Revision Rhinoplasty

giving you the nose you deserve
Revision rhinoplasty strives to allow the patient to attain a greater sense of satisfaction with their desired outcomes
Rhinoplasty is one of the most complex surgeries in Plastic Surgery. While the surgery is safe, there is a potential for complications and revision surgery is considered when the first operation wasn't satisfactory.

Revision rhinoplasty is more complex than the primary surgery so it is best to get the revision done with your primary surgeon and if not to select a surgeon with experience at Rhinoplasty. 

What are the steps to successful revision surgery?

Diagnosis of the problem
  1. Detailed history and evaluation of patient's previous surgery records and consultation to understand the patient's needs and expectations
  2. Thorough clinical examination with the use of scopes to investigate the internal structure of the nose so as to better understand the altered anatomy and to formunlate a plan for revision
  3. CT Scans are alost always required to ascertain the problems for major revisiou rhinoplasty surgeries. This will help us to understand and come to a definite diagnosis before we can come up with the ideal plan

What are the steps to successful revision surgery?

Diagnosis of the problem
  1. Detailed history and evaluation of patient's previous surgery records and consultation to understand the patient's needs and expectations
  2. Thorough clinical examination with the use of scopes to investigate the internal structure of the nose so as to better understand the altered anatomy and to formulate a plan for revision
  3. CT Scans are almost always required to ascertain the problems for major revision rhinoplasty surgeries. This will help us to understand and come to a definite diagnosis before we can come up with the ideal plan

CUSTOMISED PLAN FOR REVISION RHINOPLASTY

We have a solution for every complication 

  • Deviated Implant or Noticeable Implant

    Deviated implants or prominent implants are due to a failure to create the right pocket for the implant or if the implant is incorrect for the pocket e.g. too long. Certain other factors could lead to a deviation of the implant which leads to the implant being palpable or obvious. L-shaped implants can cause nasal tip prominence and an unnatural appearance


    The revision plan is for the implant to be redesigned and the pocket recreated to realign the implant. If an L-shaped implant was used, this can either be changed to an I-shaped implant or an autologous implant.  If there is infection, the implant has to be removed and staged re-insertion is planned.


    The other alternative is to use autologous tissue to reconstruct the nasal dorsum. (Autologous rhinoplasty)

  • Deviated nose or asymmetrical nose

    In certain cases, the underlying septal deviation or asymmetry may not have been detected and this may cause a recurrence or deviation of the nose after surgery.


    The workup of such cases would usually require a detailed scan to check on the position of the structures. 


    The surgery plan would include correction of septal deviation to ensure proper alignment before embarking on a revision rhinoplasty

  • Recurrence of hump nose

    Recurrent hump nose can be due to the following reasons:

    1. Regrowth of bone or cartilage creating the hump nose
    2. Absorption of fascia used to cover the nasal hump
    3. Hook nose correction was not performed during the first surgery

    The surgery plan would be to perform hump removal surgery and coverage with fascia graft. An alternative is to increase the nasal tip projection and dorsal augmentation to conceal the hump nose.

  • Dissatisfaction with the nose line

    Dissatisfaction with the nose line can be caused by the nasal bridge being too high or low or a prominent implant.  


    Revision surgery with the goal to recreate the ideal  nose line.

  • Damage to the skin or loss of tissue

    Compromise to the overlying skin is one of the most difficults complications to correct. This can be due to the following reasons:

    1. Infection due to implant exposure 
    2. Skin tissue loss due to infection or damage to blood supply
    3. Capsular contracture leading to short nose

    Revision surgery for such complications would be considered Reconstructive Surgery of the nose.


    Due to the extent of the deformities, it would be very common to require large amounts of autologous cartilage from the rib to recreate a strong and stable nose structure. 


    In case with missing skin cover, local tissue flaps or regional flaps may be required to reconstruct the missing tissue components


    Total autologous rhinoplasty is the gold standard for correction of these challenging complications, ensuring that there is no more foreign material in the nose.

  • Nasal congestion after primary rhinoplasty

    Nasal congestion after rhinoplasty can be due to the following reasons:

    1. Primary cause of congestion not identified during the first surgery.
    2. Surgical complication leading to nasal congestion 
    3. Collapse of external or internal nasal valves

    The plan would be to perform a septoplasty and surgery to correct deviated septum. Spreader grafts are needed to open the internal nasal valves

    and Nostril-plasty to open the external nasal valves.

Rhinoplasty Materials

Understand the different materials that can be used for revision rhinoplasty

Silicone | Goretex

Silicone has been the commonest and oldest implant for rhinoplasty. It does not get absorbed and keeps its shape even after a long time. It is great for creating the curved lines. Adequate skin cover is necessary for safe use of silicone implants. Capsular contracture can lead to short nose.


Gore-tex easily assimilates well with natural tissue due to its porous nature. Its soft texture enables it to be used in patients with then skin and it looks very natural after an operation. However it is harder to remove and may become lower due to tissue integration.

Diced Cartilage + Glue | Fascia

Diced Cartilage + Glue. Finely diced cartilage is mixed with tissue glue to create a bioactive paste which can be use to smoothen minor irregularities or create a mild elevation of the dorsum. The cartilage can be taken from the septum or ear cartialge. Due to resorption, there may be some loss of dorsal height. 


Diced Cartilage + Fascia. The diced cartilage is wrapped within fascia harvested from the scalp through a hidden incision. Economical use of the cartilage enables the surgeon to maximise the cartilage to create full dorsal augmentation. Resorption rates are low as the diced cartilage is wrapped within the fascia. Irregularities and deviation are also uncommon.


Fascia only. Fasica only grafts can be used to augment the radix or to increase the thickness of noses with very thin skin.


Dermatofat Graft

Dermal grafts can be taken from anywhere in the body. The back of the buttock is an ideal place for a well-hidden scar. The skin and fat can be used to augment the nose for a natural look without implants. There is however a 20-30% resorption rate.

Learn more

Gold standard

The rib presents a large volume of cartilage which can be used en-bloc or diced and placed within fascia. Enbloc rib cartilage is used mainly in reconstructive surgery where large volume of cartilage is required and diced cartilage is preferred for augmentation. The rib is a versatile donor site but rib surgery requires overnight stay and is the most expensive option.

Getting Revision Rhinoplasty Right

01

Diagnosis

In a revision rhinoplasty, it is crucial to ascertain the problems and have an accurate diagnosis. Internal examination of the nose and scans are often necessary to confirm the problem before we can create a plan for revision.

02

Autologous Rhinoplasty

In revision rhinoplasty, having adequate and good material is important so that we can replace and re-create missing or damaged anatomy. Cartilage grafts from the ear or rib may be necessary to avoid the use of implants.

03

Considering facial angles and proportions

Using 3D imaging software we are able to analyse and measure the problem. Planning can then be done to create a plan for revision rhinoplasty.

Hospitalisation

Day Surgery

Anaesthesia

 Local Anaesthesia or IV Sedation

Operation Time

60-180 minutes

Removal of Sutures

5 Days

RELATED PROCEDURES

TIP-PLASTY

ALAR-PLASTY

SHORT-NOSE CORRECTION

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