Revision rhinoplasty is performed when the initial rhinoplasty procedure does not meet patient’s
expectations. Although on occasion patient expectations may be unreasonable, typically, when patients
are not happy with their rhinoplasty results, there is a definite reason for their dissatisfaction. The cause
of dissatisfaction typically involves desire for more definition or contour asymmetries, and less seldom
irregularities created from poor structural support. For example, for patients undergoing an open
rhinoplasty where tip manipulation is required, reinforcement of the tip is critical; when reinforcement
is omitted, the nasal tip can drop in position and create a supratip fullness. For patients who have been
over-resected in the nasal dorsum, a saddle nose deformity may occur, where there is a saddle like,
indent at the mid nose level.
What makes Revision Rhinoplasty challenging is four fold and include:
1st: all of the nasal structures are scarred making surgical dissection and achieving hemostasis more technical
2nd: the structural supportive elements are no longer malleable and usable following the initial surgery
thus requiring introduction of new supportive cartilaginous material
3rd: more often than not, the donor supportive cartilaginous materials such as the septal cartilage have already been used up in the
4th: the overlying nasal skin tends to thin out following each surgery, making stable soft
tissue nasal coverage more challenging.
Recent advances in medicine have allowed us to overcome many of the above obstacles. For example, harvesting of rib cartilage is often required to complete a revision rhinoplasty since the septal cartilage has already been used. This harvest does add an hour to your surgery and prolongs your surgery; however, we can now use organ donated rib graft material thus avoiding need to harvest yours! Another advancement involves use of Nitro-paste to your nasal skin during surgery which promotes improved blood flow to the nasal skin minimizing risk of skin compromise during revision rhinoplasty. Revision rhinoplasty before and after results below will help you recognize what nasal contour improvements are possible for you.