Rhinoplasty Boston

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Revision Rhinoplasty (Secondary Nasal Reshaping Surgery)

Many rhinoplasty surgeons consider revision surgery an entirely different procedure if compared with the primary rhinoplasty. Although the final aesthetic and functional result should be similar to primary (first time around) rhinoplasty, how one goes about it may be entirely different. Noses that underwent rhinoplasty in the past may have lost a significant amount of their normal anatomy. In addition, scaring replaces normal tissues and makes it more challenging to reshape the nasal tissues. Tissue grafts (for instance cartilage) may have been placed in locations of the nose where cartilage is normally not present.

Below are questions that are frequently asked about revision or secondary rhinoplasties.

Is revision rhinoplasty a common surgery?

Secondary or revision nasal reshaping surgery is probably the single most common revision surgery of the face and neck only rivaled by repair of blepharoptosis, a condition where the eyelids are droopy and interfere with vision by covering the pupil. Studies vary widely in the incidence that patients seek revision surgery after rhinoplasty but numbers range from 5%, to 25%.

Is revision rhinoplasty an easy nasal procedure?

Most secondary nasal reshaping surgeries are not easy procedures to perform for the plastic surgeon although relatively straight forward “touch-up” procedures exist which may not be as involved as a complete redo. For instance, the patient may have had a nasal bump and the doctor left a little bump behind. Often this is a rather small procedure and certainly preferable to a bump removal that was overly aggressive. In general terms, it is relatively easy to remove more, it is harder to put back. In more involved revision nasal surgery the nose anatomy has been changed already. In addition, scaring is present where normal tissues used to be before. The nasal surgeon needs to establish an accurate plan with the patient in order to perform a successful revision rhinoplasty. As with most facial plastic surgeries, the final outcome is probably a little more unpredictable than that of a primary rhinoplasty because of the previous operation and pre-existing scaring.

What can I expect from revision rhinoplasty?

Common for major revision nasal procedures is the loss of nasal support structures which are mainly made of cartilage. This may be the reason for a pinched appearance, breathing difficulty or collapse of various anatomical structures of the nose. Structure will have to be replaced with “grafts”, materials taken from elsewhere. These grafts typically are made of autologous cartilage, cartilage which originates from the patient him or herself but which is harvested from elsewhere in the body.

Grafts are commonly used in revision rhinoplasty

Grafts used in rhinoplasty are tissues placed in locations, where they are usually not present in this shape or form. Reconstructive revision rhinoplasty does usually not reestablish a normal inside nasal anatomy but rather wants to establish a normal outside appearance in conjunction with good function. Most commonly, autologous grafting materials are made of cartilage or bone with cartilage usually taking the priority. Cadaveric bone and cartilage are available for revision rhinoplasty but for obvious reasons they are rarely applied. In addition, man-made materials have been described for use in the nose, their role in revision rhinoplasty is rather small and most rhinoplasty surgeons do not use materials other than cartilage or bone. The primary source for cartilage is the nasal septum. Unfortunately, the quantity available is limited and commonly, cartilage from the nasal septum has been removed already during the primary operation. Therefore, the revision rhinoplasty surgeon has to find alternate sources for cartilage and the ear or rib may serve as appropriate donor sites. In both location, cartilage can be harvested without change in function or appearance of the respective body part. The quality of ear and rib cartilage differs significantly which may limit their use for specific goals. Rib cartilage has the advantage of being available in sufficient amounts; ear cartilage may be inadequate for specific revision rhinoplasty needs.

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Written by cosmetic surgery specialist and boston rhinoplasty surgeon Dr. Fechner.
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