Nose Reconstructive Surgery (Revision Rhinoplasty)

Recreating the human nose is possibly one of the most daunting challenges facing reconstructive surgeons. It is perhaps the most important structure on the body for facial identity and appearance. Revision nasal surgery restores nose shape and function after a trauma or previous surgery.
It is important for patients to understand the risks associated with this procedure and to maintain realistic expectations for their revision rhinoplasty. The best results are achieved by choosing a highly skilled and experienced surgeon to perform your revision surgery, and by maintaining open communication with your doctor.

Who is an Ideal Candidate?

People who have one of the bellow problems can be a good candidate for revision rhinoplasty:

  • Nasal deformities produced by injuries
  • Previous rhinoplasty surgery
  • Cancer surgery
  • Congenital malformations

If you have had a rhinoplasty before, wait at least one year before considering revision rhinoplasty. While some of the nasal swelling goes down almost immediately, it can take a year for all the swelling to subside. Most surgeons believe a minor amount of swelling lasts even longer. If you go back for a revision rhinoplasty too soon, you can turn a minor problem into a major disaster; so be patient.

Revision Rhinoplasty Procedure

Revision rhinoplasty is often performed with either local anesthesia or with general anesthesia. The surgery can take longer to perform than a primary rhinoplasty, sometimes taking up to four hours to complete.
The changes necessary in secondary rhinoplasty can be done through a “closed” or “open” approach. Typically, if there are major structural changes required, and open approach may be preferred. Minor contour corrections can be performed via a “closed” technique. Closed rhinoplasty is when only internal incisions (endonasal) are made for access to the nasal structures. The closed approach may be safer if you have scarring from earlier nose surgeries. Open rhinoplasty refers to the addition of an incision in the skin bridge between the two nostrils (columella) in order to lift up the nasal skin for more direct visualization of the structures to be altered. The decision to use either the closed or open approach in revision rhinoplasty is based on surgeon preference and each technique has its pros and cons.
Cartilage grafts (portions of cartilage from the septum, ear, or a rib) are often necessary to accomplish the cosmetic and functional goals in secondary rhinoplasty. Cartilage grafts from the ear are good for nasal tip grafts but often lack strength and support needed for some reconstructive revision Rhinoplasties. In cases where several ample and sturdy grafts are required, rib cartilage may be the most ideal source of cartilage. The downsides of rib grafts is that there is some discomfort associated with the procedure and the patient has to accept an incision on their chest. There are also synthetic materials that may be used.

Revision Rhinoplasty Recovery and Aftercare

Revision rhinoplasty recovery is similar to primary rhinoplasty recovery. Nasal packing will help reduce swelling and bleeding after surgery, but you will be unable to breathe through your nose until the packing is removed. Your surgeon can prescribe painkillers to help relieve any of the pain associated with the surgery. It is also a good idea to elevate your head for the first week after surgery and to avoid any trauma to the nose area during the first six to eight weeks after surgery. Blowing your nose should be avoided for two to three weeks after any type of rhinoplasty. However, your airway should be clear as soon as the packs are removed, and the need for nose-blowing (common when the airway is obstructed) should diminish significantly after your surgery.
Though swelling is significantly reduced after the first week, it can take as much as a year for all of the swelling to disappear.