Revision rhinoplasty, also known as secondary rhinoplasty, is usually sought after whenever a previous surgery of the nose did not lead to the expected aesthetic or functional outcome. The experience of a previous surgery which resulted in an undesirable outcome, coupled with the uncertainty of the next surgery providing the long-term desired result can make considering revision rhinoplasty a very daunting task.

Based on the nature of how human beings perceive and process noses, we see our nose with a very detail-oriented view. This focus only increases when patients require revision rhinoplasty, which subsequently also raises the patient’s expectations. Completely correcting aesthetic concerns that occurred following a primary rhinoplasty is often a difficult task. Limitations due to scar tissue formation, damaged or deficient cartilage, soft tissue irregularities and other structural damages all have to factored in.

These are the main physiological and psychological reasons why revision rhinoplasty is considered to be one of the most challenging procedures, for both the patient and the surgeon. It is therefore pivotal to understand the patient in order to establish a realistic goal.

What is the goal of revision rhinoplasty?

Rhinoplasty surgery aims to improve the contours of your nasal appearance. This includes the size and width of the nose, the profile of the bridge and the shape of your tip. In case of a crooked or deviated nose, improvement of symmetry will help creating a well-balanced and natural appearance. In patients with nasal breathing issues, improvement of nasal airway passage will be an integral part of their rhinoplasty.

What is the goal of revision rhinoplasty?

Rhinoplasty surgery aims to improve the contours of your nasal appearance. This includes the size and width of the nose, the profile of the bridge and the shape of your tip. In case of a crooked or deviated nose, improvement of symmetry will help creating a well-balanced and natural appearance. In patients with nasal breathing issues, improvement of nasal airway passage will be an integral part of their rhinoplasty.

What are the benefits of revision rhinoplasty?

Revision rhinoplasty allows patients to achieve a nasal contour they hoped for. It may help leaving details that made them feel self-aware of in the past. This can increase self-confidence and quality of life.

However, it is important to remember, that even though a beautifully contoured nose may be seen a success, it does not guarantee an improvement of self-esteem or self-confidence in every patient.

Before your procedure

Understanding how you feel about your nose is key to understand your aesthetic goals. Mr. Bran will place a lot of emphasis on that particular detail by listening carefully and assessing every detail of your nose as you describe areas of concern. You will be asked to bring surgical reports from previous rhinoplasties if you have those available or are able to obtain them. He will then review your medical history and perform an endoscopic exam of your nose. This will include analysis of your nose when speaking and smiling and functional assessment of your nose when breathing with your mouth open and closed. During your consultation photographs will be taken for your medical record. Using computer-assisted simulation programs we will then shape your nose in accordance to your personal aesthetic goals and realistic outcomes. Once a a new shape for your nose has been identified, Mr. Bran will explain each detail of his tailored surgical approach to you. Appreciating your personal aesthetics, managing your expectations and elaborating a realistic goal is key to planning a successful rhinoplasty journey.

Preparing for your revision rhinoplasty

Preoperative assessment is critical in order to select appropriate patients for revision rhinoplasty surgery. Apart from a physical examination you will have a discussion about your current and past medical history, and any medication you are currently taking or have recently taken. You will be asked about allergies, particularly drug allergies. If required, an anaesthetist will see you before your surgery. Depending on your medication, you may be asked to stop or change certain drugs for a duration of time.

You should refrain from taking Aspirin, or non-steroidal anti-inflammatory drugs such as Ibuprofen in the week before your surgery.

In order to optimise your healing, we strongly advise all our patients to stop smoking at a minimum of 2 weeks prior to your surgery and refrain from cigarettes or any other nicotine containing products for 2 weeks after their procedure. Smoking significantly impairs your post-operative recovery and doubles the risk of complications such as delayed wound healing, poor scars or altered results.

RISKS REVISION RHINOPLASTY SURGERY

In accordance with the Montgomery judgement, the following risks and side-effects are associated with revision rhinoplasty surgery:

Risks Revision Rhinoplasty Surgery

Am I a good candidate for revision rhinoplasty surgery?

A good candidate for revision rhinoplasty surgery has one or more of the following:

  • realistic goals and expectations
  • any visible irregularities that can be improved with another rhinoplasty
  • impaired nasal airflow which requires structural realignment of nasal anatomy
  • you are a non-smoker or can stop smoking for a minimum of 2 months

What are contra-indications for revision rhinoplasty?

  • unrealistic expectations
  • patients that experience a lot of personal or professional stress
  • you were told by others (partner, colleagues, friends or family members) that you should have a rhinoplasty

Does revision rhinoplasty require general anaesthetic or hospitalisation?

Revision rhinoplasty is performed under general anaesthetic and can be offered as a day procedure. For out-of-town patients we suggest an overnight stay at the hospital in the first night after your procedure. In the following days patients can use our special rates at some of the hotels in Marylebone and Chelsea.

How long does revision rhinoplasty surgery take?

Depending on the complexity of the case revision rhinoplasty can take anything from 2.5 to 4.5 hours. Most revision rhinoplasty cases require significantly more surgical steps in scarred, pre-operated and very delicate tissue which has been previously operated on. This not only includes restoration of anatomy, but also additional steps like harvesting of rib cartilage, which can then be used in order to create grafts for a reliable structure of the newly shaped nose.

Is revision rhinoplasty surgery painful?

During most revision rhinoplasties the contours or alignment of the nasal bones need to be addressed. Different to conventional methods (e.g. using rasp, hammer and chisel) Piezo rhinoplasty enables us to improve the contours of the nasal bones with no trauma to the soft tissue surrounding the bone. This results in less post-operative pain and discomfort. Although less than if a conventional rhinoplasty method were used, you should still expect some swelling. The initial swelling will extend down to your cheeks and your upper lip in the first few days after surgery. Patients report breathing impairment and a tender feeling along their nose due to swelling. Some patients experience oozing from the nose in the first few days post-operatively. You will be given adequate pain medication and appropriate instructions how to take care of your nose and how to keep your discomfort at a minimum.  If rib cartilage needs to be harvested, patients usually describe a tender feeling in this area, similar to sore muscles after an intensive work out.

How long is the recovery after revision rhinoplasty?

We advise our patients to plan enough time for their recovery. The minimum after any rhinoplasty are usually 10-14 days. In this time, you should expect swelling around your eyes, your cheeks and lips. Most of the swelling will usually resolve over the two weeks. Due to the delicate nature of our nose, residual swelling can take up to 12 months to fully settle. You will receive a guide what to do and what to avoid in the first weeks after your procedure. Cooling packs may be applied within the first days and you will be advised to rest with an elevated position of your head. After 6-7 days the sutures used to close the incisions will be removed. The cast on the back of your nose usually comes off on day 10. Patients can go back to their daily activities approximately 14 days after surgery. We advise our patients to avoid strenuous activities or exercise completely for 3 weeks after surgery.

Will I have noticeable scars after rhinoplasty?

One incision is placed across the columella, which is the skin under your tip, between both of your nostrils. In selected cases, whenever the width of the nasal base is reduced, additional incisions will be placed inside the nostrils, extending into the natural fold underneath your nostrils. You will receive instructions how to take care of your scars on a daily basis. As the scars continue to mature they will become barely visible. Mr. Bran wrote his PhD on scars and continuously improved his surgical techniques in order to create the least noticeable scars.

What can complement revision rhinoplasty surgery?

Other beneficial procedures that can be performed in conjunction with rhinoplasty surgery include chin surgery, buccal fat removal or ear surgery.

In order to find out more you should book a confidential consultation with Mr. Bran. As an expert in facial plastic surgery, he will be able to answer all of your questions and explain the details of your tailored procedure.

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