Any “revision” procedure implies that the same surgery has been done in the past. So, a revision rhinoplasty is a nasal surgery, to improve aesthetics and/or function, for patient who has had a previous rhinoplasty. The procedure may also be called a “secondary” rhinoplasty.
Why Patients Need Revision Rhinoplasties
There are two main reasons why a patient will want further nasal surgery. First, he or she may be unhappy with the appearance of the nose. This is the most common problem, since most people undergo rhinoplasty in the first place to change the nasal appearance. Second, the patient may be experiencing nasal obstruction after surgery. Sometimes the obstruction was present before the first surgery, and did not improve enough. Other times, obstruction can be caused by surgery.
It is usually difficult to determine why a particular patient experience one of these two imperfect outcomes. Rhinoplasties are always very challenging operations, due to the complex anatomy of the nose, and the way that scar tissue changes the nose for months and years following any surgery. Sometimes it is impossible to exactly predict how a nose will look or function years after surgery. The best surgeons can most accurately estimate the final result, but no surgeon can predict the future perfectly.
When a nose has already undergone an operation, there are two major changes to the anatomy compared to a nose that has not had surgery. First, although the same components of skin, cartilage, bone, and mucosa (pink tissue inside the nose) are present, their shapes have been altered by the previous surgery. A revision surgeon therefore cannot rely on the normal shapes, or “landmarks”, when doing a revision surgery. He or she needs to proceed more slowly and carefully when identifying all structures. Second, there is always scar tissue that builds up under the skin and around the nasal structures. This scar tissue is firm and difficult to open. It hides the structures of the nose, so again, the revision surgeon must proceed slowly and carefully.
When a surgeon performs a revision rhinoplasty, it is very helpful to have a good understanding of what was done during the primary surgery. So, if you have had a rhinoplasty in the past, you should try to obtain an operative report from the first surgeon, and let Dr. Kabaker review it thoroughly.
Types of Revision Rhinoplasty
A revision surgeon has the same choices for “type” of rhinoplasty as a primary surgeon: open or closed. But, because a revision surgery is more difficult due to changes in nasal anatomy, the open approach is used much more often.
Suitable Patients for Revision Rhinoplasty
Almost any patient who has had a rhinoplasty can have a revision rhinoplasty, if he or she is unhappy with the look or function of the new nose. The patient should be healthy, and have a good understanding of the limitations of a revision case and the expected outcome. During your consultation with Dr. Kabaker, the expectations will be reviewed completely.
A consultation for a revision rhinoplasty in our San Francsico office is quite similar to that of a primary case, but you should try to have as much information available as possible about the first case. Though it is difficult, having the actual operative report of your earlier procedure is best.
The Pre-operative Process
The pre-operative process is similar for a revision case. Please review the Rhinoplasty page for details.
As mentioned above, revision cases are often done using the open technique. Also, your revision case will probably be longer than the primary case. Often, a revision case can last up to four hours.
If cartilage is needed to improve the shape and support of a nose during a revision case, it sometimes must come from one ear. Dr. Kabaker will let you know if this will be needed in your case.
The anesthetic for a revision case is usually the same as that for a primary case.
Your recovery after a revision rhinoplasty will also be like your primary case. The discomfort, bruising, and swelling are all similar.