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Revision Nasal Surgery (Secondary Rhinoplasty)

What Is It?

The majority of patients are pleased with the results of their rhinoplasty surgery. However, it is a technically demanding operation, and it is reported in the literature that 15 to 20% of patients end up having a result with which they are not entirely happy. It is usually best for these patients to address their concerns with the initial surgeon and often times a revision procedure can achieve the desired outcome. This is gratifying to both the patient and the primary surgeon, and is also financially most feasible.

When there has been an exceptionally unfavourable result, when revisionary surgery has been carried out and still does not achieve the desired outcome, or when there is a problem in the patient/surgeon relationship, then it is wise for the patient to consider additional opinions. One resource is the family doctor, who may be able to provide the name of a plastic surgeon specializing in secondary rhinoplasties. The patient can also contact the Canadian Society for Aesthetic Plastic Surgery or the Canadian Society of Plastic Surgeons for an appropriate referral.

There are not many plastic surgeons with the specialized expertise to deal with this type of surgery. It is advisable to confer with one or two local plastic surgeons for second opinions; if they feel uncomfortable with the complexity of the procedure, they will make a referral to someone who they trust will be able to handle the problem.

Dr. Neu’s rhinoplasty practice is 40% secondary surgery. As reviewed previously in the section on primary rhinoplasty, Dr. Neu is internationally recognized in the field of rhinoplasty and enjoys the unique challenges of secondary procedures. He is sensitive to the special requirements of disappointed patients, and draws upon his vast experience to provide patients with gratifying results, even after multiple prior procedures.

Patient Examples

Click on any photo for larger version and more views of that patient.

Before Surgery Consultation

In the initial consultation, Dr. Neu will take a detailed history of the patient’s past health and the events and procedures that led up to the existing nasal problems, both in terms of aesthetics and breathing. While it is not essential, it is helpful if copies of previous operative reports and photographs are available.

Dr. Neu will document concerns, and will carry out a detailed examination of the nose, externally and internally. The various deficiencies, excesses, distortions and asymmetries will be carefully recorded, along with possible options for repair. In roughly half of the patients seen in consultation for revision rhinoplasty, Dr. Neu will explain to the patient that though they may not have quite received the result that they had hoped for, the benefits of further surgery are outweighed by the potential problems from additional procedures. In the other 50% of patients, Dr. Neu will detail a specific plan outlining what can be done to enhance the existing result and make it as natural as possible.

It should be noted that every rhinoplasty takes 12 to 18 months to completely settle down in terms of swelling and scar maturation. It would be rare for Dr. Neu to advise any revisionary surgery until that timeframe has passed.

The Surgery

Most secondary rhinoplasty is done through an open approach, where a small incision is made across the segment of skin between the two nostrils. This is usually necessary to expose exactly what was done in the previous operation, and to determine what effect the scar tissue has had on the anatomy.

Dr. Neu will have explained beforehand the possible need for cartilage or bone grafts that might be required during the operation. Sometimes the procedure is quite straightforward, while at other times the cartilage and bone components of the nose may need to be completely reshaped and realigned, and put back together again. These operations can take three to four hours.

Resumption of Activity

Most patients can resume sedentary activities within a week of surgery, and more vigorous activities two weeks postoperatively. They should not participate in contact sports for six weeks after surgery to avoid injuring the nose.