HAVE YOU HAD A PRIOR RHINOPLASTY PROCEDURE AND NEED REVISION?
It is not uncommon for the rhinoplasty surgeon to be presented with a patient that has had a prior rhinoplasty. It is estimated that between 2 and 30% of rhinoplasties result in secondary rhinoplasty. The preoperative assessment described above for primary rhinoplasty, for the most part, applies in revision rhinoplasty. Of particular importance is the patient’s previous surgical history, the nature of their concerns or dissatisfaction, the patient’s social history and psychiatric history and, of course, a thorough objective evaluation of the patient’s anatomy.
REASONS FOR REVISION RHINOPLASTY:
- Too much was taken out or left in
- The bump on the nose was not properly corrected
- The tip of the nose is too upturned
- The nostrils are too wide
- The nose looks “surgical” or “pinched”
- Nasal obstruction – difficulty breathing
It is important to attempt to obtain the operative record of any and all previous nasal surgeries as part of the preoperative evaluation of a patient presenting for revision rhinoplasty.
The surgeon needs to have a very clear and specific understanding of the source of the patient’s dissatisfaction. Perhaps even more than with the primary rhinoplasty, realistic expectations must be established. If the patient’s expectations are judged to be unrealistic, it should be made clear and documented whether the surgeon believes that their desired results are attainable.
A full examination and facial analysis should be performed. The height, width and symmetry of the nose should be asserted.
Skin examination in the patient who has had a previous rhinoplasty is important as it can be thinned or scarred from previous surgery.
The full nasal exam and analysis as described above will provide insight about the structural support remaining in the previously operated nose.