Revision rhinoplasty refers to a procedure done to correct a deformity or breathing problem resulting from a previous rhinoplasty surgery. In general, revision rhinoplasty is reported to occur at a rate of about 5%-18%. It is important to remember that problems leading to revision surgery can result in any patient and any surgeon - regardless of experience or training.
Although the deformities for which patients seek revision may occur in any patient and with any surgeon, the risk or rate of needing revision rhinoplasty is certainly noted to be higher in the hands of inexperienced surgeons.
In medical literature, the reasons for a patient seeking revision rhinoplasty are given as the following:
Poor surgical technique - In the case of a surgery that was preformed by an inexperienced or occasional rhinoplasty surgeon, over reduction of the bridge and tip structures are among the most commonly encountered defects.
Generally, a major revision needs to be done in this setting involving grafting (movement of cartilage from other areas to strengthen or rebuild skeletal nasal structures weakened or removed by preceding operations). Many of these changes are covered up by swelling during the initial months, but eventually as the healing process continues, and swelling subsides - deformities that may have previously gone unnoticed begin to appear.
Poor surgical planning or judgment - This can result from inexperience, being rushed, surgical complications or variations such as bleeding, or excessive swelling during the surgery. Many of these deformities are easier to correct and generally involve tweaking or adjusting the skeletal nasal structures
Airway problems – Although some cosmetic operations can result in nasal airway changes, many of my patients seeking revision rhinoplasty have airway problems that were left untreated during the first operation. The most common airway problem resulting from rhinoplasty is collapse or narrowing of the lower third of the bridge or nasal valve area. Generally, this complication can be avoided by steps taken to maintain an appropriate amount of width and strength in the cartilages responsible for holding the nose open during inspiration. Consequently, there are cosmetic problems that can be avoided using these same techniques.
Pursuit of perfection - There are a subset of people who, after a rhinoplasty with "acceptable" results, or in some people's eyes good results, will look for perfection. This type of revision rhinoplasty should be very carefully considered with very frank discussions about the pros and cons of undergoing revision for minor changes. In some cases, the push for better results may lead you down the road to worse. These types of revisions should only be considered with experienced surgeons with whom your sense of aesthetic taste is a good match. This can only be determined with detailed and frank conversations using visual aids such as the three dimensional morphing technology used at Lasky Clinic.
In summary, though detailed classification of postoperative deformities have been published in the past, the truth is that all patients are different. All previously operated noses are different, and all will need a combination of different reconstructive techniques to improve upon their results.
When choosing a surgeon for a revision rhinoplasty, the important considerations are your trust for the surgeon, the surgeon's experience with revision surgery and, most importantly, establishment of realistic goals for both the patient and the surgeon.
Behrooz Torkian, MD
Facial and Nasal Plastic Surgery
Lasky Clinic, Beverly Hills