Rhinoplasty in real life means to deal with a revision rhinoplasty if necessary. Rhinoplasty is likely among the ten most frequently performed plastic surgery operations in the face. Revision rhinoplasty is also with all likelihood the most frequent revision operation of all cosmetic procedures in the face.
Revision Rhinoplasty: A Reality of Nose Job Surgery
The anatomy which determines the external appearance of the nose consists of a complex, linked system of bone, cartilage and skin. Modern natural rhinoplasty consists of multiple manoeuvers to skillfully rearrange this framework while maintaining its stability to avoid the “overoperated look”. The forces of tissue healing and scar development add an additional component of unpredictability. Thus, more so than in other cosmetic operations, the results may not be perfect. Rhinoplasty has a definite potential to produce sometimes aesthetically and functionally unsatisfactory results. Thus the desire or need for revision rhinoplasty, often also called secondary rhinoplasty, may arise.
Back in the maybe not so good old days when endonasal or closed rhinoplasty with reduction of the bony and cartilaginous framework used to be the predominant operative strategy, revision rhinoplasty was relatively common. The need for revision rhinoplasty became more apparent the longer the follow up was. A lot of the detrimental effects of the operative technique only became apparent over months. Revision rhinoplasty in fact used to be so common that several well known rhinoplasty surgeons rose to fame due to their innovative methods to plan and execute revision rhinoplasty and the large number of cases of that kind they operated.
Revision Rhinoplasty on the Decline after Natural Rhinoplasty
Revision rhinoplasty today is by far not as frequent as it used to be. Modern natural rhinoplasty is now predominantly performed through a so called open approach. Elevating the soft tissues off the entire tip and bridge of the nose permits direct visualization of the framework of the nose and particularly of the tip cartilages in their natural, undistorted state. Whatever one can see better can also be treated and sculpted better. Several other key factors contribute to the decline of revision rhinoplasty. First, natural rhinoplasty rearranges the framework without destroying it. Secondly, whenever needed, even preventatively, the framwork is strengthened. Third, the use of cartilage grafts has obviated the frequently employed strategy of the past to adapt the entire nose to fit its smallest component and thus often overly reducing the framework. Today’s rhinoplasty operation strives to balance the nose – small reductions, rearrangements, other parts are augmented using the body’s own materials. Fourth, synthetic material in the nose is avoided at all cost. Five, preventative use of small beams of cartilage to splint the air passages open has greatly helped to ensure proper breathing through the nose after rhinoplasty. These steps all taken together helped to bring revision rhinoplasty down to today’s all time low.
Revision rhinoplasty though still exists. Even modern methods can not bring the risk of reoperation to zero. The only fail safe method to avoid any and all risk of a revision rhinoplasty is not to do any primary rhinoplasties. The contemporary scientific literature still states an average risk of about ten percent. So revision rhinoplasty is here to stay.
Revision Rhinoplasty: The Inside Look
If rhinoplasty is a difficult operation then revision rhinoplasty is, well, of exceeding delicacy and full of tremendous challenges and often ghastly surprises. Broadly, two scenarios can be distinguished. The first maybe somewhat easier on the rhinoplasty surgeon. The strategic objective is to add steps which could have or should have been done during the primary rhinoplasty. The purpose of the revision rhinoplasty is to complete the primary rhinoplasty. While “touch up” is most certainly sugar coating of the true difficulty of a secondary rhinoplasty even under these circumstances, it beats the alternative every single time. The second scenario in revision rhinoplasty is to undo something which was done during the primary rhinoplasty. This type of revision rhinoplasty most frequently involves building up an excessively reduced and unstable framework of the nose and reconstructing those elements of the nose, which were cut, destroyed or removed during the primary rhinoplasty. Most often, graft material has to be obtained from donor sites outside the nose. While the use of synthetic material is not a good idea during primary rhinoplasty, artificial implants are an absolute no-no in revision rhinoplasty.
Revision Rhinoplasty: Keys to Success
One of the key aspects of performing revision rhinoplasty, whether a surgeon is revising one of his own cases or those referred to him from other surgeons, is not to rush into it. The minimum period of time between the primary and the revision rhinoplasty is six months, far better twelve months. By that time the healing process after the primary rhinoplasty is complete, scars have matured, tissues have settled. The nose does not change much any longer, it has become a static, not a moving target. By that time the true extent of the problem will also be obvious for patient and surgeon alike. Thus the true need (or lack thereof) for revision rhinoplasty will be apparent. While this may put a lot of strain on the patience of both the rhinoplasty surgeon and patient, it is a truly time honored approach and deviating from it and operating on a moving target usually tends to compound the problem. While the rate of revision rhinoplasty may be around ten percent, the rate for revisions of revisions (tertiary rhinoplasty) is much higher. The best strategy to avoid a tertiary rhinoplasty after a revision rhinoplasty is to let enough time pass and to set the objectives very clearly. The good fairy will only grant one or two more wishes in revision rhinoplasty !