Revision rhinoplasty or secondary rhinoplasty is an operation that is performed for the purpose of re-correction a failed rhinoplasty. The purpose of rhinoplasty; is to achieve a natural-looking, and an attractive nose. Instead, a substandard surgery may reveal an unnatural, strange-looking nose. While this may have different effects on one's self-esteem, it may be a source of insecurity and depression for some, and may affect almost all aspects of daily life. Although there are many reasons for a failed rhinoplasty, one of the most important reason is inadequate surgical technique. In addition to cosmetic and functional losses, the person has to deal with frustration, regret and anger while looking for a reliable surgeon to correct his nose.
Correcting undesirable consequences of previous rhinoplasty
Although it may seem simple to correct a nose with the desired results in the first rhinoplasty surgery, revision rhinoplasty is actually more complicated and more difficult than the first one. It is necessary to reinforce and replace the fine, delicate structures of a beautiful three-dimensional nose shape that has been damaged, collapsed or destroyed. While the contours of the nose should be smooth and attractive, the air passages must remain large enough to allow for comfortable breathing. Even after all structures have been corrected and assembled, the entire nasal skeleton must have sufficient strength to withstand the distortions forces that result from the healing process of the skin and soft tissues over time. Therefore, this operation, also known as secondary rhinoplasty or nasal revision, is considered one of the most demanding operations of aesthetic surgery. Some important differences between primary (initial) nasal aesthetics and nasal revision are notable. First, the nose revision takes much more time. Because of the obstacles created by the complexity of scar tissue and surgical procedure, the total operation time of revision cases is at least 4-5 hours. Likewise, the length of surgery, a more difficult dissection, and the presence of previous tissue damage will prolong the healing process. In patients with thin healthy skin, the results may be seen in 6-12 months, while in patients with thick skin and prone to poor wound healing, this process may take up to 2 years.
Can cartilage grafts be used for revision rhinoplasty?
In addition to increased treatment time, revision rhinoplasty almost always requires the use of certain graft materials. Graft materials are cartilage tissues that are usually taken from the patient's own body and used when reshaping the nose. Cartilage grafting may be necessary even in patients who want a smaller, more delicate nose. Depending on the lack of nasal structures, the severity of the deformity, the preference of the surgeon, and the authorization of the patient, cartilage grafts may be removed from one or more locations. Frequently taken places; nasal septum cartilage, ear cartilage or rib cartilage. Cartilage from either or all of these sites may sometimes need to be taken in order to achieve good results in very severely damaged noses.
Revision or not?
Taken as a whole, revision rhinoplasty is a complex initiative with many potential risks. While surgical techniques and principles are applied properly, successful and satisfactory results are possible. But absolute perfection is almost impossible. It is also important for patients to understand that modern medicine cannot cure all problems and that a severely damaged nose cannot always be corrected with a single procedure. Because of the pre-existing tissue damage and the limitations outlined above, the cosmetic gains to be achieved in a damaged nose can only be achieved with a challenge and step by step. In addition, attempting to achieve perfection by correcting a nose in this condition in a single operation can go no further than destructive damage to already weakened tissues.
While a successful surgeon seeks to achieve the best possible outcome in each patient, the desire to achieve a striking result should provide the balance between the possible risks and complications of revision rhinoplasty.
The surgeon who knows when to step back is a skilled surgeon. As Hippocrates said; “Primum non nocere!”, “Don't hurt first!……