Revision rhinoplasty

It is performed to eliminate the unsuccessful results of the previous rhinoplasty. Unfortunately, rhinoplasty cannot be successful in every patient. The tip of the nose can be in the appearance such as compressed, narrowed, wide, asymmetric, lower, raised (pigs nose). The nasal holes can be asymmetric or wide. There can be collapse and breathing difficulty in the side walls of the nose. There can be collapse in the back of the nose, the appearance of polly beak as a result of not taking cartilage part as needed or saddle nose as a result of taking cartilage more than needed. There can be reverse V deformation in the middle part of the nose, continuation of the deviation of twisted nose, roughness on the back of the nose, growth of scar tissue inside or outside of the nose and skin and soft tissue problems.

Firstly, revision surgery can be needed in 5 -8% cases after rhinoplasty. Some of them need minor and some of them need major intervention. In minor revision, the result of the first surgery can be accepted as close to normal, only small intervention is done. The patient can be satisfied with his/ her existing nose and general appearance, but he/ she may want some small corrections. If there are serious deformations after the previous surgery, major revision surgery is performed.

Why is rhinoplasty unsuccessful?

1. The lack of sufficient practice of the surgeon
2. Patients requests not being real
3. Problems arisen due to poor healing and scar tissue
4. Nose injury after the surgery.

For preventing or reducing failure:

1. There should be detailed examination, a good plan and precise and patient work on the basis of the surgery before the surgery. It is always important not the time of the surgery, but its result.

2. The nose should be corrected as a whole, thats both from external and internal functional point of view.

Though the revision rhinoplasty can be performed after 6 months from the first surgery at the earliest, it is useful to wait for 9 – 12 months. It is necessary to wait the full formation of the nose within 2 -3 years in some noses with thick skin.

Septum deviation with anterior rhinoplasty, growth in lower concha, sinechia, scar, septal perforation etc. abnormalities are determined. Other symptoms (concha bullosa, adenoid, polyp, chronic sinusitis, choanal stenosis) cannot be seen with this treatment. Therefore, endoscopic examination should be definitely conducted and if needed, sinus tomography should be taken.

The course of the surgery:

Open or closed rhinoplasy can be performed. Open and closed method is not a surgical technique, it is a way used to reach bones and cartilages of the nose.

The skin is raised with reverse V cut up to columella (the part which separates nostrils from each – other) and cartilage parts are reached with open method. The cut is stitched and closed at the end of the surgery. Almost the scar is not felt during the recovery period. It can be felt or seen while looking at carefully and very closely. Cuts are inside the nose in closed technique. There is no any rule related to the issue of which is better between open or closed techniques in the nose. Here the main aim is the type of intervention and the method of solution. Open method is used in cleft lip, asymmetry in the tip of the nose, twisted nose and in noses which need major revision. The advantage of the open method is the possibility of use of different graft and stitching techniques dominating over the nose.