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Ask the Experts
Revision Rhinoplasty, also known as Secondary Rhinoplasty or Complex Rhinoplasty, is usually sought after whenever a previous surgery of the nose did not lead to the expected aesthetic or functional outcome. The experience of a previous surgery which resulted in an undesirable outcome, coupled with the uncertainty of the next surgery providing the long-term desired result can make considering Revision Rhinoplasty a very daunting task.
Based on the nature of how human beings perceive and process noses, we see our nose with a very detail-oriented view. This focus only increases when patients require Revision Rhinoplasty, which subsequently also raises the patient’s expectations. Completely correcting aesthetic concerns that occurred following a primary Rhinoplasty is often a difficult task. Limitations due to scar tissue formation, damaged or deficient cartilage, soft tissue irregularities and other structural damages all have to factored in.
These are the main physiological and psychological reasons why Revision Rhinoplasty is considered to be one of the most challenging procedures, for both the patient and the surgeon. It is therefore pivotal to understand the patient in order to establish a realistic goal.
When is a Revision Rhinoplasty necessary?
A Revision Rhinoplasty becomes necessary when it is needed to address imbalances that persist or are newly created by the first procedure. An unforeseen healing complication or improper healing itself may lead to the need for this second procedure in order to ensure facial balance. This being said, a secondary rhinoplasty is a much more complicated procedure compared to the initial procedure, but with an advanced cosmetic surgeon your secondary procedure can also be very successful.
It is also very important that we work closely with you to manage your expectations. A Revision Rhinoplasty can improve the appearance of the nose and ease of breathing, but it’s important to note that risks and unpredictability cannot be entirely eliminated. Realistic expectations and a grounded acceptance of what your ‘new’ nose may or may not look like is essential before we begin any further cosmetic surgery.
Previous surgery can complicate any further work, which is what makes Revision Rhinoplasty a more complex procedure.
The procedure is usually performed under general anaesthetic, but there is scope for it also to be performed under sedation and local anaesthetic in extenuating circumstances. Almost always, a Revision Rhinoplasty will be performed as an open procedure to allow the surgeon better access to the delicate tissue, cartilage and bones that are responsible for the appearance of the nose. This requires a small incision being made on the outside of the nose so that the skin can be lifted, but it is subtle and can easily be concealed in the contour of the nose postoperatively.
In simpler Revision Rhinoplasties, your surgeon may have to remove excess tissue or cartilage that may have been missed in the original surgery. Where necessary, they may also have to straighten out a crooked nasal bridge by fracturing the bone in a controlled way.
For more complicated procedures, a total overhaul may be necessary. When patients have had too much tissue removed from the nose, a graft using cartilage or bone will have to be used, which can be taken from the ear, temple or ribs.
There is also a chance that scar tissue will have developed as a result of the first procedure, in which case surgery is inadvisable, or the skin in the area may be insufficient.
These circumstances make Revision Rhinoplasty problematic, and should be discussed carefully with us.
For a relatively straightforward procedure, Revision Rhinoplasty will take 1-3 hours. If you require a graft, this may become more.
Complications are fortunately rare. Time will generally improve the swellling and hence the appearance of the nose. Occasionally bruising takes longer to disappear especially in darker skinned people. Nose bleeds and infections are all possible complications but extremely rare and easily corrected if early treatment is obtained. As swelling of the nose settles following surgery, the nose shape will gradually change over a period of months and minor irregularities should therefore not usually be addressed until most of this swelling has settles which is usually 10-12 months following your initial surgery.
Scarring can occur and in these cases the scar maybe a different colour to the surrounding skin or raised and lumpy. Again scars take time to settle and will usually fade and soften over 6-9 months following surgery.
It is common for the nose – especially the tip – to feel numb following secondary rhinoplasty. This should settle over 4-6 months.
Some nasal asymmetry may still be present following surgery, especially if the nose was deviated before surgery although usually this should be much improved.
Occasionally allergic reactions can occur to sutures, tape, splints and may require treatment.
Wound disruption or delayed healing can occur and rarely some areas of the skin may necrose. This is more likely in patients who either have had multiple procedures on their nose previously, or in smokers and immunosupressed patients e.g. diabetics.
If some cases cartilage grafts need to be placed to support the structure of the nose and this cartilage is usually harvested from the septum inside the nose. Occasionally this can cause a septal perforation which usually does not need further treatment but occasionally can cause discomfort with airflow and breathing and require a secondary procedure to correct.
Differences in breathing maybe apparent following surgery and in the initial healing period nasal airway obstruction is common as the mucosa is more congested and nasal drops may help with this.
As with all surgery there is a risk of dissatisfaction after surgery and this is more so following Revision Rhinoplasty. As such we will take time to discuss the procedure with you so that both you and your surgeon are satisfied that your expectations are realistic.
If you require a splint, this will be applied during the procedure. It must remain there for 7-10 days after your procedure, because it helps to control swelling. If you have had a cartilage graft – which moderate to severe Revision Rhinoplasty cases usually will – you may also require an internal splint, which will remain in place for 5-7 days after surgery.
You may experience some bruising around the eyes and over the upper face, which will begin to fade after around 3 days. Keep your head elevated while you sleep to aid the healing process. You may experience some discomfort, which can be managed by painkillers.
If you are wearing glasees you should take care not to wear them for long periods, and it will not be appropriate for contacts wearers to use lenses while the eyes are still swollen.
You should expect to take 10-14 days off work, and 6 weeks from exercise.
Like any surgery there can be complications and this is even more of a consideration when correcting previous surgery. Whilst all our surgeons are highly experienced we will inform patients of any risks or concerns ahead of surgery. We will ensure that patients know what is realistic in order to avoid disappointment.