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Revision/secondary/complex rhinoplasty

Complex rhinoplasty is one of the most technically challenging cosmetic facial surgeries, and requires a highly personalised approach, including several consultation and consideration of the face as a whole. So if the initial procedure is not performed with due diligence, it can lead to patient dissatisfaction postoperatively – either in terms of the appearance of the nose, or medically, manifesting as breathing problems. If this is the case, a revision rhinoplasty becomes necessary in order to correct the original procedure and create a more flattering result.

What does the surgery involve ?

Previous surgery can complicate any further work, which is what makes revision rhinoplasty a more intricate procedure.

The procedure is usually performed under general anaesthetic, but there is scope for it also to be performed under sedation and local anaesthetic in extenuating circumstances. Almost always, a revision rhinoplasty will be performed as an open procedure to allow the surgeon better access to the delicate tissue, cartilage and bones that are responsible for the appearance of the nose. This requires a small incision being made on the outside of the nose so that the skin can be lifted, but it is subtle and can easily be concealed in the contour of the nose postoperatively.

In simpler revision rhinoplasties, your surgeon may have to remove excess tissue or cartilage that may have been missed in the original surgery. Where necessary, they may also have to straighten out a crooked nasal bridge by fracturing the bone in a controlled way.

For more complicated procedures, a total overhaul may be necessary. When patients have had too much tissue removed from the nose, a graft using cartilage or bone will have to be used, which can be taken from the ear, temple or ribs.

There is also a chance that scar tissue will have developed as a result of the first procedure, in which case surgery is inadvisable, or the skin in the area may be insufficient.

These circumstances make revision rhinoplasty problematic, and should be discussed carefully with a surgeon.

For a relatively straightforward procedure, revision rhinoplasty will take 1-3 hours. If you require a graft, this may become more.

What can I expect after revision rhinoplasty?

If you require a splint, this will be applied during the procedure. It must remain there for 7-10 days after your procedure, because it helps to control swelling. If you have had a cartilage graft – which moderate to severe revision rhinoplasty cases usually will – you may also require an internal splint, which will remain in place for 5-7 days after surgery.

You may experience some bruising around the eyes and over the upper face, which will begin to fade after around 3 days. Keep your head elevated while you sleep to aid the healing process. You may experience some discomfort, which can be managed by painkillers.

Glasses wearers should take care not to wear them for long periods, and it will not be appropriate for contacts wearers to use lenses while the eyes are still swollen.

You should expect to take 10-14 days off work, and 6 weeks from exercise. Speak to your surgeon about specific time frames for your individual needs.

What are the risks of revision rhinoplasty?

Complications are fortunately rare. Time will generally improve the swellling and hence the appearance of the nose. Occasionally bruising takes longer to disappear especially in darker skinned people. Nose bleeds and infections are all possible complications but extremely rare and easily corrected if early treatment is obtained. As swelling of the nose settles following surgery, the nose shape will gradually change over a period of months and minor irregularities should therefore not usually be addressed until most of this swelling has settles which is usually 10-12 months following your initial surgery.

Scarring can occur and in these cases the scar maybe a different colour to the surrounding skin or raised and lumpy. Again scars take time to settle and will usually fade and soften over 6-9 months following surgery.

It is common for the nose – especially the tip – to feel numb following secondary rhinoplasty. This should settle over 4-6 months.

Some nasal asymmetry may still be present following surgery, especially if the nose was deviated before surgery although usually this should be much improved.

Occasionally allergic reactions can occur to sutures, tape, splints and may require treatment.

Wound disruption or delayed healing can occur and rarely some areas of the skin may necrose. This is more likely in patients who either have had multiple procedures on their nose previously, or in smokers and immunosupressed patients e.g. diabetics.

If some cases cartilage grafts need to be placed to support the structure of the nose and this cartilage is usually harvested from the septum inside the nose. Occasionally this can cause a septal perforation which usually does not need further treatment but occasionally can cause discomfort with airflow and breathing and require a secondary procedure to correct.

Differences in breathing maybe apparent following surgery and in the initial healing period nasal airway obstruction is common as the mucosa is more congested and nasal drops may help with this.

As with all surgery there is a risk of dissatisfaction after surgery and this is more so following revision rhinoplasty. As such your surgeon will take time to discuss the procedure with you so that both you and your surgeon are satisfied that your expectations are realistic.

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