When a patient is considering a revision rhinoplasty, some considerations must be taken into account:
- As a general rule, secondary surgeries are more complex and longer, due to difficulties in dissection, over-resection of the previous cartilage and bone and presence of fibrosis in the skin. We consider these surgeries as reconstructive and augmentation surgeries, since we often have to provide material that was previously resected.
- The need for costal cartilage grafts to reconstruct the internal structure is very likely. In primary cases, the cartilaginous septum is the best donor area, but having been previously operated, it is very prone to be insufficient. In fact, if we have to reconstruct the dorsum and tip, we start the surgery by obtaining the costal cartilage, on the other hand, if we only have to reconstruct the tip or the dorsum, we start the surgery by opening the nose and exploring the septum, hoping to find the necessary material to avoid taking rib grafts.
- The healing process in secondary cases takes a little longer and requires between 1 and 2 years to be definitive.
- We must adjust very well the expectations regarding the result, since there are certain technical limitations and we are conditioned by the previous conditions that are often unfavorable. Revision rhinoplasty patients often have much higher expectations as they are better informed and choose a better surgeon, however, it is the surgeon’s duty to explain the improvement areas and also the existing limitations.
- Multi-operated patients may often have breathing difficulties that are difficult to correct, due to previous scarring, synechiae or mucosal/submuscular thickening of the septum and/or turbinates.
- It may be necessary to prepare the skin prior to surgery with PRP or lipofilling to improve its quality.
- Often, previous scars limitate the approach to surgery. We can improve the scars, make them more symmetrical, less widened, but they cannot be erased.
- The decision of doing surgery of the wings of the nose, is taken at the end, once we have treated the dorsum and tip. It is important to take the necessary time to perform these maneuvers since asymmetries of less than 1mm are highly perceptible.
- Patients may require nostril retainers to improve the symmetry of the nostrils.
- Postoperative radiofrequency is very useful to promote the process of wound healing.
As a plastic surgeon, I think it is very important to dedicate the necessary time to the patient consultation so that he/she can expose his/her problems clearly.
A good identification of the problems (one by one) by the patient, and the discussion with the expert about the possibility and degree of improvement, represents the cornerstone of this consultation. This trust relationship between patients and doctors is built on honesty.