Revision Rhinoplasties Requires a Facial Plastic Surgery Expert
Rhinoplasties are among the most challenging surgeries a surgeon performs on the face. Every nose is different, and no one technique will always work on everyone to achieve the results you’re looking for. An additional challenge is that even after a good surgery, there is a small degree of inherent uncertainty on how your particular nose will scar in response to the surgery. And all these factors relate to the cosmetic factor—we haven’t even talked about the functional component. When a rhinoplasty requires revision, all these factors are magnified and you really should seek a surgeon with expertise in the nose—both functionally and cosmetically.
Facial plastic and reconstructive surgeons are surgeons with intimate knowledge of nasal and sinus function, as well as good grasp of aesthetic relationships of the nose to the face. In addition, we are well trained in surgical techniques that will best achieve the goals of maintaining or improving function along with changing the appearance of your nose.
Revision rhinoplasties are much more challenging than a primary rhinoplasty because of the scarring that is now in your nose. This will affect the ease of dissection, as well as determine the difficulty of implementing various surgical techniques. Additionally, it’s not uncommon to have much less cartilage available. Cartilage is crucial to any rhinoplasty, but particularly more so for revision rhinoplasties.
This is because frequently revision rhinoplasties have functional problems due to valve problems. Furthermore, in order to correct many cosmetic deformities in revision surgeries, a surgeon needs to “rebuild” the nose, rather than take more cartilage. Cartilage is what we use to build a nose. If there is not enough cartilage left in the nose, a surgeon will have to use alternative sources. These are typically donor cartilages from your own body such as the ears or rib cartilages. If substantial donor cartilage is needed, another great source is irradiated cadaveric rib cartilage—which is my preference over your own rib cartilage.
The most important function of your nose is related to your airway. While it’s important to have a nose that looks good and balanced on your face, it’s more important that you breathe well with your nose. Nasal obstruction can be a significant factor in one’s health. We are designed to breathe through our nose. The nose humidifies and warms the air. Mouth breathing will dry the mouth and can affect our sleep and cause sore throats. Though many medications can help improve nasal obstruction, if there is a valve problem or anatomic obstruction, surgery is often the only effective way to improve your breathing. The septum should be midline, and the inferior turbinate’s should not be overly enlarged.
We also have two sets of nasal valves—the internal and external valves. To correct internal and external valve weaknesses, we need to surgically strengthen (or in severe cases- reconstruct) these structures. Options include a host of options—spreader grafts, alar batten grafts, alar strut grafts, butterfly grafts, etc. Due to the complexity of placing these grafts, especially in a previously operated nose, many of us will recommend an open approach. This means a small incision is placed in your columella and through this approach; the nasal skin is elevated off the underlying structures.
It’s not uncommon to not have enough cartilage in your nose to reconstruct or strengthen your valves, or not enough to rebuild your nose. Depending on the goals, your ear cartilages may be enough to use. If not, or if your nose requires significant structural support, then rib cartilage is needed. There are different opinions in the literature about whether your own rib cartilage or a donor cartilage is better. You’ll find world experts on both sides of the debate. Your own cartilage is from your own body. The absence of transmission of disease can be comforting to some people. Some experts will cite less risk of resorption of your cartilage compared to an irradiated donor rib. But there are real risks to using your rib cartilage.
Another surgery on your rib is needed. This wound can be more painful than the nasal surgery. There is a real risk of accidental injury to your lungs, which will complicate your recovery. On the other hand, using cadaveric irradiated rib cartilage is as simple as opening a sterile jar or package and shaping the cartilage for insertion. The risk of warping is same as your own cartilage. There may be a slightly higher risk of resorption.
Risks of infection are similar between your own and cadaver’s rib cartilage. While the risk of disease transmission does exist, that risk is extremely rare. Remember, cadaveric donor tissue is used every day by orthopedic surgeons when they reconstruct knees and other joints. Many oral surgeons use cadaveric donor grafts for bone implants. In my opinion, while the risk is present, the extreme unlikelihood of this problem doesn’t outweigh the higher risks of chest wall pain, scarring, and lung injury.
By now, hopefully you have gotten a sense of why a revision rhinoplasty is a much more challenging surgery. If you already are a candidate for revision surgery, I think it’s crucial you see the right expert that can fix your problem. With rhinoplasties, you really only have a limited amount of times you can have surgery before vast majority of surgeons will refuse to operate.
Be sure you see a facial plastic surgeon. If you do see a plastic surgeon, make sure you do your research to make sure he/she has experience with improving the function of the nose. There are some plastic surgeons who are capable, but you should also realize the majority of plastic surgeons just don’t have the rhinoplasty experience that’s needed for revision cases.
For more information about San Antonio rhinoplasty surgery, please visit our interactive website at www.dryuplasticsurgery.com. Dr. Kenneth Yu Facial Plastic and Reconstructive Surgery is a qualified team of experts serving the San Antonio, Texas area. To schedule a consultation, please contact our Concierge Patient Coordinator at (210) 876-6868 or info@dryuplasticsurgery.com.
