There are no specific statistics about the revision rate for rhinoplasty but an average of 10% is generally mentioned, with a range of 5% to 25%. This rate varies a great deal among surgeons.
What is Revision Rhinoplasty?
Revision (re-do) rhinoplasty is a second rhinoplasty procedure needed because the result from the first (primary) surgery was not optimal. It is a completely different operation than primary (initial, or first-time) rhinoplasty. First, the complex anatomy of the nasal cartilages and bones has been altered and the effects of healing and scarring have changed the nose after the primary procedure. Second, the nose may be missing certain tissues (cartilage, bone, and soft tissue) that may have been removed during the initial surgery. Third, certain grafts of cartilage or other material may have been inserted during the initial procedure and placed in areas where they are not naturally present in an unoperated nose. All of these factors make the surgical outcome of a revision rhinoplasty less predictable.
What Can I Expect from Revision Rhinoplasty?
It is important that patients undergoing revision rhinoplasty have realistic expectations regarding the possible result. Although a good or even excellent result is possible, certain changes may not be as easily achieved in a revision procedure as they are in a primary one. A thorough discussion with your surgeon should serve to clarify expectations.
Are All Revision Rhinoplasties Similar?
Not all revision rhinoplasty procedures are alike and the extent of the revisions varies greatly. Some revisions consist of small touch-ups. An example is where a hump was incompletely reduced and some prominence remains. A simple procedure to reduce the remaining excess tissue is all that is required. However, a complete revision rhinoplasty is needed when there is a significant esthetic deformity or functional (breathing) problem. This is usually due to excessive tissue removal during the initial primary procedure, which results in a loss of structures responsible for nasal support.
The Goal of Revision (Secondary) Rhinoplasty
The goal of a secondary rhinoplasty should be to re-establish normal breathing and restore as natural an appearance to the nose as possible. Frequently, this necessitates replacing tissue where too much had been removed, to strengthen areas of weakness, smooth prominent edges, or restore shape. This replacement of missing tissue is the more challenging part of the procedure. The material used for this purpose is referred to as a graft.
Grafts in Revision Nasal Surgery
Grafts can consist of the patient’s own tissue, such as cartilage or bone taken from elsewhere in the patient’s body, or foreign material, such as silicone or Gore-Tex.
The patient’s own tissue
The patient’s own tissue has the advantage of being better “accepted” by the body when implanted in the nose. This means a lesser risk of infection or rejection later on. However, this graft material, most commonly cartilage, needs to be taken, or harvested, from another site of the body (donor site). The most common donor sites to harvest cartilage are the nasal septum (the wall separating the two sides inside the nose), the ears, and in cases where an extensive amount of cartilage is needed for a complex reconstruction, a rib. The latter is not a commonly performed procedure in most rhinoplasty practices.
There are some drawbacks associated with using the patient’s own tissues as grafts. First, additional surgery time and an additional wound are needed to harvest the graft from the donor site. Second, there is a finite amount of cartilage available that can be removed from the septum or the ears. Finally, an additional amount of work and skill are required to shape the graft and tailor it to be placed in a specific location in the nose.
A wide variety of foreign materials have been used in nasal surgery. These include silicone, Gore-Tex, Mersilene, Dacron, and many others. Some of these materials are used in other places in the body with excellent safety records. These include Gore-Tex in the heart and vessels, silicone in the face and other body areas, and many other such examples. The advantages of foreign materials are their unlimited availability, ease of use during the surgery, and ease of insertion.
The most significant disadvantage with the use of foreign materials is that they can become infected and rejected. In such instances, the only treatment is surgery to remove the implanted graft and antibiotics to treat the infection. As a result, the deformity initially present, for which the graft was used, still needs to be addressed with an additional surgery. The infection will have caused additional inflammation and scarring which needs to be overcome at that subsequent procedure. Infection and rejection can occur soon after the surgery or as a delayed complication, sometimes several years later. The second potential complication of a foreign material implant is the movement of the implant from where it was placed, causing a visible deformity.
The Bottom Line
Rhinoplasty, being a delicate procedure, needs to be performed by surgeons with extensive experience in nasal surgery (see select your surgeon). This recommendation is even more pertinent regarding revision rhinoplasty because of its added complexity. The patient needs to have a thorough and clear discussion with the surgeon in order to enter the process with realistic expectations. With these considerations in mind, most functional and esthetic nasal problems are amenable to correction with good results if performed by skilled hands.
Dr. Samaha has extensive experience in analyzing an operated nose, determining what modifications are necessary for its repair and successfully performing these modifications to obtain an optimal result. Many patients who consult Dr. Samaha regarding revision surgery are referred by other surgeons who call on his expertise because revision rhinoplasty requires more advanced techniques. He will use the patient’s own tissues, usually cartilage, to replace tissues that have been excessively removed and restore esthetics and breathing. Dr. Samaha does not use foreign material in the nose because of the potential problems mentioned above.