Revision rhinoplasty has become a very common procedure, partially because primary or original rhinoplasty is performed frequently by surgeons of many different skill and experience levels and remains a challenging and complex procedure to master. The two major types of appropriate revision rhinoplasty procedures that are performed are for:
- Incomplete primary procedures, where the nose and septum remain deviated and too long for the face
- Overdone primary procedures, where excessive cartilage has been removed from the tip and bridge, resulting in a sunken look, pinched look, or excessively small or nonfunctional nose.
Interestingly, where type 2 (overdone) revisions were more common in the 1990s and early 2000s due to an over-aggressive reduction rhinoplasty pattern frequently performed in coastal cities, the type 1 (incomplete) revision is becoming far more common, and may even be the most frequent pattern seen now.
What Causes Incomplete Procedures?
This is in part due to changes in rhinoplasty training, where most physicians performing rhinoplasty are now taught that only grafting and suture techniques are appropriate and that any cartilage removal is incorrect. So, we see a higher incidence of incomplete rhinoplasties, in many cases where some excessive grafting or cartilage addition is performed that has incompletely addressed patient’s complaints and in some cases results in bulkiness or longer noses than aesthetically desired. The truth, of course, is that some cartilage removal is almost always required to resize and shorten a nose. The graft-heavy procedures espoused by most came in to favor to treat the overdone rhinoplasties of the past, but have become overused in many primary rhinoplasties today.
Keys to Rhinoplasty Success
The key to success requires a delicate balance between conservatism and aggressive cartilage removal, but really arises from experience of how the septum, tip, and bridge cartilages ideally exist in a harmonic functional and aesthetic interaction. A deep understanding of the anatomy of these structures and their relationships is very helpful in achieving consistent results in primary and revision (secondary) rhinoplasty.
In many ways, the incomplete revision rhinoplasty cases that we see today are much simpler to repair than the overdone rhinoplasties of the past, requiring mostly primary techniques, but requiring an elaborate understanding of what deficiencies exist. Patients who require revision rhinoplasty of either type frequently experience anxiety or stress about discussing a revision procedure. By discussing very specific anatomic goals and outcome expectations, these fears can be allayed during the pre-operative period. Ideally, an extensive discussion with the surgeon is recommended, where all questions and expected outcomes should be discussed at length. The surgeon can predict the outcome fairly accurately with proper analysis.