Revision rhinoplasty, also known as secondary rhinoplasty, is a complex procedure to reshape or resize the nose after the initial procedure. This surgery is performed on patients who are dissatisfied with the aesthetic or functional results of the original procedure and seek additional corrective surgery. Reasons for dissatisfaction with the original procedure may include a complicated pre-surgical condition, an inexperienced surgeon or a faulty healing process. Because of its complexity, revision rhinoplasty requires the skills of a highly trained specialist.
Reasons for a Revision Rhinoplasty
Problems patients complain of after the initial rhinoplasty procedure may range from minor cosmetic imperfections to serious medical problems and may include:
- Nostril deformities
- Nasal bone fractures
- Cautery burns
- Septal tears
- Breathing difficulties
Candidates for Revision Rhinoplasty
Anyone who is unhappy with the results of their initial rhinoplasty procedure may be a candidate for revision rhinoplasty. Patients should discuss their initial procedure with their surgeon in order to determine the new goals of the revision. It is important that the patient be emotionally and financially prepared for additional surgery. Through consultation and physical examination, the doctor will help determine whether or not revision surgery is an appropriate course of action.
Revision Rhinoplasty Procedure
The revision rhinoplasty procedure is usually performed on an outpatient basis under deep sedation or general anesthesia to help reduce any potential discomfort. The surgery is typically performed using an open technique, allowing for greater visualization of the nasal cavity because the already-reshaped bone and cartilage may be more difficult to sculpt.
In cases where reshaping is difficult, a cartilage graft from the nasal septum, ear or rib may be required. Injectable fillers may also be used to correct small defects after the initial procedure, although use of the patient's own cartilage is preferred. The entire procedure usually takes two and a half to four hours to perform.
Risks of Revision Rhinoplasty
While generally a safe procedure, revision rhinoplasty carries the same risk factors as the original procedure. The second surgery, since it involves skin thickened by scar tissue, less cartilage within the nose, and nasal airways that may have been affected by the earlier surgery, is more complicated than the initial one. Risks of revision rhinoplasty may include:
- Excessive bleeding
- Injury to the septum, the wall between the nostrils
- Skin irritation and even skin necrosis
- Infection
- Nasal blockage caused by swelling
- Complications of anesthesia.
Recovery from Revision Rhinoplasty
After the revision rhinoplasty procedure, patients will usually experience bruising and swelling for 5 to 7 days, along with some mild pain that can be managed with medication. As after the original rhinoplasty procedure, nasal surgical packing will be removed within 2 days. Some bruising and swelling at the surgical site is to be expected for up to 2 weeks. Ice packs will provide relief from these symptoms. During the first few days after surgery, the head should be kept elevated and for approximately 10 days to 2 weeks patients should avoid strenuous exercise.
Once bruising and swelling subside, patients are usually able to return to work and other regular activities. Initial results of the revision procedure will be noticeable right away, but the patient's appearance will continue to improve as swelling subsides and the nose heals. The appearance of the nose may slightly alter over the course of a year after surgery, when full results will be visible.