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Revision (Secondary) Rhinoplasty

Primary Rhinoplasty offers the surgeon a unique opportunity to manipulate undisturbed tissue planes and native anatomy to produce a result that meets both aesthetic and functional goals. It is during the first nasal surgery that the opportunity to achieve the best results exists.

Failed Rhinoplasty can be devastating and can have a sever emotional impact Rather than gaining a long-awaited nasal enhancement, the patient is left with a disappointing and unfamiliar facial appearance. The resulting impact upon self-confidence can vary, but for some, embarrassment, lack of self esteem and depression can affect nearly every facet of life.

Although the causes of a failed Rhinoplasty are many, including non-compliance on behalf of the patient, not following post operative instruction or not coming for follow-up appointments. Other causes of unsatisfactory results are — post operative complications like infection, hematoma formation and trauma to the operated nose.

In my practice — 50% of the patients already had one go with the nose and came for revision surgery. Nasal obstruction, dorsal irregularities, poly beak deformity, columellar deformities, tip irregularity and Nasal obstruction are common problems

The trouble with Silicone

Use of artificial material like Silicone — the initial operation is simple as it requires just insertion of an implant results can be done in half an hour’s time as day surgery, immediate results are very good a happy patient but in most cases it leads to severe complications later which can happen months or even years after the operation.

One of the most devastating causes is technical incompetence

Rhinoplasty is a difficult operation and few people master it, while otherwise excellent cosmetic surgeon operates all surgeries from head to toe and also do occasional Rhinoplasties, they do not wish to leave any patients and the results are devastating

Beware The ‘Two Team’ Approach

There is a special problem in countries like India where 2 surgeons join hands to do a Rhinoplasty, especially in cases of a crooked Nose with breathing problems — where typically one surgeon is called to do a septum surgery for functional region and the other surgeon do the aesthetic part.

This is a perfect recipe for disaster, as Rhinoplasty surgery is one surgery where aesthetic and function are interlinked and the surgeon should be competent to deal with both by himself.

It may not be a good idea to have a Nose Job from the cheapest surgeon

You might end up having to pay a lot more for it later. Substandard surgery can produce an unnatural and awkward appearance that is decidedly less attractive than the original (birth) nose.

Revision Surgery

The medical and artistic challenge in a damaged nose may appear deceptively simple, is considerable — typically far more complex than the initial Rhinoplasty. Remember first chance is the best chance and every revision surgery is a compromise. It’s like the difference between making a new house and repairing a damaged house.

It requires correction of the thin and delicate skeletal components of must be precisely recreated to strengthen or replace shredded, collapsed, twisted (or even absent) skeletal remnants, while the outer contour must be smooth and attractive, the air passages must also remain large enough to facilitate comfortable nasal airflow.

It requires considerable experience in Revision surgery and you must be careful in your choice of the surgeon.

Several important differences between primary (first-time) Rhinoplasty and revision are worth noting. First, revision Rhinoplasty takes far more time. Because of the obstacles posed by scar tissue and the increase complexity of surgery, revision cases require at least 3–4 hours or more of total operative time.

By the same token, the more difficult dissection, the greater length of surgery, and the presence of pre-existing tissue damage also equate to a much longer period of recovery. Patients with thin healthy skin may require 6–12 months, whereas patients with thick scar-prone skin may require up to two years for all manifestations of inflammation to resolve.

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