Written by Dr. Julian De Silva
Rhinoplasty, a surgery to fix either the cosmetic defects or improve the function of the nose, is one of the most technically difficult surgeries. Many 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 great 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 imperative 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. When patients have had too much tissue removed, leaving a severe deformity and even compromising the structural integrity of the nose, these cases are the most difficult to repair. These cases will require a tissue graft of cartilage or bone from donor sites such as the ear, temple, or ribs; patients requiring grafts will experience a longer recovery time and potentially further side effects. 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
Dr. De Silva prefers to harvest cartilage from your own 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. However using modern techniques, for the majority of patients the grafts are a long-term solution. There is a risk of infection with any graft material, and hence every precaution with antibiotics is made before, during and after the surgery to minimize this.
Revision rhinoplasty is still an outpatient procedure (when a graft is not required) and can take between two to four hours. At London Facial Plastic Surgery, we offer several options of sedation, including twilight anesthesia and general anesthesia. Recovery may be easier than a primary rhinoplasty, with less bruising and pain, but a full week will still be required before daily activities can be resumed.
If you are in the UK and have had a previous rhinoplasty with unsatisfactory results, please contact us to schedule a consultation at our Centre for Advanced Facial and Cosmetic Plastic Surgery, located in West London in Hammersmith, to discuss your revision rhinoplasty options. Dr. De Silva is regarded as one of the best rhinoplasty surgeons in London, and he will be able to help you determine what best possible results can be achieved with a revision rhinoplasty. Using state of the art computer imaging technology, Dr. De Silva can show you what the results will look like before the procedure. It is important to have realistic expectations from any surgery, but especially from a revision rhinoplasty, as the area may be too compromised for significant improvement.