- Results of the Revision Rhinoplasty
Reasons for Revision Rhinoplasty
Nose plays a very significant role in beauty and harmony of the face. In this regard, a failed rhinoplasty emotional impact upon a patience can be devastating in some cases. Rather than coming to see themselves with a long-awaited nasal improvement, the patient may come to be left with a disappointing and unfamiliar facial appearance. In addition, nose has other important elements with significant roles that may be damaged during the first Rhino-plastic surgery. This accordingly, leads to nasal tissues destabilization which often results in further deformity via a slowly progressive distortion of the nasal skeleton, usually with a corresponding nasal function deterioration. In these cases, revision rhinoplasty will be needed.
The principles of secondary rhinoplasty are very much the same as those in the primary rhinoplasty situation. It is important to consider nasal balance, function, deformities of cartilage and bone, areas that need additional support or reshaping, and to devise a safe plan that satisfies, to the greatest degree possible, the patient’s aesthetic goals.
Revision Rhinoplasty Candidates
If you have or are experiencing one or more of the following symptoms you be suggested to have a revision rhinoplasty:
- Restricted breathing, nasal obstruction or a functional problem following your initial rhinoplasty
- An injury to the nose sustained during the surgical recovery period
- Dissatisfaction with the final appearance of your nose after it has healed
How long after the first surgery can a revision be done?
Wait at least one year before considering revision rhinoplasty. While some of the nasal swelling goes down almost immediately, it can take a year for all the swelling to subside. Most surgeons believe a minor amount of swelling lasts even longer. It also takes at least a year for scar tissue to soften, and a firm scar can prevent your surgeon from making an adequate correction. If you go back for a revision rhinoplasty too soon, you can turn a minor problem into a major disaster; so be patient.
Procedure and Potential Challenges
During revision nose surgery, the aim is to restore both structure and function. In some cases, a surgeon may try to recreate symmetry by adding back or taking away cartilage. If needed, extra cartilage can be taken from the nasal septum, your ear or one of your ribs. Newer pre-shaped implant materials like Medpor are virtually immune to resorption or warping and can be precision carved for a custom fit. In general, it is easier to fix problems when not enough cartilage was removed during the primary surgery, because your surgeon can go back and take away more cartilage. More often, however, revision rhinoplasty involves adding cartilage to open the airway or to recreate shape and proportion.
The incisions for revision rhinoplasty can be made on the inside of the nose (closed rhinoplasty), or on the underside of the nose between the nostrils (open rhinoplasty). Closed rhinoplasty has the advantages of being less traumatic and invasive to the tissues because the surgeon only uncovers the areas that need correction, whereas the open approach involves a wider dissection and more disconnection and reconnection of supporting structures. The closed approach may be safer if you have scarring from earlier nose surgeries, but some surgeons prefer the open approach for the exposure that it provides, or to better understand and visualize complicated cases.
Revision rhinoplasty is more challenging than primary rhinoplasty. Nasal lining that has undergone surgery is now subject to scar tissue, which also increases the complexity of revision surgery. Therefore, amount of surgical time required to perform revision rhinoplasty typically is longer than primary rhinoplasty.
One risk of primary rhinoplasty is the appearance of telangectasias – little spider like veins that are typically present prior to surgery but become more noticeable after rhinoplasty. This is not commonly an issue and the overall improvements far outweigh the appearance of these. However, in revision rhinoplasty, the appearance of telangectasias can be more pronounced. This point should be discussed prior to revision surgery so your doctor can provide his opinion depending on your individual skin type, texture and thickness.
Revision Rhinoplasty Recovery Timeline
No two patients will heal at exactly the same rate, as each body is unique and will respond to the surgery in different ways. As such there is no definitive revision rhinoplasty recovery timeline. Here are a few additional guidelines to help you achieve the best results and a rapid recovery:
- Stick with a healthy diet by eating the right foods and drinking plenty of water.
- Do not smoke. If you do, quit as quickly as possible.
- Avoid taking Advil, Aspirin and Motrin for two weeks prior to surgery. Be sure to discuss any vitamins, minerals, supplements and medications with your surgeon before surgery.
But on average, 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.
Taken as a whole, revision rhinoplasty is a fiendishly complex endeavor with numerous potential risks and pitfalls. Obtaining suitable cartilage, assembling the cartilage in a stable and attractive configuration, and managing the soft tissues to promote a favorable and complication-free recovery is a difficult challenge that even some accomplished rhinoplasty surgeons opt to avoid. While nearly all revision rhinoplasty patients can be improved when appropriate surgical principles are properly applied, absolute perfection is virtually impossible. Due to pre-existing tissue damage and the limitations outlined above, cosmetic gains are often hard-fought and incomplete, making step-wise improvement a necessity in the severely injured nose. Be that as it may, Dr. Hossein Nejad with clinical experience and considerable expertise, derived from thousands of nasal surgeries will help you get a clear picture of the revision and always considers the patient’s desires. However, as with any surgery, there are certain limits to what can be accomplished. If the surgeon feels that the patient’s goals are not achievable, he will address this during the consultation.