Before and After: Nose Re-Shaping

Revision Rhinoplasty

Written by Dr Julian De Silva

  • Revision rhinoplasty is the terminology for undergoing surgery after having a previous procedure on the nose, including previous rhinoplasty, septoplasty or substantial trauma.
  • The anatomy and soft tissues of the nose is intricate, and once surgery has been completed there is a degree of scarring and change in anatomy that is unique to each individual patient.
  • The level of scarring is dependent on multiple factors including the previous surgery, the surgeon, the ethnicity of the patient and their individual genetics and healing.
  • The treatment of patients who have undergone previous nose surgery is challenging and is dependent on the degree of change and patients’ expectations from surgery.
  • Although for most patients a substantial improvement can be made, the key to success is the achievement of patient’s expectations.
  • Approximately thirty percent of Dr De Silva’s patients are revision surgeries.
Revision Rhinoplasty

How Do You Approach Revision Surgery?

  • Rhinoplasty, a surgery to fix either the cosmetic defects or improve the function of the nose, is one of the most technically difficult surgeries. Patients may end up dissatisfied with their end results, and wish to fix their unsuccessful nose jobs, which has created a large need for secondary or even multiple surgeries.
  • Because nose surgery is a challenging procedure, if the surgeon is not sufficiently skilled or experienced, patients can end up with breathing problems or dissatisfaction with the cosmetic appearance of their nose. Revision surgery seeks to solve these problems, and as each case is unique, the techniques used will also vary per patient. A previous surgery complicates any further work, which is why revision rhinoplasties can add more difficulties to an already demanding surgery. That is why it is important to choose a surgeon who has a great deal of technical skill, knowledge of the latest techniques, an artistic touch, and extensive experience, especially with dealing with the patient’s specific ethnic group and problem.
  • Simpler cases will remove some excess tissue or cartilage that was missed in the first surgery. There are also cases of straightening out a crooked nose, and the most complicated cases will require a complete overhaul of the nose.
  • There are also further limitations on a rhinoplasty in London that was not present in an original surgery: scar tissue may have built up to a point where surgery is inadvisable, or the skin in the area may be compromised or insufficient. Revision surgery can be very challenging with a combination of scar tissue and a change in natural anatomy, realistic expectations are an important consideration.

Reduced Breathing After Surgery?

Commonly patients come to see Dr De Silva improve both their breathing after undergoing the previous surgery. To assess breathing requires an assessment in person and cannot be completed with photographs or imaging alone. For specific patients’ further tests may be required to evaluate the cause of their reduced breathing and include a CT (computerised tomography) scan.

Although measures can be taken to preserve breathing during surgery, rarely breathing maybe be compromised as the nose has been reduced in size. Additional measures including the use of graft material are often required to improve breathing in revision cases.

Revision Rhinoplasty

How Long Does Revision Surgery Take?

Revision surgery is an outpatient procedure and can take between three to four hours. The surgery takes approximately 30-50% longer than a primary rhinoplasty.

Recovery Time After Revision Surgery?

Often recovery time is longer with revision surgery as a consequence of increased swelling and scar tissue. After surgery, Dr De Silva uses specialized anti-inflammatory medications to enhance recovery and has pioneered the use of regenerative medicine in the UK.

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What Are Common Indications for Revision Surgery?

  • Revision to the nasal tip (pinching, asymmetry, inadequate projection of tip), bridge of the nose (irregularities, Polly beak fullness, saddle depression, residual nasal bump, wide-open roof), nostrils (asymmetry, flaring, collapse) size of the nose (too short, too long), breathing difficulty). Most of these complications are minor and can be easily corrected and may occur in the best of hands as a patient’s healing process play an important role in results.
  • Each revision surgery is unique and requires customised treatment with respect to the position, shape, scarring and function of the nose.

What is Different in Revision Surgery?

  • Revision rhinoplasty is a more complex procedure with the presence of scarring and a change in the natural anatomy of the nose and often requires additional specialist techniques to improve the aesthetic result.
  • For some patients, Dr De Silva imports specialist graft material from the US to improve the final result for some patients, and other techniques may be required such as the use of the patient’s ear cartilage to support a long-lasting result.
  • As a consequence of having a previous procedure on your nose, the recovery after revision surgery can be longer as swelling can longer to resolve, for some patients the use of anti-swelling medicine after surgery can be a powerful tool to speed up recovery after surgery.
  • The nose is an intricate part of the face with unique anatomy and function, millimetres are the difference between success and failure.
  • The nose has an important function in breathing and Dr De Silva often takes additional measures to improve the function of your nose.

Why is Graft Material Required in Revision Surgery?

  • Often with revision surgery anatomy is weakened and graft material (cartilage) is required to improve the nose shape and structure.
  • When patients have had too much tissue removed, there can be a deformity and compromise of the structural integrity of the nose. These cases will require a tissue graft of cartilage or bone from donor sites such as the ear, temple, or ribs.
  • Dr De Silva prefers to harvest cartilage from your own nose (septum) if possible. However, in many cases, this is not an option, as it may have already been harvested in the original procedure. When this is the case, Dr De Silva may use ear or rib cartilage. He prefers not to use the patient’s own rib cartilage due to the scar it leaves behind, as well as potential risks such as injury to the lung or chest. Instead, Dr De Silva obtains irradiated rib cartilage from a rib bank in the US and has the flown in specially for each patient. Rib cartilage is a safe option that works well to support or add to areas of collapse. It works particularly well as a source of support for the nasal bridge which requires a long straighter graft. No graft material is perfect, and the potential downsides of cartilage grafts are reabsorption of the graft or warping.
  • Using modern techniques, for the majority of patients, the grafts are a long-term solution. There are benefits and drawbacks to all graft materials, and hence it is important to take precautions such as the use of antibiotics.

Can Revision Rhinoplasty Always Be Completed?

Dr De Silva is able to achieve excellent results and will operate on cases where he feels he can achieve a success that is within the patient expectations, if he cannot achieve this he may advise against further surgery.

Dr De Silva asks some patients to send information such as medical history and photographs of their nose in advance of a consultation to ensure that we are able to help.

Revision Rhinoplasty

I had a difficult recovery after rhinoplasty, I am worried about have further surgery…

Many of our patients are anxious about revision surgery, they did not have the result they were looking for after the first surgery and are worried about undergoing further treatment. Dr De Silva takes time to ensure we provide a thorough discussion regarding further treatment, recovery and offering emotional support before and after surgery. Our aim is to provide the best possible experience and to foster a long-term relationship with our patients to provide ongoing care for years to come.

Will I Be Happy After Revision Surgery?

Dr De Silva only provides patients with sincere information on results from revision surgery, and a minority of patients he advises against surgery. Although most patients’ symptoms can be improved substantially it is important to have a discussion regarding realistic expectations, as the previous scarring cannot be reversed only improved. A small proportion of patients may require two procedures.

What is the Worst Complication?

After a thorough examination most serious issues can be excluded (nasal collapse, breathing issues). The key aspects are recovery often takes longer with the final result as long as 18-24months after surgery. In addition, realistic expectations for improvement are important to discuss.

I Live Abroad, How Can I Have Revision Surgery?

A large number of Dr De Silva’s patients live overseas. Our specialist team can assist with setting up a virtual consultation and coordinating your travels to the UK for your revision surgery. We are able to utilise the latest technology to enhance your recovery including oxygen therapy and regenerative medicine.

Why Come to the UK for Revision Surgery?

London and Harley Street have been famous for providing world-class medical services since the 19th Century. A combination of state-of-the-art facilities, stringent safety regulations and international clinicians make this an ideal location for revision rhinoplasty in London. Dr De Silva has treated patients from all continents of the globe looking to have the best quality of care in the world.

  • Over 30% of Dr De Silva’s patients have undergone previous surgery.
  • Dr De Silva has completed numerous book chapters and research articles on rhinoplasty and revision rhinoplasty.
  • Dr De Silva published a book entitled A Complete Guide to Nose Surgery and Rhinoplasty in 2017.
Revision Rhinoplasty - globe
About the Author: Dr. De Silva

About the Author

Finding the most reputable facelift expert is never easy. Therefore, you should always research the best surgeons in your area and ask plenty of questions. Dr De Silva is a facial cosmetic surgeon, author, educator, with a track record of doing procedures for top celebrities. He is based at world-renowned Harley Street in Central London and specializes in three main procedures: Face and Neck lifts, Blepharoplasty, and Rhinoplasty.

Come witness a custom-built surgical centre that is not your average hospital. You are guaranteed to experience natural-looking results and fast healing thanks to growth factors, oxygen therapy, and state of the art technology.

By specialising in only the face, you can rest assured knowing that you’re getting premier results. Dr De Silva achieves natural-looking results for his patients using the latest technology, so they can heal quickly and look their absolute best. No matter what your reason for wanting a cosmetic treatment is, Dr De Silva and his team are here to help. To find out more information about Dr De Silva and his work, check out our website.

Dr De Silva’s Google Scholar

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