Secondary or revision rhinoplasty is performed to improve the results of previous rhinoplasty surgery. Surgical treatment is customized to an individual’s anatomy and issues and not generalized to a “one-size-fits-all” approach. Revision rhinoplasty is one of the most challenging cosmetic surgeries and requires an experienced surgeon.
If you are considering revision rhinoplasty, it is crucial to understand that this procedure is not a simple fix and requires careful consideration. Your surgeon must consider the previous rhinoplasty procedure, time duration since the previous procedure, skin thickness, breathing difficulties, and your individual
facial and nasal anatomy. Patients may experience dissatisfaction with the results of their initial rhinoplasty, whether due to an unsatisfactory appearance or functional issues such as breathing difficulties. Revision rhinoplasty can address these concerns, but it is essential to have realistic expectations and understand the potential risks and limitations of the procedure.
There are several reasons why you may need revision rhinoplasty:
Revision rhinoplasty is typically performed under general anesthesia. This means you will be asleep during the procedure without pain or discomfort.
Revision rhinoplasty may be performed with a closed or open technique, depending on the complexity of the revision. The closed technique is performed entirely inside the nose and is often called “scarless rhinoplasty.” The closed technique is usually performed for less complicated rhinoplasty revisions. The open technique provides better visualization, and the small external scar is barely visible post-operatively.
During the revision, rhinoplasty soft tissue, cartilage, and bone may be removed or added depending on the desired surgical outcome. The tissue added may come from cartilage (typically ear, rib, or nasal septum cartilage,) bone from the rib or calvarium (skull,) autologous fat, and nasal implants or donor cartilage grafts for additional nasal support.
Nasal bones are re-shaped during the revision via osteotomies (surgically breaking the nasal bones) and may be combined with septoplasty or turbinate surgery.
Once the desired surgical changes are made, the incisions are closed, internal nasal splints, nasal taping, and a cast or firm splint are placed externally. The internal nasal splints are removed within seven to ten days, but the external nasal cast or splints usually remain in place for ten to fourteen days. The nasal splints mustn't be removed too early as they promote nasal healing.
The final results of revision rhinoplasty may not be evident for several months as your nose will continue to heal and settle into its new shape. Be patient and follow your surgeon's instructions for the best possible results.
We'll schedule follow-up appointments to monitor your healing progress and ensure your results are satisfied. It is essential to attend these appointments and communicate any concerns or questions you may have.
When planning revision rhinoplasty surgery, patients must understand that an adequate post-surgical follow-up is critical. You may experience more postoperative swelling, bruising, and discomfort than with your original rhinoplasty; this is to be expected. Your surgeon will prescribe pain medication, Arnica Montana (a natural herbal remedy that decreases bruising and swelling), and antibiotics to help manage these symptoms.
Keeping your head elevated the first few days after surgery and arranging your bed pillows so you do not alter the position of your external nasal splint while sleeping help minimize swelling.
Gentle cleansing of the suture line and skin care after external nasal splint removal is a priority in all rhinoplasty procedures. A cleansing regimen is organized to control breakouts and acne exacerbation. This helps to reduce skin inflammation, and oftentimes patients need to be managed by a dermatologist.
It is important to avoid blowing your nose or any strenuous activities for at least two weeks after surgery. You should also avoid wearing glasses or sunglasses that rest on your nose for four to six weeks to prevent pressure on the healing tissues.
If you have undergone revision rhinoplasty, your recovery period may be longer than that of primary rhinoplasty. Following your surgeon's postoperative care instructions ensures a smooth recovery process. It is not infrequent that swelling may be persistent for well over a year after revision rhinoplasty surgery. Long-term follow-up is essential and is the only objective way to evaluate results. Postsurgical photographs are taken at least six months, one year after surgery, and annually if possible.
You may return to work or school ten to fourteen days after surgery. However, you should avoid activities that increase your heart rate and blood pressure at least two weeks after surgery. Additionally, you should stick to an easy-to-chew diet two weeks after surgery, as excessive chewing causes movement of the facial muscles and may interfere with bone healing.
Sanctuary Plastic Surgery performs primary rhinoplasties and corrects unsatisfactory results of previously performed rhinoplasties at other plastic surgery institutions or practices.
Our Rhinoplasty Expert, Dr. Rondi Walker, is a University of Washington, Yale University, Oxford University, Georgetown University, and a Professor Daniel Marchac Fellow from the Necker Hospital in Paris. Dr. Walker is highly knowledgeable regarding revision rhinoplasty surgery and is a member of the American Board of Plastic Surgery and the American Board of Otolaryngology-Head and Neck Surgery.
She is taking new patient consultations at Sanctuary Plastic Surgery and would be delighted to meet you and assist you in formulating a surgical plan for your revision rhinoplasty. Please schedule your appointment with Dr. Walker if you have any questions regarding your nose. She is well-versed in breathing issues and cosmetic nasal surgery.
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