Revision Rhinoplasty – The Ultimate Guide Series Part 1

Welcome to the Revision Rhinoplasty Ultimate Guide Series.  This will be a series of posts tackling revision rhinoplasty issues in detail, along with my personal philosophies on various revision rhinoplasty topics.  Enjoy!

Revision rhinoplasty is one of the most difficult plastic surgery operations that can be performed.  Revision rhinoplasty is really at the core of my practice, which focuses on applying the most advanced techniques to complex surgical problems.  Successful revision rhinoplasty operations represent a coming-together of years of training, surgeries performed, hundreds of postop visits, careful photographic analysis of outcomes, wisdom gained from other surgeons, and game-time performance.  Achievement of a great outcome in a revision rhinoplasty is one of the most satisfying surgical outcomes and there is no doubt it is life changing.

First, there are really two types of revisions.  The first is what I call a “minor revision”.  This means that the primary surgery essentially went well, but perhaps a healing issue occurred and there is some minor irregularity that develops.  One of the more common forms of this is a residual hump left on the nose.  In an effort to avoid overscooping or destabilizing the nose (saddle nose) it is possible that there is a residual hump on the nose.  Frequently this is not a problem, as there is still a dramatic improvement from preop.  Importantly, however, correction of this in a revision is a relatively small matter, and can usually be done in the office with local (injection) anesthesia.  The aesthetic consequences of leaving it alone are also very small, so there is very little urgency with doing it right away, and it is relatively easy to allow for sufficient healing to occur prior to any intervention.

The second type of revision is what we will focus more on in this series.  This is the complete “re-do” or the reconstruction of a “botched” first surgery.  This is the procedure that is considered one of the most challenging in all of plastic surgery, but if done well can easily be one of the most rewarding.  This is a procedure I have dedicated my practice to studying, learning, and mastering.  Thankfully it is only relevant to a small percentage of the patients who undergo a rhinoplasty, but for those who had a bad experience, finding a surgeon they can trust to do a revision is one of the most daunting aspects of the whole process.

First, the most important thing to acknowledge is that bad outcomes from rhinoplasty are really devastating psychologically.  As a central facial feature, deformity in this location is distracting and leads to extreme self-consciousness.  I have a lot of empathy for patients in this position and I try my best to understand how difficult it really is to go through this.  Nearly 100 percent of the time, the deformities that are the worst are in the nasal tip.  Nostril asymmetry, retraction, deviation, scarring, all of these are very disfiguring in a way that a residual bump on the bridge or some mild deviation of the nose could never be.  If the skin is damaged the problem is much worse, leaving visible scars, major nostril asymmetries, breathing problems, or worse.

The good news is that techniques and surgical training have evolved so that most surgeons avoid these kinds of issues.  At one point in the history of rhinoplasty most surgeries left some form of these issues even if they were mild.  Thankfully this has changed as top revision rhinoplasty surgeons have educated the field on how to avoid these outcomes and have steered the field towards more natural outcomes that preserve the many essential functions of the nose.

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