Secondary Rhinoplasty (Nose revision)
Secondary rhinoplasty is a revision surgery intended to solve any form defects and functional problems arising out a previously performed rhinoplasty surgery. The surgical experience of physicians in Turkey in the field rhinoplasty surgeries is more profound than even in several European countries. However, the significant increase in the number of rhinoplasty surgeries in recent years has brought onto the agenda the need to inform relevant people also on secondary rhinoplasty. It is possible that up to 10% of rhinoplasty surgeries may potentially lead to issues necessitating revision surgery. This revision rate is applicable to all rhinoplasty surgeries performed in developed countries. Reputable authors from the USA mentioned that they performed revisions at a rate of 10% during the Cutting Edge congress, one of the most prestigious plastic surgery congresses, which was held in New York in December, 2016.
A revision surgery is undoubtedly not desirable for patients; however, it is a reality that one should resort to obligatorily in case of need. Problems including all sorts of protrusions, collapse, thickness, deviation, extreme tilt of the tip, drooping of the tip and apnea can almost all be corrected by means of a secondary rhinoplasty surgery. However, the surgeon to perform this second operation should be absolutely very experienced in secondary rhinoplasty. As a matter of fact, adhesions and deformations resulting from the first surgery would change the normal anatomy. For that reason, it is very important to choose surgeons who are familiar with these problems. Furthermore, it is also essential that the patient is involved in this process with a realistic expectation in proportion with the degree of deformation.
During the first visit, the problems are discussed in length and breadth and the surgeon explains in detail the types of methods to be followed for correction. It is also possible to get help from computerized systems using simulation software (also used in designing the first surgeries) regarding the final form and corrections expected from the secondary rhinoplasty procedure. An intranasal examination is performed to identify any ongoing problems in the septal cartilage in the mid-section, swelling of the nose flesh and other intranasal problems.
For patients who do not wish to undergo revision surgery for minor defects, correction can be achieved by performing a dermal filling procedure. Generally speaking, I personally resort to this method in selected patients in order to overcome small pits or enhance the nasal tip projection. However, secondary rhinoplasty is required in order to correct the defects of patients presenting with more serious problems.
In secondary rhinoplasty surgeries, the cartilage tissues present in the inner sides of the nose are used for repair while it may at times be necessary to receive supplement from the cartilage tissue in the ear or rib cage and/or soft tissue under the scalp. These adjacent tissues are used to compensate for deficient tissues in the nose and to provide camouflage in order to correct any deformations. The use these adjacent tissues does not result in deformations in the ears or problems in the scalp. It is also not needed to trim the hair. When it is necessary to harvest tissue from the rib cage, there may be a mark of 4-5 cm under the chest and some pain while inhaling/exhaling for a few days. It is also possible to use the cartilage from cadavers that are imported from abroad as an alternative to harvesting cartilage from the rib cage. Erosion of these cartilage and soft tissues derived from adjacent sites is not really common. As for the cartilage derived from cadavers, their risk for erosion is slightly higher; however, I have not encountered such a result in several patients that are currently under my follow-up.
It is necessary that at least eight months, preferably twelve months have elapsed after the first surgery so that the secondary rhinoplasty surgery can be performed. Because it is necessary that edema from the first surgery is healed, the nose assumes the final shape it would assume and becomes suitable for a revision surgery. Secondary rhinoplasty surgeries take approximately 2-4 hours depending on the degree of the defect. For cases where intervention on the bone is not needed, splints are not used. For patients who do not require extensive intervention inside the nose, it is not necessary to use plugs. Only plasters are used. For patients who require intervention on the bone or inside the nose, both splints and plugs are used.
Problems with the deviation of the nasal tip/nasal bridge can result from various reasons. The most common reasons include tilting of the nasal septum cartilage, uncorrected asymmetries of the nasal tip as well as migration of the grafts placed on the site called columella, which separates the nostrils. In the past, it was possible to assess whether the nasal tip and/or bridge is in the middle only by observing it from various angles. I have developed a device called the “Rhinoplasty Setsquare Device” intended to confirm that such deviation problems are completely corrected and I have obtained the patent for this device. This device has specifications that enable us to confirm that both the nasal tip and nasal bridge are on the midline at the end of surgery. This device, which provides the means for a more objective assessment on a subject which has so far been decided on only based on observation, has been made available for all surgeons interested in rhinoplasty. Thanks to this device, which I've been using in both primary and secondary rhinoplasty surgeries for nearly six months, I have been more assured that the nose is in the midline.
In conclusion, there has been a rapid increase in the number of rhinoplasty surgeries in parallel with the rising importance of image. Hence, the revision surgeries, which are a natural projection of these surgeries at a rate of 10%, have also become part of this trend. The secondary rhinoplasty surgeries, which have significant differences from the methods employed in the first surgery, are important operations that would enable the recovery of the desired image and patient satisfaction in more experienced hands.
Dr. Aret Çerçi Özkan, Plastic Surgeon
Esthetic and Plastic Surgery Specialist
Mobile: 00 90 532 476 35 02/ Office: 00 90 212 296 31 20
Zuhuratbaba Mah. İncirli Cad. Bayrak Apt. 89/7 Bakırköy Istanbul Turkey