other peoples noses that you like the most important thing is to have clear ideas about your own nose. It may be helpful to bring in some photos from before the first rhinoplasty procedure. If you can identify specific issues that require your surgeon’s attention you are much more likely to achieve and be happy with the final outcome.
If you have breathing problems or have started to develop sinus issues it is important to cover these. Image morphing can be helpful in revision rhinoplasty planning.
Depending on your skin type, anatomy, and overall shape of your face there can be limitations as to what rhinoplasty can achieve and these limitations should be discussed.
You should feel confident that you are with a rhinoplasty expert and that you have clearly defined a shared goal with your rhinoplasty surgeon.
How likely is a revision rhinoplasty procedure to address all my concerns?
Even small problems can sometimes be challenging to correct in a revision rhinoplasty procedure. Surgeons across the world typically report revision rhinoplasty procedures on average are revised again with a further procedure in about 1 in 5 cases. It is possible that your nose will look and function better after your revision procedure but it may not be perfect.
Will a revision rhinoplasty always be done through an open approach? Or can it be addressed through a closed approach?
Sometimes it can be preferable to perform a revision rhinoplasty through closed approach rhinoplasty incisions. This means that a columellar incision does not need to be made. Smoothening bumps on the dorsum or making small changes to the tip and lower lateral cartilages can often be approached in this way. Crooked noses may able to be corrected in this manner as well.
More extensive revision rhinoplasty problems that require the carving and placement of cartilage grafts to reshape or strengthen the nose typically require an open approach rhinoplasty procedure.
When can I have a revision rhinoplasty?
After a rhinoplasty there is significant swelling of the nose for 3 to 12 months. Around 75% of the swelling will be resolved by 3 months. The nasal tip takes the longest for the swelling to resolve. There may be some movement of the nostrils and tip position during the first year as swelling settles.
Generally it is prudent to wait 12 months before undertaking a revision procedure. If there is a major problem, an earlier revision may be considered.
How do I choose a revision rhinoplasty surgeon?
Research your surgeon carefully. You should choose a surgeon who specialises in revision rhinoplasty. Ideally you want your revision rhinoplasty procedure to be the last operation you need on your nose rather than the first of a series of surgeries.
Why are the costs of revision rhinoplasty typically higher than a primary rhinoplasty?
Revision rhinoplasty takes more planning before surgery and typically takes much longer to perform the surgery. Patients are often much more demanding than primary rhinoplasty patients and pre-operative and post-operative consultations tend to be longer. This is understandable as they often had a somewhat traumatic experience the first time around. All these factors are taken into account when calculating the overall cost of a revision rhinoplasty procedure.