Rhinoplasty patients often wish to improve upon the results of surgery done elsewhere. Reasons for dissatisfaction range from assymetries and undercorrection of previous deformity to poorly planned procedures with overcorrection and associated nasal obstruction. Revision rhinoplasty is widely considered one the more complex procedures in plastic surgery, and requires careful planning and realistic objectives. The procedure may involve grafting of cartilage or other materials to restructure and strengthen the nose, as well as improve breathing.
A key first step with revision rhinoplasty patients is to identify the problems. Usually, patients point out the obvious concerns: a persistent hump, a scooped out bridge or "saddle-nose" deformity, an overly wide tip, etc. Other problems require a careful physical examination and may include alar retraction, persistent deviated septum, nasal valve collapse, scar tissue, etc.
Once the patient's concerns are identified, along with other issues that may require correction, a realistic surgical plan is formulated. The patient must understand that with each surgical procedure scar tissue is created, and scar tissue makes results of further surgery more difficult to predict. Nevertheless, many patients are excellent candidates for revision rhinoplasty, as long as their expectations are in sync with what is surgically feasible.
Revision rhinoplasty may require more operating time than primary rhinoplasty, as the dissection and sculpting need to be meticulous. Grafting is often used to rebuild the nasal bridge or add strength to the nose. Cartilage from the nasal septum may be used, but if this is not sufficient ear cartilage can be used with minimal scarring and no change to the appearance of the ear. Occasionally, artificial dermis may be added to thicken nasal skin that has retracted from previous surgery.
San Diego Facial Plastic surgeon Dr. Roy David Amir is a member of the American Academy of Facial Plastic and Reconstructive Surgery, and specializes in plastic surgery of the Face, Nose, Eyes, Neck, and Scalp. Dr. Amir is double-board certified by the American Board of Facial Plastic and Reconstructive Surgery, and the American Board of Otolaryngology. He is one of a select group of surgeons to complete a prestigious Fellowship in Facial Plastic Surgery under the auspices of the AAFPRS. Raised in Northern California, Dr. Amir attended UCSD, where he was appointed a regents scholar and graduated summa cum laude. He went on to attend medical school at Pen University, one of our nation's top medical schools. Dr. Amir then completed a five year surgical residency in Otolaryngology- at UIC in Chicago, which included intensive training in cosmetic and reconstructive surgery of the head and neck and an additional year of fellowship at the renowned Rousso Facial Plastic Surgery Clinic in Birmingham. Dr. Amir practices in La Jolla CA. See: http://www.sandiegoface.com