Revision rhinoplasty, also known as secondary rhinoplasty, is where someone has surgery on the nose after previously having had nasal surgery. The reasons for performing revision rhinoplasty are as varied as the reasons for having a nose job in the first place. These can include unacceptable look or aesthetics, breathing difficulties or both. Revision rhinoplasty can be one of the most challenging yet rewarding operations in facial plastic surgery. This operation can pose several obstacles unique to revision including:
- altered and unnatural anatomy
- scar tissue
- over resection of necessary supportive structure of the nose
- limited supply of cartilage or “rebuilding material”
- particular anatomic difficulties that made the first surgery especially challenging such as overly thick or thin skin, severely twisted and asymmetric cartilage and soft tissue, twisting of the septum and others.
Due to the added layer of challenges and difficulties unique to revision rhinoplasty, revision rhinoplasty surgeons should have experience, training and mastery in all different techniques and approaches to rhinoplasty surgery. They should have a “tool box full” of helpful tools and the experience to utilize those tools for the benefit of the patient.
Patients seeking revision rhinoplasty have often experienced a very complex and emotionally trying road between their first surgery and revision or revisions. They usually approach their first surgery with hope and optimism only to be disappointed and discouraged. After doing much research, sometimes for years, they reach out again but with nervousness and trepidation. Again, this can be a very draining and emotional road. While this can be difficult, it can make for some of the most rewarding overall experiences for both patient and surgeon. Seeing discouraged patients who are finally made happy, with their original hope and optimism restored, is a wonderful and exciting part of what motivates and drives a revision rhinoplasty surgeon.
If you are considering a Revision Rhinoplasty, please consider and keep in mind the principles listed below:
- It is usually best to wait 1 year from your previous operation before you consider re-operation. Reasons for this are several including unresolved swelling and immature scar tissue, changes to the nose that are in the process of occurring and even problems that may resolve with out further intervention obviating the need for another surgery. In almost all circumstances, it is best to wait even when both surgeon and patient are convinced another operation will be necessary.
- You should expect improvement, even dramatic improvement; however, you should not expect perfection. While this statement is true of primary rhinoplasty, it is particularly true of revision rhinoplasty.
- Recovery from revision rhinoplasty is usually longer than recovery from primary rhinoplasty. The nose may swell more and for longer. It may be more tender and congestion may be worse than with the first surgery.
- If you are reasonably happy with your first surgery and have “just a couple minor things” you want fixed. You really should think and rethink your decision to go in for another operation. You likely will not ever achieve the “perfect” result. Having said that, please do not think you have to live with an undesirable or unacceptable primary or previous revision rhinoplasty. We can achieve dramatic improvement and beautiful results even in revision cases.
- Balancing function (ability to breath) with aesthetics is very important. No matter how pretty your nose may look, if you cannot breathe, it was not a successful surgery. This is an important component of all rhinoplasty surgeries. Beautiful noses should work well and look beautiful.
- It is very common for revision rhinoplasty patients to come in to the office and express regret or remorse over their initial decision to have a rhinoplasty. They will bring pictures of themselves prior to the initial surgery and say, “I just want my old nose back.” Essentially, their goal of the revision operation is to simply undo the previous surgery and get them back to where they were before surgery. Unfortunately, this goal is simply not possible to achieve. Once the nose has been opened in any fashion and surgery has been performed, irreversible changes occur that can’t be returned. The native cartilage require grafting for strength and support, cutting, modeling or molding of the nose have been performed that can not be undone. Even the skin covering the nose behaves differently once surgery has happened. Remember, there is a reason you originally wanted a rhinoplasty. Having a mindset that, despite the fact that your original goals were obviously not achieved, you will continue moving forward with new goals is best. This helps you set appropriate expectations and makes going in to surgery and the sometimes long recovery much more manageable.
Dr. Bitner has extensive experience and is a true expert in the aesthetic art of revision rhinoplasty through the use of both open and closed surgical techniques, rib grafting and more. He has performed hundreds of revision rhinoplasty procedures on patients from across the US and outside the country. Although an in-office consultation and evaluation is always ideal it is not always possible. To accommodate patients from across the globe who seek his expertise, Dr. Bitner offers the convenience of virtual consultations through Skype and email. If you have had a rhinoplasty or nose job and it didn’t go the way you wanted, there is reason for hope. With Dr. Bitner’s training, skill and artistry you can achieve the nose you wanted. Call or email us for to set up a consultation today!