Revision Rhinoplasty

Revision rhinoplasty: how to face a disappointing nose job

What can you do if the result of a rhinoplasty does not live up to your expectations? How to deal with postsurgical aesthetic and/or functional defects? A revision rhinoplasty, which is a nose job to correct unsatisfactory surgical outcomes of the previous rhinoplasty/rhinoplasties, may be the right solution for this case. Nose revision surgery can correct both aesthetic imperfections and functional problems, first of all of impaired nasal breathing.

There can be several reasons for dissatisfaction after a rhinoplasty. Some are basically aesthetic, such as the so-called “surgical look” which a revision rhinoplasty expert can convert to more natural result. Others, on the other hand, involve the internal and external nasal structures and functionality, which causes major issues. A careless and aggressive approach in the primary reduction rhinoplasty can disrupt the supportive mechanism of the dorsum and/or tip, causing it progressive weakness and inadequacy. Excessive resection of the nasal septum, bridge and tip makes revision surgery much more challenging, up to extreme rhinoplasty. Needless to say, that it is the surgeon’s responsibility to clarify from the first consultation that a “simple nose-job” in patient’s eyes can, actually, involve complex reconstructive provedures.

However, advancements of the minimally invasive surgery over the last decade have dramatically reduced the frequency and complexity of revision rhinoplasty. In particular, minimal invasive rhinoplasty makes structural grafts substantially unnecessary in the first operation. Nevertheless, it is crucial to emphasize that every male or female rhinoplasty is a case in itself and ,as such, requires meticulous pre-operative analysis and a precise surgical project “tailored” to each patient.

Experienced and prudent surgeon will always keep in mind the hypothetic possibility of the revision surgery on the same patient. Frankly speaking, in expert hands it is rare, but possible. Therefore, a careful, conservative and mini-invasive approach should be the fundamental rule in all rhinoplasties (first of, for all in primary rhinoplasties) that creates a essential basis for the possible retouch or a complete nose job revision.

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The best nose job revisions: from adjustments under local anesthesia to extreme surgery

Let’s take it for granted that there is no “routine” surgery. Nevertheless, we can distinguish nose jobs revisions for their technical complexity. Of course, we cannot equate extreme surgery and light touch-ups under local anesthesia. However, both surgeries require maximum focus and expertise from the rhinoplasty surgeon, who should be ready to evaluate the state of the internal and external nose in a correct way and to apply, consequently, a correct technique to address all the defects each single female or male rhinoplasty presents.

The secondary rhinoplasty expert can be involved in dealing with the complex and extreme problems, such as:

  • saddle nose, or the sagging of the nasal dorsum, caused by an excessive removal of bone and/or cartilage
  • steps formation on the dorsum and/or lateral walls due to insufficient or inadequate osteotomies;
  • inverted V-shaped deformity, which is a serious post-surgical complication due to an overaggressive dorsum work with consequent disarticulation between the bone and the cartilage;
  • collapse of the nasal middle third, caused by a reckless resections of the triangular cartilages;
  • nasal ala collapse, which occurs when the alar walls lose their support leading to the respiratory dysfunction (the patient often experience obstructions when inspiring as a result of the nasal valve collapse) and aesthetic defects (the so-called “pinched nose”, which gives a “surgical” and unnatural look to the nasal tip);
  • notable asymmetries in different areas of the nose (dorsum, tip, lateral walls)
  • severe respiratory problems.
  • perforation of the nasal septum.

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The best second rhinoplasty benefits a lot from the right approach in the primary rhinoplasty

A conservative, non-destructing approach in primary rhinoplasty, secured by the minimally invasive techniques, generally leads to a much more predictable final result. To some extend, it “simplifies” also a possible revision nose job by providing a greater room for maneuver, safety and success.

However, due to inexperience or, in opposite, excessive overconfidence, the surgeon sometimes:

  • accepts incongruous, unrealistic, or even “risky” requests from patients such as a desire of a particular profile line which in incompatible with the present anatomical structures (ex., very narrow tip, too low dorsum, too much overrotated tip, and so on);
  • underestimates the importance of a thorough and accurate preoperative analysis;
  • neglects the patient’s anatomy and nasal structures, which create the conditions of numerous visible defects in a long term;
  • uses cartilaginous grafts even when not strictly necessary (i.e., when the osteocartilaginous framework has evident defects of support).

In all these cases the patient may need a revision expert to correct aesthetic defects such as a “surgical nose” stigma, the collapse of the nostrils or dorsal structures, discrepancies or asymmetries and even major functional problems.

Nose job revisions for defects related to the healing process

Nasal surgery is a complex art, and as such it requires a long, in-depth experience and a complete dedication of a surgeon. However, even the most skilled, experienced and competent surgeons can have dissatisfactory or imperfect results. These unfavorable events mainly occur during the healing process – an important and not completely predictable variable of rhinoplasty.

  • among the healing problems, hypertrophic visible scars can occur at the ste of the external columellar incision after open rhinoplasty
  • the so-called fibrous Polly tip, an unsightly build-up of fibrous scar tissue just above the nasal tip, is another common postsurgical defect. These tenacious subcutaneous thickenings can occur at the supratip area producing so-called polly beak of supratip deformity.

In these cases, an accurate and regular post-operative check-up allows to intervene promptly in these cases. Treatments like micro-infiltrations of corticosteroids can give perfect results. Retouching, when required, can be done with a minimally invasive outpatient surgery under local anesthesia. Same procedure could be applied to correct minimal dorsum imperfections, local subcutaneous scar thickening, small loss of projection and rotation of the tip – just to name the most frequent causes.

Super-specialized surgeon for your revision rhinoplasty

What to do if you are not completely satisfied with your appearance or, even worse, if your respiratory function is compromised after nasal surgery? You can go back to the the surgeon who operated on you and ask for a nose job revision. Or you can contact an expert in revision rhinoplasties. Rhino- and septoplasty are operations of considerable complexity, requiring the skills of a super-specialized surgeon with decades of experience, expertise and specific skills in nasal surgery.

Revision rhinoplasty requires even more advanced surgical skills, ranging from the ability to identify and interpret the defect in the preoperative analysis, to the selection of the most appropriate operative technique. Precision of the surgical maneuvers is a must Surgery should be performed in a reasonable operating time to minimize the possible risks the long-time operation (7-8 hours) can lead to. These kind of surgical risks could be justified in much more complex surgery, complex surgery such as cardiovascular surgery, neurosurgery, organ transplantation, complex multi steps oncological operations.

Each secondary (and each following) rhinoseptoplasty is a unique, talor-made to the needs of each individual patient surgery that demands all the attention and dexterity of the most expert surgeon. If you are thinking about reshaping of your nose, the best advice we can give you is to carefully choose whom to contact for the first in-depth evaluation. If this is true for the primary rhinoplasty, it is even more valuable when we come to the question of the revision surgery. The inspiring criterion is the pursue of the perfect synthesis between minimum invasiveness and maximum effectiveness.

Revision rhinoplasty specialist in Milan

“Who is the best surgeon for a secondary rhinoplasty in Milan?” is a frequently asked question without a single right answer. However, absolutely right is that Dr. Palma specializes exclusively on the nasal surgery. In course of almost thirty years of surgical experience, Dr. Palma and his team have faced a wide range of aesthetic and functional problems of varying complexity.

The revisions place the surgeon in front of serious structural alterations both of the bone-cartilage skeleton and of the external and/or internal nose. These technically highly complex reconstructions create extreme situations that require the use of grafting material of the same patient harvested from the different donor sites apart the nose (ear, ribs). Dr. Palma and his team created a detailed tailor-made approach they apply in each case, highlighting the pros and cons of every therapeutic choice, and then discussing it in detail with the patient.

Do you need more information on secondary/tertiary rhinoplasty? Are you willing to find out whether you are a potential candidate for a revision surgery? Do not hesitate to contact us and schedule an appointment with your nose job revision surgeon in Milan.

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Pietro PALMA Chirurgo Rinoplastica


FAQ

HOW THE FIRST CONSULTATION IS CARRIED OUT?

The aim of the first consultation is to make a correct diagnosis of your external and internal nose as well as to evaluate your past medical history. Specific nose-related symptoms will be evaluated by taking a thorough history, a nasendoscopy, and performing morphological analysis of the external nose. Finally, I will take professional quality photographs of your face and nose for detailed analysis.

IS THE FIRST CONSULTATION FREE OF CHARGE?

The first consultation is not aimed to sell a product. It cannot be free of charge as it is a very specialized consultation lasting 30’-45’ by an international rhinoplasty expert using high tech-tools in a modern, comfortable and well equipped medical office.

HOW MUCH DOES RHINOPLASTY COST?

As each case is different, a standard cost cannot apply. Costs are related to the extent of surgery and the duration of the operation. Within the first 48-72 hours of the first consultation, a detailed quotation will be emailed to you.

WHICH TECHNIQUE DO YOU USE?

As your surgeon, I will adapt my technique to match your specific anatomical findings and with respect to your wish list of desirable changes. Due to my decades of dedicated rhinoplasty surgery, I can call upon a vast array of techniques in order to safely cope with the myriad variants of nasal anatomy.

I prefer closed (endonasal) rhinoplasty for most of my patients in order to be respectful of nasal anatomy and avoid unnecessary surgical aggressiveness. In more complex cases, I use an “hybrid” closed approach that allows me to utilize techniques commonly used in the open approach (sutures, grafts) but without opening the nose. I opt for the open approach in severe malformations or in specific revision cases.

IS IT POSSIBLE TO OPERATE SEPTUM AND TURBINATES AT THE SAME TIME OF RHINOPLASTY?

The nose is a complex structure in which form and function are intimately connected. Almost always, rhinoplasty is a septo-rhinoplasty because the septum not only plays a functional role, but also contributes to common problems of the external nose. Examples include: crooked nose, hump, drooping tip, excessive nasal length, over-projection of the nasal tip, just to name a few of the common deformities seen in my practice.

Inferior turbinates are probably the commonest cause of nasal obstruction, and their treatment is commonly associated with septo-rhinoplasty or rhinoplasty. Modern, minimally invasive endoscopic techniques allow the surgeon to manage these important structures precisely and conservatively.
Therefore, it is absolutely indispensable that your rhinoplasty surgeon possesses specialist training and substantial experience in treating problems of the internal nose.

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