What is a revision rhinoplasty?
Revision rhinoplasty is a surgical technique that can modify the nose of a person who has already undergone primary rhinoplasty.
It can be proposed to correct the unsatisfactory results of a rhinoplasty. It can also be used to improve already satisfactory results.
On this site, we will discuss the different aspects of revision rhinoplasty, including the reasons why it is performed, the different techniques used, the possible risks and benefits, and the information needed to prepare for the operation.
Below, you will find the most common indications for secondary rhinoplasty.
The attached photos were published with the kind consent of the patients to illustrate the different situations.
Their reproduction and use is strictly prohibited.
FUNCTIONAL PROBLEMS :
Nasal obstruction may be related to a deviated septum which was not treated during the first operation, or which was highlighted following a reduction in the size of the nose. In this case, it is quite possible to rework the partition in order to keep it straight. On the other hand, a first rhinoplasty is generally not responsible for smell disorders.
Some patients evoke an impression of a runny nose that seems to have appeared following the first operation. This is classic but the explanations are not clear insofar as the mucosa is not modified. Exceptionally, it is possible to feel pain related to too much refinement of the "soft parts" ensuring the interface between the skin and a too prominent nasal structure, especially when wearing glasses. This is treated by grating the structure and restoring the missing interface with a graft.
Cartilage grafts are usually taken from the nasal septum (the septum). As part of a secondary rhinoplasty, it is common for the partition to be deficient, so it may be necessary to remove cartilage from the ears (the concha) or the ribs.
The concha is the cartilage located behind the ear. The harvesting does not change the shape of the ear if it is done according to the rules of the art. It is a graft that is easy to take and causes little pain. Its disadvantage is its thickness and lack of rigidity, which makes it not useful for a tip reconstruction.
Rib cartilage is the graft of choice in multi-operated patients. It is usual to remove one or two pieces of rib by making a small incision under the breast on the right. This results in a scar that is usually very inconspicuous. The pain is moderate for 10 days. The rib cartilage makes it possible to obtain a large quantity of grafts of very good quality. Its main drawback is that it can twist slightly over time.
MOST FREQUENTLY ENCOUNTERED AESTHETIC PROBLEMS IN SECONDARY RHINOPLASTY
RESIDUAL DEVIATION OF THE NOSE
Deviations are treated by repeating the bone section traces, in particular with an ultrasonic rhinoscupture tool. The noses which present a residual deviation frequently have a high deviation of the septum which will have to be treated.
BACK SCAR RELATED TO SKIN SUFFERING
In these cases, it is not possible to make the scar disappear without creating others. On the other hand, a "lipostructure" fat graft can improve it. In addition, reducing the size of the nose makes the scar less obvious.
ENLARGED NASAL BONES
In these cases, it is advisable to repeat the bone cuts to refine the structure. In addition, it is possible to reduce the excess bone by "rhinosculpting" it with ultrasound or with a rotary bur.
OVER PINCHED NASAL BONES
In these cases, two alternatives are possible: it is possible to repeat the bone cuts "osteotomies", spread the bones and then insert a wedge (usually with a cartilage graft). The other alternative, simpler, but just as effective, is to inject diced cartilage into the depression areas.
The inverted V is the most classic sign after rhinoplasty, making it possible to recognize at a glance a patient who has already had surgery. He can be seen 6 to 9 months after a first rhinoplasty. The inverted V corresponds to a fall of the upper lateral cartilages, appearing in rhinoplasties with significant dorsal reduction without reconstruction of the middle third by "spreader grafts or flaps". This aspect is treated by placing cartilage grafts under the upper lateral ones.
POLLY BEAK DEFORMITY
The so-called Polly Beak deformity aspect corresponds to a profile view between the tip and the back of the nose. This aspect is generally linked to the conjunction of two factors: insufficient resection of the nasal septum (this is why the corbin is hard on palpation and moves with the septum) and fall of the tip linked to an insufficiency of structure. This is treated by reducing the bulk partition and strengthening the tip. More rarely, Corbin is linked to an accumulation of fibrosis. In this more delicate case, fibrosis can be reduced during revision surgery.
The saddle nose is the aspect observed when the nasal septum has collapsed and takes away the lower part of the dorsum. This is the reverse of the Polly Beak and is frequently associated with respiratory disorders. This aspect is treated by reconstructing the nasal septum, most often with a costal cartilage graft.
HARMONIOUS BUT TOO BIG NOSE
In these situations, the first rhinoplasty was well performed but the nose was still deemed too large by the patient. This is a very delicate situation because the benefit/risk balance is not necessarily in favor of a new intervention.
Dorsal cyst in rhinoplasty
In this situation, there is a soft pocket on the back of the nose, variable in volume depending on the day. This complication, rare but classic, is related to the placement of a graft containing a small fragment of mucosa, which will systematically turn into a cyst. This cyst must be completely removed during revision surgery.
EXCESS RESECTION OF TIP CARTILAGES
The cartilages of the tip are frequently reduced during a first rhinoplasty. If done excessively, especially on weak cartilages, it can lead to drooping of the tip, as well as retraction of the wings of the nose. This condition is treated by reconstruction and/or reinforcement of the cartilage, by cartilage grafts. This is a particularly difficult technique that must only be performed by a trained surgeon.
TIP CARTILAGE MALPOSITION
The cartilages of the tip are frequently worked and modified by sutures during a first rhinoplasty. If done improperly, it can lead to malposition of the tip, as in the attached photo. In this case, it is necessary to undo the sutures, reinforce the cartilage with grafts and replace the tip in the correct position. This is a particularly difficult technique that should only be performed by a trained surgeon.
SUBCUTANEOUS TISSUE SUFFERING
This aspect is observed after several rhinoplasties, especially if there has been a very strong subcutaneous degreasing. In these particularly complex situations, it is common to offer fat injections (lipostructure) and sometimes hyperbaric chamber sessions. In some cases, the benefit / risk balance does not allow us to consider a new intervention.
COMPLICATIONS AFTER SETTING UP IMPLANTS
Silicone, Medpor or Goretex implants are often offered to recreate a nasal bridge. These implants cause frequent complications such as infection and rejection that cause unsightly scars at the tip. Surgical recovery is subsequently a great difficulty. The ideal is to remove the implant before it becomes infected and replace it with a cartilage graft.
Am I a good candidate for surgery?
The best candidates for secondary rhinoplasty are people who are emotionally and physically healthy and realistic about the potential for improvement. A person with a secondary nasal problem should seek improvement, not perfection.
Depending on the type of deformity, nasal form or function may or may not be completely improved. Deciding to have secondary nasal surgery should not be an impulsive decision, but rather a well-considered decision. That's why it's important to be realistic, be informed, and be true to yourself about what's really bothering you about your results.