What is Revision Rhinoplasty?
Revision rhinoplasty is a secondary or additional surgical intervention performed on individuals who have previously undergone nasal aesthetic surgery to address aesthetic and functional issues. It is undertaken when the results of the initial surgery do not fully meet the patient’s expectations, complications arise, or the nose is functionally inadequate. These surgeries are meticulously planned to achieve both aesthetic appearance and breathing comfort.
When is Revision Rhinoplasty Performed?
Revision nasal aesthetic surgery is performed in the following cases:
Aesthetic Inadequacies:
The shape of the nose after the first surgery may not be harmonious with the patient’s facial features, or the expected aesthetic result may not have been achieved.
- For example, the nasal tip may be too low or too elevated.
- Irregularities or depressions may be observed on the nasal bridge.
Functional Problems:
Post-surgery issues such as nasal congestion or septum deviation that make breathing difficult may arise.
Postoperative Complications:
- Adhesions inside the nose (synechiae).
- Thinning or thickening of the skin.
- Asymmetries and curvature in the nose.
Deformation Due to Trauma:
Deformations in the nose may occur due to trauma or impact to the nasal area following the initial surgery.
Challenges and Characteristics of Revision Rhinoplasty
Revision rhinoplasty is a more complex process compared to the first nasal aesthetic surgery. The primary reasons for this complexity include:
Dense Tissue Adhesions:
During the first surgery, the skin, cartilage, and bone structures are more easily separated, whereas in revision surgeries, dense adhesions between these tissues may be present. This requires the surgeon to work more carefully during the procedure.
Cartilage Deficiency:
- Cartilage used to shape the nose in the first surgery is often depleted for subsequent surgeries. Therefore, additional cartilage grafts are required in revision rhinoplasties. Cartilage is typically sourced from:
- Ear Cartilage: Suitable for small-scale repairs. However, only a limited amount can be harvested from the ear.
- Rib Cartilage: Preferred for larger and more complex repairs. Its advantage is being the patient’s own tissue. During the revision rhinoplasty, a 1 cm incision is made under the patient’s breast tissue to harvest cartilage from the rib. This wound heals quickly and becomes invisible over time due to aesthetic sutures.
External Materials:
In cases where the patient’s own tissue cannot be used, biocompatible artificial materials may also be used. However, it should be noted that these materials carry a risk of infection.
Planning Process for Revision Rhinoplasty
A detailed planning process is essential for successful revision rhinoplasty. This process includes the following steps:
Reviewing Past Surgeries:
The type of previous surgeries, techniques used, and existing problems are evaluated in detail.
Physical Examination:
The nasal aesthetic structure, skin thickness, and bone and cartilage structures are examined.
Functional checks are conducted to ensure the airway is open.
Determining Patient Expectations:
The patient’s aesthetic and functional expectations should be clearly understood, and the achievable realistic outcome should be explained.
Visual Simulation:
Using technological devices, potential results are shown to the patient, aligning expectations with the likely outcome.
The Process of Revision Rhinoplasty Surgery
Revision rhinoplasty surgeries are generally performed under general anesthesia and include the following steps:
Cartilage Graft Preparation:
Required cartilage is obtained from the ear, rib, or external materials.
Correction and Reshaping:
- Irregularities on the nasal bridge are corrected.
- The angle and height of the nasal tip are reshaped.
Airway Repair:
Breathing issues such as septum deviation or nasal adhesions are resolved.
Skin Adjustment and Suturing:
The nasal skin is carefully repositioned over the reshaped nasal structure.
Postoperative Recovery Process for Revision Rhinoplasty
The recovery process after revision rhinoplasty is generally similar to that of the initial nasal aesthetic surgery but may show some differences:
Postoperative Swelling and Bruising:
In cases where cartilage grafts are used, less bruising in the nasal area is possible.
Bandage and Splint Use:
A splint may be used for several weeks to maintain the new shape of the nose.
Final Results:
The results of revision rhinoplasty usually take between 6 months and 1 year to fully manifest. During this time, the nasal shape and function should be regularly monitored.
Patient Psychology and Expectations
Patients undergoing revision rhinoplasty often have higher expectations due to dissatisfaction from their previous surgery. However, the following points are crucial:
Realistic Expectations:
Revision rhinoplasty cannot guarantee the complete resolution of all issues from the initial surgery. The main goal is to improve the current condition as much as possible.
Psychological Support:
Providing psychological support during and after the surgery can help the process proceed positively.
Waiting Period for Revision Rhinoplasty Surgery
Before deciding on revision rhinoplasty surgery, it is recommended that patients wait at least 6 months after their previous surgery. However, the ideal period is 1 year to allow the tissues to heal completely and the final result to become evident. This period enables more accurate surgical planning.
Conclusion
Revision rhinoplasty is a surgical intervention requiring experience and expertise to achieve better aesthetic and functional outcomes. Compared to the first nasal aesthetic surgery, this process is more challenging, making the alignment between patient expectations and the surgeon’s skills critical. Patients should not view revision surgery as a simple correction procedure and must remain patient throughout the process. A successful revision rhinoplasty can significantly enhance the patient’s quality of life both aesthetically and functionally.
