Revision Rhinoplasty

What is Revision Rhinoplasty?

 

Revision rhinoplasty, often called secondary rhinoplasty, is the term used for any patient who has previously undergone rhinoplasty, one or more times. Revision rhinoplasty is performed to correct functional or cosmetic concerns that persist or develop after previous rhinoplasty procedures. Revision rhinoplasty is regarded as significantly more difficult than primary rhinoplasty, for a number of reasons. Usually, the need for revision is presented when deformities are significant, functionally and cosmetically.  The inevitable presence of scar tissue, abnormal nasal framework and delicate soft tissues that have been disrupted by a previous surgery are distinguishing characteristics that contribute to the difficulty of a revision rhinoplasty procedure. Even in the best of hands, cosmetic and functional imperfections may occur due to the complicated anatomy of the nose and the unpredictability of healing.

 

Repairing the Damage

 

You may be surprised to learn that as many as 13-15% of rhinoplasty patients undergo at least one revision rhinoplasty in their lifetime. In fact, rhinoplasty is one of the most likely procedures to require a revision. As is the case with primary rhinoplasty, the need for realistic expectations is paramount in undergoing a revision rhinoplasty and patients who seek quick fixes, perfection or have unrealistic expectations are likely to dig deeper and deeper holes for themselves.

Depending on the severity of the patients concerns, revision rhinoplasty can range from a minor fix to a more extensive surgical procedure. The greater the severity of the damage, the more limited the possibilities for improvement. Due to the complex nature of rhinoplasty, it is often not possible for Dr. Waterman to assess the extent of revision needed until access is gained during surgery. While revision rhinoplasty may seem, to some, like a straightforward procedure, the artistic and medical challenges are generally far more complex than that of primary rhinoplasty.

What to expect

 

As is the case with any surgical procedure, revision rhinoplasty requires an understanding of realistic expectations. The decision to re-operate will be made jointly by the patient and surgeon after extensive consideration of improvements, risk factors and expectations. In general, revision rhinoplasty presents many obstacles that are not present during primary rhinoplasty. Due to the increased complexity of surgery and potential for obstacles presented in revision rhinoplasty, revision cases often require a larger time commitment and financial commitment than primary rhinoplasty.

In addition to the need for a longer operation, revision rhinoplasty generally requires a longer, more extensive recovery period. Previously disrupted tissues are more likely to exhibit inflammatory response that have the potential to affect the surgical outcome.

 

How do I know if I’m a candidate for revision rhinoplasty?

 

In general, revision rhinoplasty is considered when the functional or cosmetic result of a primary rhinoplasty is less favorable than the pre-operative foundation. In most cases, a revision is not considered until at least 12 months post-operatively. However, in some cases waiting 12-18 months or longer, especially in thick skinned patients, is advised in order to adequately assess the initial result and minimize any adverse effects of additional operations. In some patients the genetically pre-determined inflammatory result and cumulative soft tissue damage are too severe to warrant a successful secondary rhinoplasty. Unfortunately, there is no definitive means of identifying these patients before surgery, making revision rhinoplasty a gamble for any patient.