What's Revision Rhinoplasty?
It is a surgery performed to correct the undesirable results of a previous rhinoplasty (nose aesthetic) surgery. There is some debate in terminology. According to some, the second surgery performed to correct the negative results of the surgeon's own surgery is called revision rhinoplasty, while the correction of those performed by other surgeons is called secondary rhinoplasty. However, in widespread use, the second or more corrective rhinoplasty surgeries performed regardless of who performed the first surgery are called revision rhinoplasty (secondary rhinoplasty).
Unfortunately, rhinoplasty surgery does not yield positive results in every patient. The tip of the nose may appear squeezed-narrowed, wide, asymmetrical, low, drooping or excessively shortened and lifted (pig nose). The nostrils may be asymmetrical or wide. There may be collapse in the side walls of the nose (alar collapse) and difficulty breathing. The hump on the bridge of the nose may continue, there may be a collapse on the bridge of the nose, a parrot nose (pollybeak) appearance due to insufficient removal of the cartilage hump in the nose, or a saddle nose due to excessive removal. There may be an inverted V appearance in the middle of the nose, a twisted nose, continued deviation, irregularities on the nasal dorsum, excessive scar tissue development inside or outside the nose, skin and soft tissue problems.
In fact, aesthetic and functional complications in primary rhinoplasty constitute the indications (justification) for revision rhinoplasty. Unfortunately, 7-15% of revision (correction) surgeries are required after primary rhinoplasty. Some of these require minor and some require major revision. In minor revision; the result of the first surgery is acceptable and minor touch-ups are required. The patient may be happy with their current nose and general appearance but may want minor corrections. However, if there is a significant deformity as a result of previous rhinoplasty surgery, major revision is required. Unsuccessful rhinoplasty surgery can reduce the patient's self-confidence and social activities, the patient is generally unhappy with their nose but is also afraid of revision surgery. (Will it fail again or get worse?, Can I trust my doctor? etc.)
There are many reasons for failure in rhinoplasty. The most common cause is errors during surgery.
If you are a patient who will have rhinoplasty for the first time; you can visit our 'Rhinoplasty' section.
How Surgery Performed?
Revision rhinoplasty can be performed with an open or closed approach, as in primary rhinoplasty. It is important to know that the open or closed approach is not a surgical technique but a method used to reach the cartilage and bone structures of the nose. In the open or, as it is also known, external approach, a small incision is made in the shape of an inverted V or W on the columella (the structure that separates the nostrils from each other) and the skin is lifted to reach the cartilage and bone structures of the nose. In the final stage of the surgery, the incision on the skin is stitched closed. This incision scar is normally not noticeable after healing, but it can be noticed when looked at very closely and carefully.
Why Revision needed?
1. The surgeon may have insufficient experience.
2. The patient's expectations may be unrealistic.
3. The surgeon's goal may be overly ambitious.
4. Functional problems may be observed due to poor healing and scar tissue.
5. Nasal trauma may have occurred after the operation.
To prevent or minimize failure;
1. A detailed examination and good planning must be done before the operation and meticulous and patient work must be done during the operation. Wrong incisions, excessive or insufficient removal of cartilage and bones, and failure to repair nasal support mechanisms are common causes of poor results. One should not be impatient in finishing the operation. In cases where the surgeon is not satisfied during the operation and realizes that it is not exactly as desired, he must definitely go back to the beginning and make the necessary corrections if necessary. The result, not the duration of the operation, is always important.
2. Experience; At least 5-7 years of experience is required for rhinoplasty surgery. It is frequently stated by both ENT and plastic surgeons that rhinoplasty surgery is one of the most difficult among aesthetic surgeries. It is not enough to be a talented surgeon. At the same time, it is necessary to be a surgeon who is artistic, patient, meticulous, and treats tissues gently and respectfully. It is necessary to think and repair the many structures that make up the nose and their relationships in 3D. It is also necessary to predict which forces will affect the nose in what proportion during the postoperative recovery process and how the nose will remain stable in the long term. All of these require experience. Revision rhinoplasty, on the other hand, requires extra experience compared to normal rhinoplasty.
3. It should not be forgotten that healthy breathing is the main function of the nose and one should not focus only on the external appearance. It is necessary to try to correct the nose as a whole without compromising either the breathing function or the aesthetic appearance.
For revision rhinoplasty, approximately 1 year should be waited after the previous surgery.
Revised Rhinoplasty Operation Process
Since smoking negatively affects wound healing, it is recommended to quit smoking before rhinoplasty surgery if possible. It is also important to completely stop herbal mixtures (teas, additives, etc.) before surgery as they can increase the risk of bleeding. Those who use regular blood thinners should also change and stop the medication under the supervision of a doctor.
Step 1: Before Surgery
Since smoking negatively affects wound healing, it is recommended to quit smoking if possible before rhinoplasty surgery. Again, it is important to completely stop herbal mixtures (teas, additives, etc.) before surgery as they can increase the risk of bleeding. Those who use regular blood thinners should also change and stop the medication under the supervision of a doctor.
Step 2: Discharge
Discharge; The discharge period is determined according to the type of anesthesia used in the surgery. Since rhinoplasty is performed under general anesthesia unless necessary, it is recommended to stay in the hospital for 1 night. Discharge procedures are started after the doctor's control.
Step 3: 1st Night After Surgery
The First Night After Surgery Rhinoplasty surgery is a difficult surgery as we mentioned above. It can be a painful surgery from person to person. There may be some sensitivity on the first night and even the first week. This is a natural situation. Since the anesthesia used is general anesthesia, the first night after surgery will be spent in the hospital. In case of pain or sensitivity, the medications given by your doctor will be sufficient.
Step 4: Day 7 After Surgery
A check-up is performed on the 7th or 14th day after the Rhinoplasty surgery, depending on the procedure performed.
Step 5: Month 3 After Surgery
The fastest recovery period after surgery is the first 3 months. Most of the edema and swelling disappear during this period and the nose begins to regain its natural appearance. Glasses can be used. Even if the glasses are prescription or sunglasses, care should be taken to ensure that they are light.
Step 6: Year 1 After Surgery
In Rhinoplasty surgery, as in other surgical operations, the full recovery process is 1 year. The nose receives its final result after 1 year. Patients should be patient until this time period. Situations and movements that may cause impact should be avoided. There should be no hitting, hitting, or pulling. In any possible case, the recovery process may slow down and may take longer than 1 year.
