Revision Rhinoplasty / Revision Nose Job
The term rhinoplasty refers to plastic surgery of the nose, often known by most people as a “nose job.” A revision rhinoplasty is corrective nasal surgery that serves to alter the form and/or function of the nose after a previous rhinoplasty. Revision aesthetic and reconstructive nasal re-shaping is indicated for cosmetic or functional deformities not properly treated or made worse from the primary operation. Some also refer to revision rhinoplasty as “revision rinoplasty.” This broader terminology can apply to rhinoplasty required beyond a revision operation, such as a third or fourth operation.
Rhinoplasty is perhaps the most challenging of all plastic surgery procedures. Even in the best of hands, external deformities or breathing difficulties may occur after rhinoplasty. This is due to the complicated anatomy of the nose and the ‘vagaries of healing’.
Patients request revision rhinoplasty to address specific imbalances that persist, are newly created, or that have become more severe. Often the nose is imbalanced or in disharmony with the rest of the facial features due to an un-anticipated healing complication, improper, or incomplete surgical maneuvers. A revision rhinoplasty is often much more complicated than a primary rhinopasty. The first time in rhinoplasty is always the best time to address all the cosmetic and functional nasal issues, however with appropriate application of advanced techniques by a rhinoplasty specialist, revision procedures can be successful. The majority of surgeons who specialize in rhinoplasty also have necessary experience with more complex revisional surgeries and will be able to address patient concerns. Of course, as with primary rhinoplasty, your expectations and goals need to be appropriate and thoroughly discussed with your surgeon. It may be helpful to bring in photos of your nasal appearance prior to your previous operation. Your rhinoplasty surgeon may also request previous operative records and medical records, although this is not mandatory.
Revision Rhinolasty Procedure
The procedure is usually performed under general anesthesia. Incisions are primarily internal, though a small external incision is sometimes used. The bone and cartilage of the nose is reshaped, and care is taken to preserve the breathing function of the nose. Dr. Most is often able to actually improve nasal breathing for his patients.
Patients may expect 5-7 days of swelling in the nose. Dr. Most uses absorbable sutures that do not need to be removed, and uses advanced techniques that allow him to avoid packing in most cases.
Common Problems that Require Revision Rhinoplasty :
- Nasal airway obstruction
- Collapse of cartilage or nasal bones
- Artificial cosmetic appearance to nose (“Overdone nose job”)
- Internal and external nasal valve collapse
- Worsened asymmetry
- Over reduction or inadequate reduction of dorsal height (bridge height/hump)
- Incomplete shaping (not enough of a cosmetic change)
- Excessive or inadequate tip projection
- Excessively narrowed nasal tip (“pinched tip”)
- Excessive internal and/or external scarring (thickened scar tissue)
The changes necessary in revision rhinoplasty can be done through a “closed” or “open” approach. Typically, if there are major structural changes required, and open approach may be preferred. Minor contour corrections can be performed via a “closed” technique. Closed rhinoplasty is when only internal incisions (endonasal) are made for access to the nasal structures. Open rhinoplasty refers to the addition of an incision in the skin bridge between the two nostrils (columella) in order to lift up the nasal skin for more direct visualization of the structures to be altered. The decision to use either the closed or open approach in revision rhinoplasty is based on surgeon preference and each technique has its pros and cons.
Cartilage grafts (portions of cartilage from the septum, ear, or a rib) are often necessary to accomplish the cosmetic and functional goals in revision rhinoplasty. It is very common for the primary procedure to have depleted much of the nasal cartilage. A lack of septal cartilage is the most common indication for needing ear or rib cartilage sources for graft material. These segments of cartilage are then shaped into structural and shaping pieces for use in the nose. As with primary rhinoplasty, there is very little room for error and it is vital that you seek a rhinoplasty expert who is skilled and has vast experience in revision techniques. In order to reduce the rates of further revisions and ensure a successful outcome, it is best to seek a plastic surgeon or facial plastic surgeon who specializes in rhinoplasty and revision rhiinoplasty.
Considering that revision rhinoplasty is one of the most difficult plastic surgical procedures, evaluating patient satisfaction is fundamental in order to determine success and identify variables that may affect the outcomes. Our first study objective was to determine satisfaction levels in revision patients and to compare results with those obtained in primary rhinoplasty patients. Second, we sought to identify factors that may influence the degree of satisfaction.
Revision Rhinoplasty Nose Job Methods
Satisfaction was evaluated in 54 revision and 54 primary rhinoplasty patients using the rhinoplasty outcome evaluation questionnaire. To identify associated factors, patients were assessed for demographic characteristics, medical history, follow-up time, reason for revision, graft usage, the severity of nasal deformity, and satisfaction with the provided care and information given before the surgery.
Revision Rhinoplasty Nose Job Results
All revision and primary rhinoplasty patients experienced improvements in satisfaction scores. Although the improvements were higher in primary rhinoplasty patients, the levels obtained in revision patients can be considered high. We found that young and male patients tend to have less satisfaction increment after the surgery. Patients who underwent revision for aesthetic reasons had higher improvements in satisfaction scores when compared to those patients who underwent revision for a combination of aesthetic and functional reasons. The improvement in satisfaction scores in patients who were satisfied with the information given before surgery was higher.
Revision Rhinoplasty Nose Job Conclusion
Our data suggest that significant patient satisfaction is achieved after revision rhinoplasty and highlight the importance of the informed consent process when planning revision, especially on young and male