Revision Rhinoplasty

REVISION RHINOPLASTY IS A SURGERY THAT EVERYONE IS CURIOUS ABOUT. I WANTED TO EXPLAIN THIS METHOD, WHICH IS ALSO KNOWN AS CORRECTION AND SECONDARY SURGERY, IN THIS ARTICLE WITH ALL THE DETAILS.

Revision rhinoplasty is a surgical procedure that provides the correction of cosmetic or functional defects caused by the previous rhinoplasty.

When you look around, you can see many people who are happy with the surgical outcome but you can also see people who are unhappy and even regret to have had this surgery. Revision surgery is needed for “different reasons” to treat the patients in this second group and to eliminate their sadness in a sense.

First surgery failing to satisfy the cosmetic expectations and functional problems (nasal congestion) or often the coexistence of two problems are the main causes of revision rhinoplasty.

Revision surgery is needed for two reasons in rhinoplasty operations performed for the first time: (1) the nasal structure is highly impaired or has not been intervened too much or (2) the presence of asymmetry. Another rare condition is the highly visible scars.

What can be achieved with Revision Rhinoplasty?

As in the first operation, the aim of revision rhinoplasty is to improve the nose shape and nasal functions.

The result obtained by the first surgery sometimes does not meet the expectations of the patient or surgeon. In such cases, corrections are made with revision rhinoplasty to correct the results of the first surgery. These corrections may be 15-20 min interventions that can be performed under local anesthesia or long-lasting complicated interventions.

Functional problems (nasal congestion, etc.) may arise after the rhinoplasty although they are not present before the surgery. In such cases, correction is made to ensure breathing.

Do not forget that rhinoplasty is the most complex and difficult one among the facial cosmetic surgery applications. It requires fine surgical skills. Wrong moves and bad changes in the shape of the nose can cause functional problems.

What are the problems that can be corrected with revision rhinoplasty?

• Nasal septum deviation
• Nasal tip asymmetry
• Sharp and asymmetrical nasal tip
• Cartilage deviation
• Humped nose
• Extremely upturned nose
• Saddle nose deformities
• Asymmetry of the nostrils
• Bird beak deformities (cartilage or soft tissue origin)
• Problems related to breathing functions

I’m always trying to solve both cosmetic and functional problems at the same time in revision rhinoplasty.

Nasal congestion is the most significant functional problem encountered during revision rhinoplasty. Many different causes such as nasal septum or nasal wall can lead to nasal congestion. Even if they are not aware, many people have deviations in their noses, meaning that the nasal cartilage and bone wall is crooked. Rhinoplasty becomes mandatory in cases where the nasal congestion is severe. So cosmetic surgery is essential for functional improvement.

The deviation problem may be worsened by the changes made during rhinoplasty. In some cases, nasal functions may become dysfunctional and deviate after the first surgery.

The nose is a delicate organ. Aesthetic interventions on cartilage and bone are always more difficult than interventions made on soft tissue and skin. Minor changes can result in major functional and aesthetic changes. Therefore, rhinoplasty has a very high revision rate compared to other types of plastic surgery.

Revision rhinoplasty requires a skillful combination of science and art. In order to achieve good results in revision rhinoplasty, surgical experience and competence are essential.

What cannot be done with Revision Rhinoplasty?

As in all other surgical applications, your expectations in revision rhinoplasty should be realistic. Expecting a major change after surgery is a great false notion. After revision surgery, your nose will undoubtedly have a better appearance and you will feel better. I always tell my patients that making a bad-shaped nose perfect is not easy. I think it is more realistic to dream of the next level. Our goal should be to convert a bad nose to a medium-level nose and a mediocre nose to a good nose.

Detailed Examination

A detailed examination should be performed for the revision surgery. It is of great importance because the patient must accurately explain why he/she is not satisfied with the outcome of the first surgery and the surgeon must understand the aesthetic expectations of the patient. The surgeon’s goal should be to improve the appearance of the nose and reduce disturbing defects. If there are harmony and balance between the nose and nasal tip, nostrils, and nasal bridge, it means that the target is reached. Furthermore, the nose should be in balance with other facial structures which are forehead, eyebrows, cheeks, lips, and chin as a whole. Considering all these variables, a nose looking natural and functioning well will be achieved.

In the examination of patients who apply for revision rhinoplasty, the following points should be examined and evaluated:

Aesthetically;

Upper part of nose – nasal bones

Middle section of nose – cartilage network

Nasal tip and nostrils

Thickness of nose skin

Functionally;

Septum deviation, turbinates, nasal valve and allergy

It is, of course, important that your nose looks beautiful and nice, but the proper functioning of the nose is also essential.

I’m doing a special program in your revision rhinoplasty examination. In this way, I create a design in accordance with your wishes and needs and examine the images from different angles and discuss them with you. This is really a helpful application in taking me and you to the desired result.

Are you a suitable candidate for Revision Rhinoplasty?

Adults who have undergone one or more rhinoplasty operations but whose aesthetic concerns or functional problems have not been resolved can apply for revision surgery. Anyone who has a demand for aesthetic or functional improvement and whose expectations are realistic in this sense is the right candidate for revision rhinoplasty.

I want to draw attention to something at this point. First of all, the person must have healthy facial tissue and muscle structure and it is also important that he/she does not have any health problems that may prevent the surgery.

For your own safety, you should provide your physician with accurate information about your health during the examination. In particular, patients with thyroid disorders, diabetes, hypertension, and blood circulation problems should consult their physician.

Tobacco, cocaine, and heroin addiction has started to increase in recent years. Especially if you have such an addiction, I recommend that you should inform your physician about this situation at the first interview for your health and the success of the surgery.

It is of great importance to show the visual designs of your previous surgery, before&after photos, and to forward your detailed surgery note (if any) to your physician, who will perform your revision surgery, and to discuss with him/her about the surgery in detail. Any information you share will make your examination more detailed and fruitful. Although your physician will physically examine your nose, it is important that you clearly understand and explain exactly what kind of interventions have been made to your nose in the previous surgery.

How is Revision Rhinoplasty performed?

After the detailed examination, I explain how and why the problem occurs. Then, I focus on potential solutions and discuss them with you. By explaining what should be done, I produce personal solutions tailored to your needs. First of all, surgery differs from person to person by nature.  In rhinoplasty operations, the nose is reshaped by using the cartilages in the nose, changing their locations, and repositioning them. Since almost all of the cartilages in the nose are used in the first operations, it is preferred to take cartilage from the ear or rib in the revision surgeries. In bone or cartilage supplementation, I prefer to use the cartilage and tissues obtained from the patient’s own body to prevent any risk of an allergic reaction.

Revision rhinoplasty operations are also performed under general anesthesia.

The duration of surgery varies depending on the structure and condition of the nose.

Preparation for Revision Rhinoplasty

Once you have chosen your surgeon, your preparation process will also begin. Your preparation process for revision rhinoplasty is actually the same as the preparation stage of the first surgery.

Your physician will surely tell you that you should stop taking blood thinners such as aspirin before surgery. If you smoke, you should stop smoking a few weeks before surgery. We recommend our patients stop smoking at least a month before surgery. It is of great importance to stop smoking before surgery because it seriously affects the healing process, especially in revision surgeries.

You should also stop drinking alcohol about a week before surgery. You shouldn’t eat and drink 8 hours before your surgery.

After the Operation

It is possible to use splint or plaster to protect your nose and to ensure proper healing. Sometimes special pads such as soft internal splints or dissolvable pads like Nasopore are placed inside the nose. It is important that these pads remain on the nose for at least 24-48 hours after surgery to ensure the stabilization of the nose.

Keeping your head at the same level as your chest when you are lying or resting will reduce bleeding and swelling. As in the first operations, it is normal that there is a small amount of bleeding and mucus drainage in the nose for a few days after the revision surgery. This can be seen especially when the dressing is removed.

Small gauze pads placed inside your nostrils will control any possible leakage from your nose.  After the operation, the nurses will show you how to change these pads.

You shouldn’t do strenuous activities such as running and aerobics for a while after revision surgery. You shouldn’t swim until your nose is fully healed. You should avoid blowing your nose, eating hard-to-chew foods, and facial muscles like smiling or laughing until your bleeding is reduced. You should move your upper lip to a limited extent when brushing your teeth. Prefer clothes that are not worn over the head.  Do not wear glasses or sunglasses as they will put pressure on the nose.

It is quite normal to have bruises on eyes and eyelids after revision surgery. All swelling and bruises will disappear within a week.  Cold compression with ice will reduce swelling and bruises.

However, please don’t forget that the healing process also varies from person to person. In some cases, it may take up to 6 months for the nasal tip swelling to disappear completely, while it may take up to 1 year in some patients. The swelling mentioned here can be only noticed by you and your physician.  Such swelling is not to the extent that your family and friends can see it. With the disappearance of all these swelling, your nose will get its final shape.

After revision rhinoplasty, many people can return to their normal social activities within 2-3 weeks.

What are the risks and complications?

Each surgical procedure brings a number of risks along. Risks and complications that may occur during revision surgery are as follows:

• Repeated bleeding of the nose
• Difficulty in breathing through the nose
• Numbness in the nose and around it
• Uneven or asymmetric results
• Scar
• Persistent pain, color change or swelling
• Allergy of the graft materials used

What should I pay attention to when choosing a physician for revision rhinoplasty?

Revision rhinoplasty is an operation that is performed to correct the defects caused by the first operation and because of the failure to reach the intended target in the first operation. Please remember that revision surgery will offer much fewer correction opportunities with much less tissue if the first operation provided limited correction opportunities for the surgeon. Therefore, it is a very important decision to choose the surgeon who will perform your revision rhinoplasty. I think choosing a physician who specialized in rhinoplasty and revision rhinoplasty is the first step that increases your chance of success. Instead of choosing any ENT or Plastic Surgery specialist, I recommend you to choose a physician, whose almost all surgeries are rhinoplasty and revision rhinoplasty and who has received training and has publications on that subject. A surgeon who has trained in the field of rhinoplasty and works on this subject will make the planning, risk analysis and surgical management of your operation in the best way possible. However, I have recently observed that revision is the endpoint of rhinoplasty. Most surgeons do not prefer to perform revision surgery. If you have found a physician whose revision rhinoplasty number is higher than other nasal surgeries, I recommend you to prefer this physician.

Checking the accreditation of the hospital, where the operation will be performed, is as important as choosing the right surgeon. Choosing these two points carefully and correctly explaining your general health status to your physician before surgery will minimize the possible risks.

Therewithal, it is worth mentioning once again that no surgery is risk-free. Good luck…