Rhinoplasty is without question the most challenging procedure Plastic surgeons perform. Revision rhinoplasty is even much more challenging. The healing process is dependent upon many factors within the anatomy of the nose. The nose is made of bone and cartilage and skin as well as a mucosal lining inside. Revision is a challenge because all of these structures have undergone surgical procedures. Procedures that prolong and in some instances prevent the achievement of the most satisfying result. I always caution patients who present for revision that the first time is the best time. However, that does not mean we are unable to achieve a satisfactory outcome with revision.
Patients seeking revision must be cautious about who they retain to do the procedure. Extensive before and after galleries are very valuable for the patient during the decision-making process. We separate our galleries into primary rhinoplasty and revision rhinoplasty. This gives our patients a window into my expertise.
All of the factors that contribute to the healing process are a challenge to the maximum in the revision nose. The arteries, the veins, the nerves, and especially the overlying skin work very hard to return to the preoperative condition. Dietary factors, stress, smoking, and emotional factors all participate in the healing process.
Smoking, of course, is a deterrent to optimal lung capacity. And, it is also a factor contributing to lung cancer. Furthermore, it may also inhibit the oxygen and blood flow to the nose. This can prolong the swelling. And, may in certain instances cause significant skin slough. It’s rare but it can occur.
No matter how artistic and creative I can be with respect to the bone and cartilage restructuring, the overlying skin will make the final determination as to the outcome. Often times I can overcome the restrictions put in place upon me by using cartilage graphs from very different sources.
Once the maximum anatomic creativity occurs, it may take up to a year or more for the skin of the revision rhinoplasty to finally achieve a desirable outcome. Also, I find that patients who strictly follow their postop instructions usually have a much easier and more optimal post-op course.
I prefer packing and a splint on a regular basis in order to achieve the best looking nose. Our packing usually comes out at five days or so and then the splint remains for another 5 to 7 days beyond that point. When the splint is taken out, the patient will see 70 to 75% of the new nose. However, they are told that improvement continues over the next year.