What is revision rhinoplasty?
Revision rhinoplasty (also called secondary rhinoplasty) refers to any rhinoplasty that is performed to improve or revise a previous rhinoplasty. This revision procedure is performed to correct cosmetic deficiencies and/or breathing concerns that arose from (or maybe were not addressed by) the previous rhinoplasty surgery.
Revision rhinoplasty can involve cartilage being harvested from the nasal septum and ear. These grafts are used to reconstruct the defect that could be causing a visual cosmetic problem and/or breathing difficulty. Rhinoplasty is detailed and exacting surgery, and healing problems can occur after the surgery, including graft warping. After rhinoplasty surgery, some patients may also change their expectations.
It is important to note that every Cosmetic Surgeon who performs rhinoplasty has patients who request revision. An expert Cosmetic Surgeon with substantial experience in rhinoplasty would experience very few occasions where the result was a lot different than was intended and agreed upon. An inexperienced Cosmetic Surgeon may produce poor rhinoplasty results.
Why do people get revision rhinoplasty?
Patients predominantly have primary rhinoplasty surgery to give them a nose that is balanced and proportionate in size and shape for their face. In some cases primary rhinoplasty results don’t always meet expectations, either because of unpredictable healing patterns, a misdiagnosis or inferior surgical techniques.
Before considering revision rhinoplasty, it is generally recommended that patients wait one to two years after the initial surgery. The problems patients see in the first few months after rhinoplasty surgery can also resolve by themselves. While the nose may heal in a few months, it can take up to a year for the nasal tissue to heal on the inside. This healing process is important, as it needs to be pliable enough before another surgery.
It is important to note that not all patients who are dissatisfied with the results of their prior rhinoplasty are suitable candidates for revision rhinoplasty. Some noses are as good as they can get and another surgery with the most experienced Cosmetic Surgeon may not improve it.
Common reasons to seek revision rhinoplasty include:
- The nose is crooked, or has visible asymmetries that weren’t there before, haven’t been corrected or are new.
- It is difficult to breathe. While it is normal for swelling after primary rhinoplasty to cause congestion and blockages for a few weeks, any long-term symptoms may suggest a need for revision rhinoplasty.
- The overall shape and/or size of the nose are not meeting patient expectations. This may include a bump on the nose not being properly corrected or the nose tip being too upturned.
- Over the years since the primary rhinoplasty, visible defects or irregularities have become visible.
- Misshapen nostrils that make the nose look ‘artificial’.
What happens during revision rhinoplasty surgery?
Revision rhinoplasty surgery is almost always performed under a general anaesthetic and is either open rhinoplasty or closed rhinoplasty. Find out more about closed and open rhinoplasty here.
Once the skin is elevated from the skeleton (the bone and cartilage), the surgeon will perform a series of planned tasks designed to alter the shape of the nose, and when necessary, to improve crookedness, and to try to improve the airway.
Like primary rhinoplasty surgery, some or all of the following may occur:
- Dorsal reduction
- Tip plasty
- Alar base resection
- Cartilage harvest (from the septum)
- Cartilage harvest (from the ears or rib, or both)
- Dermis graft harvest
- Bone graft harvest
- Cartilage grafting - spreader grafts, tip grafts, dorsal grafts, columellar grafts, rim grafts, batten grafts.
- Septal reconstruction
Some revision rhinoplasty surgery may require skin grafting. These tissue grafts help restore nasal cartilage, bone or fascia and can be harvested from your ear, ribs or your temple region. In some cases, skin injury and soft tissue damage can impact some revisional rhinoplasty procedures.
Extra cartilage may be needed for strength, to build up an area or fill out and soften an area. In cases like this, if there is enough septal cartilage this will be used. If there is not enough septal cartilage left for a donor graft, cartilage can be taken from the bowl of your ear (conchal cartilage) or from your rib.
Conchal graft is thin and soft, and is a good material to use for covering a defect, or for adding cartilage or a tip where too much was removed. It isn't strong though, and is not optimal where strength and structural support is needed. Rib graft is strong and can be the best material for rebuilding the structural support of a nose if septal cartilage is not available.
Once all the surgical tasks are done to alter the nose shape to the agreed plan, the incisions are closed and the operation is complete. This seems straightforward, however every surgical task is different in every nose. It can be challenging when trying to change the existing nose shape to a new shape.
After surgery, most patients have an external splint put on their nose. Sometimes the Cosmetic Surgeon will use internal splints or packs inside the nose. To help with postoperative bleeding, an absorbent gauze or bolster is placed under the nose.
Revision rhinoplasty surgery usually takes from two to three hours. If the surgery is complex, it can take up to 4 or 5 hours.
Key facts about revision rhinoplasty
- Primary rhinoplasty is almost never 100% perfect; this also applies to revision rhinoplasty. It is very important to make sure your expectations for revision rhinoplasty surgery are realistic.
- Due to the unpredictability of secondary contraction of scar tissue, revision rhinoplasty can be a more complex procedure than the initial rhinoplasty
- Complications related to revision rhinoplasty surgery include bleeding requiring return to the operating theatre, infection including graft infection, prolonged swelling, nasal airway obstruction, septal perforation and shape irregularity or asymmetry.
- After revision rhinoplasty surgery, you can usually resume driving after seven to 14 days, can see normally, can react quickly if necessary and are not taking strong painkillers.
- Heavy exercise is to be avoided for at least 3 to 6 weeks following surgery.
- After revision rhinoplasty, a period of psychological adjustment is common. Most patients go through a variety of moods postoperatively. As recovery progresses, and the postoperative period of swelling, fresh wounds and bruising passes, most people feel positive.
- Revision rhinoplasty is normally much more complicated than a primary rhinoplasty. It is very important to select an experienced surgeon who performs a great deal of revision rhinoplasty procedures.
Are there risks or complications with revision rhinoplasty operations?
Risks and complications associated with revisional rhinoplasty are typically the same as they are for primary rhinoplasty surgery Any surgical operation brings complications of anaesthesia. Your anaesthetist will be able to discuss with you the possible complications of having an anaesthetic. While your Cosmetic Surgeon and healthcare team will do everything possible to make your revision rhinoplasty operation safe, complications are possible.
Revision rhinoplasty surgery risks and complications include:
- Your healthcare team will give you medication to control the pain. To reduce discomfort and prevent headaches, it’s important that you take the medication.
- Bleeding during or after the operation. You may need to have your nose repacked with a firmer pack or have a pack in the back of your nose (risk: less than 1 in 100). If the bleeding is heavy, you may need a blood transfusion.
- Congestion, blockage and a runny nose. In some cases additional surgery may be required to correct this.
- Infection of the surgical site (wound). Let your surgeon know if your nose bleeds or if the skin over your nose becomes red, swells or is tender. An infection usually settles with antibiotics but you may need another operation.
- Blood clot in your leg (deep-vein thrombosis – DVT). This can cause pain, swelling or redness in your leg, or the veins near the surface of your leg to appear larger than normal. Your healthcare team will assess your risk. They will encourage you to get out of bed soon after the operation and may give you injections, medication, or special stockings to wear. Let the healthcare team know straightaway if you think you might have a DVT.
- Blood clot in your lung (pulmonary embolus). If a blood clot moves through your bloodstream to your lungs. If you become short of breath, feel pain in your chest or upper back, or if you cough up blood, let the healthcare team know straightaway. If you are at home, call an ambulance or go immediately to your nearest Emergency department.
What is recovery like after revision rhinoplasty surgery?
You will have a small, external splint on your nose for 5 to 7 days after the revision rhinoplasty surgery. Gauze is used to absorb the small amounts of fluid draining from the nose and medication is given to limit any pain and nausea.
You can return home on the day of surgery or have stay in hospital overnight. Discomfort on the first day is expected but it is generally not severe and decreases quickly. At home, set yourself up in a comfortable chair, couch or bed, with your head elevated.
If bleeding occurs following surgery it may be controlled by sitting quietly with ice packs on your cheeks. If the bleeding is persistent or seems severe, it may require nasal packing by your Cosmetic Surgeon. Should this happen, you must contact your Cosmetic Surgeon immediately.
Facial bruising is normal after rhinoplasty. While the extent of bruising will vary for each person, it usually fades within 14 days. Depending on your occupation, most patients take 2 weeks off work.
Following revision rhinoplasty surgery, it is recommended that you avoid heavy exercise for 3 weeks. Bending, stooping or heavy lifting may cause postoperative bleeding.
Once you are comfortable, are not taking strong painkillers and can see normally, you can resume driving. This usually takes 5 to 7 days.
You will see a noticeable change even through the splint and tapes. The nose will look different immediately after the surgery. Whilst most of the swelling will disappear within two months, the actual healing process takes a full year. Some sensation of the nasal skin is reduced, which may feel disconcerting for a while. Patience is needed, as it will take time to see the final result.
Parts of your nose will feel numb and it may take several months for normal sensation to return, with the tip taking longer than the rest.
With revision rhinoplasty, it is quite common to see some long-term reddening of the nasal skin, with visible broken veins.
What are the long-term results of revision rhinoplasty?
The success of the revision rhinoplasty surgery depends on a number of factors. It is important to note that while the surgical plan can usually be carried out, not all aspects of revision rhinoplasty are predictable.
Excessive scar formation can result in nose shape problems. Cartilage can warp leading to asymmetry, which may require improvement. If asymmetry is present before the operation, it may not be fully correctable.
Surgery to the nasal bones may leave small bumps or irregularities upon healing. Due to these factors, a proportion of revision rhinoplasty surgeries require further revision, or a second small operation, to achieve the best possible result.
Where to find the best revision rhinoplasty Cosmetic Surgeons in Australia
Before you have revision rhinoplasty, it’s important to consult with your Cosmetic Surgeon and to seek second opinions. We suggest that you consult with Cosmetic Surgeons who are experienced and expert rhinoplasty surgeons. You can find the best revision rhinoplasty Cosmetic Surgeons in Australia here.
It is also important that you have realistic about goals and expectations. Some rhinoplasty patients have two, or even three of four rhinoplasty surgeries and discover that it becomes more and more difficult for them to achieve the result they may be seeking.
Before you have surgery, it is vital that you and your Cosmetic Surgeon understand and agree upon the aims of the revision rhinoplasty operation.
Important to know
So you can make an informed decision, your elected surgeon will discuss the possible risks associated with revision rhinoplasty. Although the majority of patients do not experience these complications, it's important to understand how they can be managed in the event that they occur.