Revision Rhinoplasty–A Complex Operation

There are a subset of patients who require revision rhinoplasty, and as I do see many patients from other surgeons, this operation is common to my practice.  Revision rhinoplasty is also know as secondary rhinoplasty in some instances.  This operation is truly unique in scope, and complexity.  Only a specialist in this procedure should undertake a revision rhinoplasty, there a complex variables to deal with.  Let us discuss why this is such a specialized procedure…

Expectations:

Patients undergoing revision have undergone previous surgery, and with it, previous scars, scarring, and healing times.  During the first operation the aesthetic goals may not have been met, and thus patients are wary of now having a second operation.  For most of my revision patients, I discuss that while perfection is impossible, we can usually provide a substantial improvement in the appearance of the nose.  AN in person consultation needs to include discussion of new technique, potential results, and length to healing.  The revision procedure is much more difficult than the primary procedure.

The main aesthetic or cosmetic issues that patients encounter include:

• an overly lowered nasal bridge or “ski-slope” nasal profile
• A residual or recurrent nasal hump
• an overly pinched nasal tip from aggressive cartilage removal
• misshapen or notched nostrils
• poor scarring
• residual crooked or deviated nasal bridge

These are just a few deformities that we see in our revision patients.

Techniques:

For revision rhinoplasty STRUCTURE is critical.  These means using cartilage to rebuild the structure of a nose that may be pinched, or over-resected.  For me, that means using cartilage from your ear or rib.  Nowadays we are also using frozen rib cartilage to rebuild the nose.  My approach is to use natural tissues to provide a cosmetically pleasing result and improve the nasal structure.

BELOW: this patient underwent a quaternary (4th) rhinoplasty after three operations from other surgeons

Before                                             After

 

RESULTS:

Taping, nasal massage, and strict adherence to postop instructions is critical to maintaining a great result.  This also means restricting your activity per Dr. Narasimhan’s instructions.  This is also in the #nosebynarasimhan care instructions.  Swelling is worst the first 6 weeks after the procedure.

More Information:

Dr. Narasimhan is board-certified in plastic surgery and otolaryngology.  His primary area of expertise is facial plastic surgery, particularly rhinoplasty.  He performs rhinoplasty on a weekly basis and corrects other surgeon’s rhinoplasty results.