Being centrally located, the nose should blend harmoniously with the other facial features and not draw attention to itself. In many instances, the results of a previous rhinoplasty can fall outside of what would be considered natural and/or subtle. There can even be deformities or asymmetries that were not present before the surgery. Also, the results may appear to be satisfactory to a casual observer, but not be in keeping with the patient’s expectations. Obviously, there are many factors that impact the results of a rhinoplasty including the original deformity, the expertise of the surgeon, the skin type, the postoperative care, and the patient’s expectations. As with any plastic surgical procedure, the patient should have a realistic approach to what is achievable. When discussing additional nasal surgery, it is prudent to bring preoperative pictures that demonstrate what your nose looked like prior to the original rhinoplasty. Next, you should have a clear idea of what you are unhappy with in the results. The more specific you are in the exact details of shape, size and symmetry, the easier it is for the surgeon to comment on the appropriateness of additional surgery and what he would do. Do not forget to mention the things that you like about the results. Also, it is important to know if the surgery improved, worsened or had no effect on your breathing, and if you are experiencing significant nasal drainage and/or color changes in your nasal skin following the procedure.
Generally speaking, additional surgery is performed no sooner than 6 months after the original operation. This allows time for all the swelling to subside and the nose to settle, so that any deformities/asymmetries that were masked will become manifest. As with the original operation, a revision rhinoplasty can be performed under general anesthesia (totally asleep) or under intravenous sedation (twilight sleep). It is usually a more complex operation because of the scarring and disruption from the original surgery. Additionally, material used to correct the deformities such as nasal septal cartilage may not be available as graft material, and ear cartilage, rib cartilage or synthetic material may be needed. Though most corrections can be accomplished in one revision, occasionally additional procedures may be necessary. The postoperative care is generally the same as with the original procedure, and most patients are healed enough to return to work after one week.
Since each additional surgery is usually more complicated than the previous, it is crucial to ascertain your surgeon’s skill in doing revision rhinoplasties. You should look at as many examples of his work as you can. Remember that not all surgeons who do straightforward, primary rhinoplasties know the techniques or have the experience to do revisions.
