REVISION
RHINOPLASTY
Why
is Revision Rhinoplasty Tougher?
Revision
rhinoplasty, also commonly referred to as secondary rhinoplasty, is any time
the nose has surgery performed on it after the first surgery. Revision
rhinoplasty is more often than not more difficult to perform than a primary
(first time) procedure. It takes more time to complete, will often require
materials gained from other parts of the body, and requires more knowledge,
experience, and technical skills on the surgeon’s side.
So
why is secondary rhinoplasty much tougher to perform? Well, to begin with, the
anatomy is no longer pristine, but rather, there will often be an abundance of
thick, hard scar tissue from the previous operation. Scar tissue obscures the
natural tissue planes that separate the various cartilages, bone, and soft
tissue within the nose. Precise and careful dissection is often painstakingly
necessary to separate the scar tissue from normal structures of the nose.
Defining
the normal existing anatomy of the nose is only the beginning and this alone
can take hours. Once the existing anatomy of the nose has been clearly defined,
the surgeon then has to assess what’s present, what’s absent, what’s normal,
and what’s abnormal. This assessment is followed by correlation with the
current clinical picture and what is the desired final outcome. To achieve this
desired result, the surgeon then has to begin formulating a plan to “re-build”
the nose.
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The
nose is like a tent, supported by its poles. Underneath the skin of the nose,
there are inter-related cartilage structures that give shape to the nose. More
importantly, these cartilages also keep the nostrils open and allows a patent
airway to breathe through. Not uncommonly, a revision rhinoplasty case will
present a nose that lacks structural support. Imagine a tent which has weak
tent poles. A nose like this will lack strength and is at risk of collapse. One
of the reasons why this type of nose may lack support may be due to
over-removal of tissue from the previous operation.
To
restore structural support to the nose, one has to find material (usually
cartilage) to build and also support the construct of the nose. The cartilage
that is used is often taken from the septum (the structure that runs down the
middle of the nose), the ear, or the rib. “Harvesting” this cartilage material
is another factor which adds to the complexity and time required for a revision
rhinoplasty. It also adds to another scar on the patient.
At
the outset at any rhinoplasty, one has to devise a plan together with the
patient that aims to achieve the ideal outcome through one, first, and final,
procedure. That been said, as with any other surgery, there is always the
chance that the outcome achieved may not be 100% in line with what the patient
expects. Complications can occur, and revision surgery is always a possibility.
With nose surgery, both surgeon and patient need to be extra patient before
they evaluate the final result. Swelling in the nose can persist for many
months after surgery, especially in men and in thick skinned people.
One
must be careful not to rush into performing a revision before the final shape
of the nose is realised. The shape and function of the nose will continue to
change and often improve as swelling subsides and the scar mature. Regular
follow up between the patient and surgeon is therefore crucial to ensure that
the patient is progressing in the right direction.
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