While most people are happy with the results of their primary rhinoplasty, some may still be unsatisfied with their results. In this case, a revision or secondary rhinoplasty can be performed. This is one of the most challenging procedures in the cosmetic surgery field, but it can be one of the most rewarding for surgeon and patient alike. There are two main issues which are addressed by secondary rhnoplasty – breathing problems and appearance issues.
Breathing problems may have always been present, but made worse by primary rhinoplasty. Alternatively, the primary rhinoplasty surgery may have caused breathing problems as a side effect. In either case, basic approaches to correct the situation include making sure the nasal septum is straight, altering the turbinates (nasal air conditioners which take up space), and opening the tight areas in the nasal passage – the internal and external valves.
Cosmetic issues can be simple or complex. Minor cases can often be corrected with a simple closed rhinoplasty. However, complex reconstructions may involve cartilage grafts or bone grafts and are usually done with an open rhinoplasty approach.
If you are considering surgery, you can request a consultation with Richard J. Warren, MD. A staff member will contact you to discuss the procedure, Dr. Warren's availability, and additional scheduling information.
Frequently Asked Questions
For revision rhinoplasty, the nose has already been surgically altered. Therefore, the internal anatomy will not be normal, there will be scar tissue, and some of the normal surgical options may not be available. The surgical approaches (either closed or open), are also more difficult. Most importantly, revision rhinoplasty requires a customized approach, because every situation is completely different.
Generally there are two types of problems addressed by revision rhinoplasty – breathing problems, and cosmetic problems. If there is a problem with breathing, the first step is to diagnose the cause, and to then develop a plan to solve the problem. Common issues include a deviated nasal septum, a collapsed external nasal valve, a collapsed internal nasal valve, and hypertrophied turbinates. Many different surgical procedures have been designed to correct these problems. If the problems are cosmetic, an aesthetic diagnosis is the first step. Surprisingly, this diagnosis may not be obvious because nasal appearance involves many optical illusions. Common problems include under or over-reduction of the nasal dorsum (top of the nose), a nasal tip which is too wide, too narrow, or misshapen, a nose which looks too long or too short, and problems with symmetry. Very often the patient simply feels that their original concerns were undertreated.
The surgery is performed at the Vancouver Plastic Surgery Center, under a light general anesthetic. Every revision rhinoplasty procedure is different. Like a primary rhinoplasty, the surgery can be performed using either an open or a closed approach. Some procedures which require only minor revision can be performed through small incisions inside the nose. Major reconstructions usually require an open rhinoplasty approach and may take about 3 to 4 hours to perform. If there is tissue deficiency, cartilage grafting or bone grafting may be needed, and this will require an incision elsewhere on the body, such as the nasal septum, the ear or a rib. At the end of the procedure, tape and a plaster cast are attached to the outside of the nose.
Revision rhinoplasty procedures are usually performed under a light general anesthesia, although small procedures can be performed under local anesthetic with or without conscious sedation. Either way, the anesthesia is provided by an anesthesiologist who is certified by the Royal College of Physicians and Surgeons of Canada.
It is generally best if the patient returns to the original surgeon to discuss concerns with the results of a primary rhinoplasty. The original surgeon will have some advantages including an intimate knowledge of what was done during the primary surgery, and a feel for how that particular nose tends to heal. However, every situation will be unique in its own way, and it may be preferable for some patients, after further discussion with the original surgeon, to seek treatment elsewhere.
Comments made for primary rhinoplasty also apply here. If the surgery has been extensive, there will be a longer stay in the recovery room before being discharged home.
Comments made for primary rhinoplasty also apply here. However, there is great variation in the magnitude of surgery required in revision rhinoplaslty. If a small revision is done, recovery may be much faster and less involved than a primary. Alternatively, revision surgery may be of greater magnitude than the original, causing more bruising, swelling, and a longer recovery than the original surgery.
Comments made for primary rhinoplasty also apply here. With simple revision surgery, recovery will be very quick, with the nose looking virtually normal when the cast is removed at 10 days. However, like primary rhinoplasty, complex revision cases may take a year or longer to see the final result.