Revision Rhinoplasty (Correction Nose Aesthetics)
It is the surgery performed to remove the undesirable results of the previous rhinoplasty (nose aesthetic) surgery. There is some controversy in terminology. According to some, the second operation performed to correct the negative results of the surgery performed by the surgeon is called revision rhinoplasty, and the correction of other surgeons’s is called secondary rhinoplasty. However, revision rhinoplasty (secondary rhinoplasty), which is widely used, is called revision rhinoplasty (secondary rhinoplasty).
Unfortunately, rhinoplasty surgery does not result positively in every patient. The tip of the nose can be compressed-narrowed, wide, asymmetrical, low, drooping or extremely shortened and upturned (pig nose). The nostrils may be asymmetrical or wide. There may be collapse of the side walls of the nose (alar collapse) and difficulty in breathing. The arch on the ridge of the nose may continue, there may be a collapse in the ridge of the nose, the appearance of a pollybeak as a result of insufficient removal of the cartilage in the nose, or the collapse of the nasal ridge (saddle nose) as a result of excessive removal. Inverted V appearance in the middle of the nose, twisted nose, continuation of deviation, irregularities on the nasal ridge, excessive scar tissue development inside or outside the nose, skin and soft tissue problems may occur.
In fact, aesthetic and functional complications in primary rhinoplasty constitute the indications (justification) of revision rhinoplasty. Unfortunately, 7-15% of revision (correction) surgery is required after primary rhinoplasty. Some of them require minor revision and some require major revision. In minor revision; The result of the first surgery is acceptable and minor touch-ups are required. The patient may be happy with their current nose and general appearance, but may require minor corrections. However, if there is significant deformity as a result of previous rhinoplasty surgery, major revision is required. Unsuccessful rhinoplasty surgery can reduce the patient’s self-confidence and social activities, the patient is generally unhappy with his nose, but he is also afraid of revision surgery. (I wonder if it will fail again or worse, can I trust my doctor? etc.)
There are many reasons for failure in rhinoplasty. The most common cause is errors during surgery.
Why does rhinoplasty (nose plastic surgery) fail?
1. The surgeon’s experience may be insufficient.
2. The patient’s expectations may not be realistic.
3. The surgeon’s goal may be overly ambitious.
4. Functional problems may occur due to poor healing and scar tissue.
5. Postoperative nasal trauma may have occurred.
To prevent or minimize failure;
1. A detailed examination, a good planning should be done before the operation, and one should work meticulously and patiently during the operation. Wrong incisions, excessive or underremoval of cartilage and bones, and failure to repair the nasal support mechanisms are common causes of poor results. You should not be impatient about finishing the operation. The surgeon must return to the beginning and make the necessary corrections, if necessary, in places where he is not comfortable during the operation and realizes that it is not exactly what he wants. The outcome of the surgery is always important, not the duration.
2. Experience; A minimum of 5-7 years of experience is required for rhinoplasty surgery. It is frequently stated by both ENT and Plastic surgeons that rhinoplasty surgery is one of the most difficult aesthetic surgeries. Just being a skilled surgeon is not enough. At the same time, it is necessary to be a surgeon who has a strong artistic side, is patient, works meticulously, and treats tissues with kindness and respect. It is necessary to think and repair the many structures that make up the nose and their relationship with each other in 3D. In addition, it is necessary to predict which forces will affect the nose in the postoperative recovery process and how the nose will remain stable in the long term. All of these require experience. Revision rhinoplasty requires extra experience compared to normal rhinoplasty.
3. It should not be forgotten that breathing is the main function of the nose and it should not be focused only on the external appearance. It is necessary to try to improve the nose as a whole without compromising neither the breathing function nor the aesthetic appearance.
For revision rhinoplasty, approximately 1 year should be waited after the previous surgery.
Preoperative evaluation is like primary rhinoplasty, but requires more detailed and careful attention. In addition, the need for grafts and possible sources should be determined and the patient’s consent should be obtained.