Rhinoplasty patients often wish to improve upon the results of surgery done elsewhere. Reasons for dissatisfaction range from assymetries and undercorrection of previous deformity to poorly planned procedures with overcorrection and associated nasal obstruction. Revision rhinoplasty is widely considered one the more complex procedures in plastic surgery, and requires careful planning and realistic objectives. The procedure may involve grafting of cartilage or other materials to restructure and strengthen the nose, as well as improve breathing.
A key first step with revision rhinoplasty patients is to identify the problems. Usually, patients point out the obvious concerns: a persistent hump, a scooped out bridge or "saddle-nose" deformity, an overly wide tip, etc. Other problems require a careful physical examination and may include alar retraction, persistent deviated septum, nasal valve collapse, scar tissue, etc.
Once the patient's concerns are identified, along with other issues that may require correction, a realistic surgical plan is formulated. The patient must understand that with each surgical procedure scar tissue is created, and scar tissue makes results of further surgery more difficult to predict. Nevertheless, many patients are excellent candidates for revision rhinoplasty, as long as their expectations are in sync with what is surgically feasible.
Revision rhinoplasty may require more operating time than primary rhinoplasty, as the dissection and sculpting need to be meticulous. Grafting is often used to rebuild the nasal bridge or add strength to the nose. Cartilage from the nasal septum may be used, but if this is not sufficient ear cartilage can be used with minimal scarring and no change to the appearance of the ear. Occasionally, artificial dermis may be added to thicken nasal skin that has retracted from previous surgery.
