Revision rhinoplasty is the terminology for undergoing a rhinoplasty 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 of 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 rhinoplasty 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, key to success is achievement of patient’s expectations.
Approximately thirty percent of Dr De Silva’s rhinoplasty patients are revisions surgeries.
How do you approach revision rhinoplasty?
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. A revision rhinoplasty is a nose surgery that is done on a nose that has previously been operated on.
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 rhinoplasty 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 of revision rhinoplasty 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 revision rhinoplasty that were not present in an original rhinoplasty: 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 rhinoplasty?
Commonly patients come to see Dr De Silva to improve both their breathing after undergoing previous rhinoplasty. 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 including a CT (computerised tomography) scan. Although measures can be taken to preserve breathing during rhinoplasty, rarely breathing maybe be compromised as the nose has been reduced in size. Additional measures including the use of graft material is often required to improve breathing in revision cases.
How long does revision rhinoplasty take?
Revision rhinoplasty 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 rhinoplasty?
Revision to the nasal tip (pinching, asymmetry, inadequate projection of tip), bridge of nose (irregularities, pollybeak 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 rhinoplasty.
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 rhinoplasty?
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 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 rhinoplasty 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 a 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 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 material, 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 in revision rhinoplasty 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.
I had a difficult recovery after rhinoplasty, I am worried about have further surgery…
Many of our patients are anxious with revision surgery, they did not have the result they were looking 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 rhinoplasty?
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 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.
Sky News interviews Dr. Julian De Silva about Patient Safety in Cosmetic Surgery
I live abroad how can I have revision surgery?
Dr De Silva has a large number of revision patients that live overseas. Our specialist team can help you organise a virtual consultation and coordinate your trip to the UK. 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 the state-of-the-art facilities, stringent safety regulation and international clinicians. 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.
Renowned expert in Facial Cosmetic and Plastic Surgery. Signature techniques in Blepharoplasty, Rhinoplasty and Facelift surgery. Expert in revision surgery and pioneered use of regenerative medicine in Natural Looking Results
Through the new phase of restrictions in the United Kingdom, The Centre London will remain open for patients. We are proud to offer our services in a CQC registered clinical environment, with strict COVID hygiene and safety protocols. Our Team will contact you should your appointment need to be changed, otherwise, we look forward to seeing you at 23 Harley Street.