Revision or secondary rhinoplasty is a special and distinct category in rhinoplasty. It needs special skills and experience of the surgeon. Not all rhinoplasty surgeons deal with revisions. Dr. Shahram has developed the knowledge, skills and experience needed in challenging cases of revision rhinoplasties over the decades and has performed many successful revision rhinoplasties, correcting the shape and function of the nose.
Procedure
Revision rhinoplasty is operating and correcting the shape and function of a nose that has gone through one or more nose surgeries before. Patients often complain of difficulty of breathing, asymmetries, crookedness, inverted “V” deformity, incompetency of internal and/or external valves, ridges, scars, too low dorsum or any combination of the above.
Due to the complex nature of this operation and for optimal results the rhinoplasty surgeon would need building blocks to rebuild the defects. The building blocks necessary for correction of an already operated nose are cartilage and, in some cases, soft tissues. The cartilage is usually obtained from either the septum if still intact, the rib or ears or in occasional cases a radiated frozen cartilage may be used. The soft tissue used is usually a fascia obtained from the temporalis muscle.
Length
Surgery takes approximately two hours or more. Anesthesia General or intravenous sedation and local anesthesia are used.
INPATIENT/OUTPATIENT
In-patient: generally speaking, I usually keep my primary and revision rhinoplasty patients one night in the hospital after their operation for their safety and comfort.
POSSIBLE SIDE EFFECTS
The cartilage that has been harvested does not leave neither a functional nor an aesthetic defect.
There will be a scar that in case of the ear will be hidden behind the ear and in case of harvesting a rib will leave a small scar on the chest, which in women will be hidden under one of their breasts. Harvesting temporalis fascia leaves a scar in the hair bearing skin above and slightly behind the ears. The skin of a nose that has already been operated on is usually less pliable and therefore the final definitions are usually less, and some asymmetry might still remain.
RISKS
In experienced hands the side effects are rare but when obtaining a rib cartilage, pneumothorax is a potential risk which has to be addressed and treated. Since the skin of the nose has been one or more times elevated and undermined, the vascularity of the skin might have already been compromised and therefore, skin discoloration, longer lasting swelling and ultimately skin necrosis are potential risks.
RECOVERY
Already present scars in an operated nose and the cartilages that has been used makes the period of swelling longer than in primary rhinoplasties. Final results might take up to two years to be completely appreciated however the breathing constrains will be alleviated very soon after the operation.
RESULTS
The results are usually pleasing if the concerns have been communicated well enough. Being able to breathe again is truly improving the quality of life.
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