8 Common Issues that Require Revision Rhinoplasty

One of the reasons patients visit ENT is when they desire revision rhinoplasty surgery. Rhinoplasty is an intricate procedure that requires a surgeon to have all of these special attributes in order to achieve the highest chance of achieving success.

Here are eight common issues that require revision rhinoplasty surgery.

Nasal Asymmetry often Needs Revision Rhinoplasty

Every person is born with a level of nasal and facial asymmetry. Furthermore, most individuals will have several major or minor traumas during their childhood that may result in further crookedness of the nose. If an individual has persistent or worsening of nasal asymmetry after primary rhinoplasty, they may be candidates for revision rhinoplasty.

Asymmetry or unevenness can occur in the bridge or tip of the nose. In the bridge of the nose, the nasal bones or the cartilage may be displaced. The tip region may result in nostril asymmetry secondary to tip cartilage malposition. When tip cartilages that support the nose are reduced or when overall cartilage is excessively reduced, skin forces may change the nostrils and create a pointy tip with uneven nostrils. It is important to analyze the exact nature and have a discussion about the potential options and limitations of surgery.

Revision Rhinoplasty for Twisted Nose

Patients who seek revision rhinoplasty for a persistently crooked nose often do not have problems with their nasal bones but rather have persistent problems with nasal cartilages in the middle portion of the nose, also noted as a middle nasal vault. During the time of the revision rhinoplasty, your doctor will reconstitute and reconstruct the middle nasal vaults utilizing spreader grafts and suture grafts to better symmetry of the middle nasal vaults to the nasal tip as well as the nasal bones.

Pinched Tip

The main cause of a pinched tip deformity is excessive removal of nasal cartilage in the tip area during a primary rhinoplasty procedure. In addition to unattractive nasal tips, patients often also lose the ability to breathe through their nose. Both factors need to be corrected with revision rhinoplasty surgery. The tip cartilages must be reconstructed to reverse the collapse.

Saddle Nose

Saddle nose deformity is when the bridge of the nose is overly “scooped” resulting in an unnatural and operated appearance. Your doctor will  treat saddle nose deformity in a careful and precise manner in order to recreate the normal nasal appearance while maintaining the shape and form of the patient’s original nose.

Doctors usually recommends using a person’s own cartilage to correct this issue and advises against implants such as silicone and gore-tex with rare exceptions. In select patients, the building of the bridge can be achieved with cartilage that is finely diced up and wrapped with layer of tissue called fascia. This minimally invasive manner avoids the use of rib cartilage that can reduce the length of surgery and potential risks associated with rib harvesting.

Short Nose

The angle at which the nose is elevated from the upper lip is one of the most important aspects of nasal profile. The ideal aesthetics of “nasolabial angle” varies in each individual based on ethnicity, gender, height, and the rest of the facial anatomy. Over-aggressive primary rhinoplasty procedures often result in excessively overturned noses that are too short and are often referred to by patients as “Miss Piggy Nose.”

This is a very challenging issue that requires complex nasal reconstruction with multiple cartilage grafts and innovative techniques to reverse the overturned short nose and create better aesthetics. Often, this will require obtaining cartilage grafts from the septum, ear region, or the rib area. The results of reversing an over-shortened nose can be satisfying to the patient and surgeon alike.

Tip Bossae

An ideal nose relies on a soft smooth transition between the nasal tip and nostrils. The tip cannot be too wide or too pointy with soft highlights. Nasal tip bossae is an extremely common consequence of traditional rhinoplasty procedure that creates tip asymmetry and sharp pointy edges. This typically occurs when an excessive amount of the outer aspect of the tip cartilage is removed. The nasal skin, thereby shrink-wraps over the remaining weakened cartilage. Nasal tip bossae appear as the cartilage edges change shape and protrude.

Breathing problem may also arise as these tip cartilages in the external nasal valve region can collapse. The Doctor will usually reconstruct the tip area and create support of the tip region in order to reverse the pointy and asymmetric tip. Cartilage grafts are typically added for structural support. Most patients will also require placement of soft tissue coverage over the reconstructed tip. Typically doctors uses “temporalis fascia” which is obtained from the patient.

Persistent Large Nose

Here the goal is to create an aesthetically pleasing nose that functions properly and complements the patient’s face and ethnic appearance. The surgery should not produce dramatic results, but rather subtle improvements that still maintain a patient’s cultural identity. One of the main reasons men and women seek rhinoplasty is to reduce the size of a large nose.

Although rhinoplasty is very effective in improving the size and shape of the nose, some patients may still have a nose that does not fit their face due to a persistently enlarged nose. It is important to know that the outcome of rhinoplasty is dependent on the inherent anatomy and some individuals will have limitations as how much size reduction they can achieve. It is important that the patient and surgeon have a candid discussion about the possibilities of revision rhinoplasty to address a persistently enlarged nose.

Persistent Nasal Hump

Here the removal of bump on the bridge of the nose is done, commonly referred to as “dorsal hump.” Creating an appropriate aesthetics relies on how the forehead transitions into the bridge of the nose and how the bridge of the nose transitions onto the tip. Even though it would appear that this is a simple procedure, the aesthetic considerations and technical factors that go into creating a beautiful and attractive profile requires years of experience and keen sense of beauty.

After a primary rhinoplasty, a nasal hump may still be present resulting in an unattractive profile. The most common area that this occurs is the region right above the tip, which is referred to as “pollybeak” deformity due to its resemblance to a parrot’s beak. Revision rhinoplasty for pollybeak deformity is fairly simple, yet requires a precise understanding of anatomy, function, and aesthetics.

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