Perhaps one of the most challenging aspects of plastic surgery is the revision rhinoplasty. There are almost 300,000 rhinoplasties performed just in the USA each YEAR. Of all the procedures plastic surgeons offer, revision rhinoplasty requires the greatest skill. Revision rhinoplasty requires vision and attention to the smallest details.
Whenever I see a patient with an unsatisfactory rhinoplasty result, and they are desiring improvement I first ask is it possible to return to the original surgeon. I do this because I want to give this doctor the opportunity of addressing the issue and possibly making any needed corrections. More often than not that relationship has been severed and the patient does not wish to return to that doctor. Therefore, we then discuss what this individual finds offensive and undesirable about the present condition of the nose and begin to have and achieve a meeting of our minds. Complaints I’ve faced when discussing with patients who require revision rhinoplasty include:
1.- The nose is too long
2.-The tip is to fat or to pointed or pinched
3.-The profile is unacceptable patient desires a more elegant profile
4.-The nostrils collapse while resting and with a deep breath
5.- The profile is scooped or indented
All of the above, I lump into the category of complications. These are best described by not being happy with the result. Bleeding, infection, and scarring risks which we face with most plastic surgery procedures, is very infrequent both in primary and revision rhinoplasty. The skin draping the nose has been a challenge by a previous surgical procedure on the nose that may present additional risks.
The nose skin is usually very forgiving, resilient, and possesses an adequate blood supply. Therefore, skin complications are limited but can occur. The most challenging aspect of the skin is the thickness and oiliness which can prevent or limit the draping over the underlying, realigned structures. Thin and/or previously traumatized skin can also present a problem. Also, the patient’s own healing characteristics can be problematic. As I state above, usually the skin of the nose is very forgiving and heals well.
CLOSED VS OPEN–CARTILAGE SOURCES
It is my personal opinion and experience that the closed technique is the method I prefer. This is whether it be primary or revision rhinoplasty. Cartilage grafting – whether from the septum, the ear cartilage, the patient’s own rib cartilage from the tissue bank – can all be performed with precision. This is done by using the closed or intra-NASAL approach. The scar across the tissue separating the two nostrils, in my opinion, is unnecessary.
IN MEDICINE AND ESPECIALLY PLASTIC SURGERY-THERE IS NO SUBSTITUTE FOR PERSONAL CONTACT. TALK TO THE DOCTOR – HE IS TRAINED TO LISTEN.
THOMAS P. TREVISANI MD
BOARD CERTIFIED PLASTIC SURGEON