The number of revision rhinoplasties is increasing consistantly as the demand for rhinoplasties is rising. The complete comprehension of the complex anatomy of the nose in combination with operative measures that consider the longterm consequences of surgical steps are requirements for the understanding, why complications occur.
In publications revision rates of 5-18% are described. The amount of complications is base upon the kind of patient selection, the qualification and experience of the rhinoplastic surgeon and the initial diagnosis. Of the patients that wish for a revision rhinoplasty or a corrective procedure, approximately 50% have one deformity, 30% two deformities and 20% three or more problematic areas of the nose.
A majority of the patients with wishes for revision has problems with the lower third of their nose, as well as the tip of the nose. The most common problems are:
Problems (open roof, bony irregularities) in the upper third of the nose for example develop because of the following reasons:
Difficulty &treatment:
Problems in the middle third of the nose (polly beak deformity, too tight inner nasal valves or collapse of collapse of them, saddle back nose) develop for example through:
Difficulty &treatment:
Problems in the lower third of the nose (drooping or broad tip of the nose, hanging columella) develop through:
Difficulty &treatment:
The revision rhinoplasty has grown into a specialty within septorhinoplasty. The rhinoplasty surgeon doesn’t only have to be able to handle scarred, previously operated on tissue, take functional and aesthetical aspect into consideration, but also has to know the particular psychological situation of the patient and his/her family.
Patients are traumatised after a failed previous operation and understandably enough overly sensitive. As a physician you have to be prepared not only to carry out the specific surgical aspects of the operation but also to offer the psychological support after the revision procedure. The time of waiting for the swelling to go down and the revelation of the final result, may take up to 3 years and it should be clearly communicated, what the patient has to expect once again and approximately at what time.
All the more it is imperatively important to raise realistic expectations in the affected patient. The computer simulation is a compulsory necessary tool, to achieve this goal. Digital morphin (computer simulation) helps to achieve the understanding between aesthetical wishes of the patient and realisticaly achievable surgical possibilities.
A thorough examination of the patient stand at the beginning of every diagnostic procedure of a ventilation disorder:
subsequent investigations according to the initial situation:
Functional aspects of revision rhinoplasty contains nasal septum deviation, collapse of the inner nasal valve, nasal conchae hyperplasia (enlargement), nasal septum perforation and adhesions of the nasal mucosae (synechia). In the last 20 years the increasing use of spreader grafts (small cartilaginous splints, preferably from the nasal septum, are being set in between nasal septum and lateral nasal cartilage after removal of the nasal hump) to open the tight nasal valve has improves the operation method and functional outcome.