Second Times a Charm- Keys to Revision Rhinoplasty

Second Times a Charm? Keys of Revision Rhinoplasty
Many patients do not realize the complexity of the surgical nose job, or rhinoplasty. Rates of revision in this country average about 15%, clearly much more than most facial plastic surgical procedures. When considering the cost, down time, and recovery involved, one would assume that these patients are very motivated to seek a second procedure.
Why so many revisions?
It’s difficult to explain the exact causes the of failure of the first nose job. Certainly rhinoplasty is a particularly challenging and technical surgery to begin with. Revision cases are even more complicated. Anatomy has been altered. Many times, the cartilage that a surgeon uses to reconstruct the anatomic parts is in short supply. Additional sites of harvest including ear and rib cartilage have to be considered.
I advise my patients to reach out to previous surgeons to gather the operative note for the procedure. This report should include a dictated description of the examination findings, operative goals, and technical details of the procedures completed. Many times this will allow us to have a better discussion of types of maneuvers planned for the secondary revision rhinoplasty procedure.
Preoperative photographs before the first surgery can be more helpful than any dictated report in many cases. Often times this can be a simple set of casual photographs that a patient may have from years before the surgery.
The most important part of the revision rhinoplasty is the preoperative consultation. It is that time that we develop a prioritized list of goals and focus on a detailed internal and external examination. Obviously the technical aspects of the surgery are critical as well. However, all of the preparation for the day of surgery can simplify our approach and bring comfort to the patients.
Experience is key for approaching such a case. I really believe that communication with patients, experience with previous cases, and training history are critical to success. Seek consultation with a qualified surgeon with The American Academy of Facial Plastic and Reconstructive Surgery or a similarly qualified group. Above all, be certain that revision rhinoplasty represents a large part of that surgeon’s practice.

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