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Revision Rhinoplasty

Revision rhinoplasty is a follow-up surgical procedure to the nose after a previous rhinoplasty surgery. The first nose operation is commonly referred to as primary rhinoplasty.

Although most people are happy with their primary rhinoplasties, sometimes, for a variety of reasons, they seek revision surgery. This sometimes occurs even with people who are satisfied with the aesthetic outcomes of the first surgery.

Aesthetic concerns, functional issues or, in many instances, both, drive the need for a revision rhinoplasty. The more common issues from primary rhinoplasty have to do with having too much removed from the nose structure or having too little taken off. Symmetry is another common issue. Unusually, excessive scarring may also lead to problems requiring a revision procedure.

What a revision rhinoplasty can do for you

As with primary rhinoplasty, revision nose surgery is a procedure that helps improve the shape, contours and function of the nose. Revision surgery is essentially a follow up to a previous operation, intended to make or correct aesthetic or functional issues that may have cropped up since the primary rhinoplasty.

Sometimes the original procedure may not have produced the precise results expected, either by the surgeon or by the patient. In such cases revision rhinoplasty involves minor corrections and tweaking to fine tune the results of the previous operation.

In other instances, functional issues that did not previously exist arise after the surgery. This is possible because rhinoplasty is considered to be one of the most difficult cosmetic surgical procedures to master. Any change in form can cause a related change in function.

Common aesthetic corrections during revision rhinoplasty

Some of the common issues that are corrected during revision rhinoplasty include:

  • Asymmetry of the nose tip or a pinched appearance
  • Pointy, uneven or unnatural appearance of the nose tip, commonly due to cartilage protrusion
  • Nose bridge crooked, irregular or off–centre
  • ‘Saddle nose’ deformity, when the bridge looks scooped out
  • ‘Polly-beak’ deformity, when the upper bony bridge is over-resected and the lower cartilaginous part of the bridge is not proportionally low enough
  • An ‘inverted V’ look to the sides of the nose, which happens when too much of the middle third cartilage has been removed. This can make nasal obstruction worse.

Common functional problems corrected during revision rhinoplasty

Often the revision rhinoplasty has to correct both aesthetic and functional issues at the same time.

The most common functional issue we correct during revision rhinoplasty is nasal obstruction. Nasal obstruction can be the result of a number of factors, including a deviated nasal septum, the thin wall that separates the two sides of your nose. Many people have deviated nasal septa without knowing it. When the septum is deviated, the two sides of the nasal cavity are different, and the smaller cavity is prone to obstruction. When nasal obstruction is serious, a deviated septum can be the main reason for needing a primary rhinoplasty.

Changes that are made to the nose during a primary rhinoplasty can result in making the deviation problem worse—if it was not considered serious before—creating nasal obstruction where none previously existed.

Other causes of nasal obstruction include excessive internal scarring and nasal valve collapse due to excessive tissue removal during the previous rhinoplasty procedure. Each of these issues needs to be dealt with in a different way during revision surgery.

The nose is a delicate organ, and even minor changes can result in changing its functional or aesthetic aspects. This is why rhinoplasty has very high revision rates compared to other types of cosmetic surgery.

Revision rhinoplasty requires skilful blending of science and art.  Good outcomes require a surgeon with extensive knowledge as well as wide-ranging experience —not merely qualifications.  Dr Marcells is a master of rhinoplasty, highly skilled and experienced in performing both primary and revision procedures.

Before and after pictures

You can view the before and after photos of real patients who have undergone revision rhinoplasty procedures with Dr Marcells in the Nose Gallery of this website. All the gallery photos are those of real patients of Dr Marcells.

Clicking on each gallery image will take you to a page with photos of each patient, taken from multiple angles and showing details of the changes made during nose surgery.

What revision rhinoplasty can’t do

As with any surgery, your expectations from revision nose surgery should be realistic. Do not expect a complete transformation after surgery. Revision nose surgery essentially tweaks existing aesthetics or corrects impaired function. It will enhance your appearance somewhat and, in many cases, help you feel better about yourself and your appearance. But although you may see vast improvements, the changes are often completely unnoticed and unremarked by others. If you think about it, this is a good result.

Are you a candidate for revision rhinoplasty?

Revision rhinoplasty is performed on adult men and women who have already undergone at least one previous nose surgery procedure. Candidates should proceed with surgery with realistic goals and expectations for improving the function or appearance of the nose.

It is essential that you have healthy facial tissue and muscles and no life-threatening conditions at the time of surgery.

For your own safety, inform Dr Marcells at the initial consultation if you have any medical conditions, including disorders of the thyroid, circulatory disorders such as heart disease or high blood pressure, and diabetes.

If a surgeon other than Dr Marcells performed your previous rhinoplasty, it would be ideal to provide details and records of the previous operation, including medical records, image tests and before and after photos. The more comprehensive the information you can bring to the initial consultation the better. Because your nose is a delicate organ, what exactly has been done to it previously is essential knowledge.

At the initial consultation, Dr Marcells will conduct a physical exam of your nose.

 

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How revision rhinoplasty is performed

After conducting the initial examination, speaking to you and studying your records, Dr Marcells will explain how the problem has occurred and discuss potential solutions with you. You will learn what needs to be done to rectify the situation. Obviously, what is required depends on your specific needs.

For both primary rhinoplasty and revision surgeries Dr Marcells prefers the open nose technique, because he knows from experience that this technique produces the longest lasting results. Open surgery exposes the nose structure for better visibility and improved manoeuvrability.  As opposed to alternative techniques, which only require incisions to be made inside the nose, open rhinoplasty involves an incision underneath the nose, at the bottom of the wall that separates the two nostrils.

For reinforcing the bone or cartilage, Dr Marcells only uses tissue taken from the patient’s own body—such as the ear, or in some cases, the ribs—to rule out the risk of allergic reactions or rejection. Both these are possibilities when material from external sources are used to reinforce the nose structure.

Revision rhinoplasty, like primary rhinoplasty, is performed under general anaesthesia.

How much time is needed to complete a revision rhinoplasty depends on the extent of work that is needed.

Preparing for your revision rhinoplasty

The preparation process for a rhinoplasty involves taking a number of tests. Currently Dr Marcells is involved in studies that gauge long term results of rhinoplasty operations. As part of these studies there will be several tests that measure the nasal peak flow rate, which are particularly useful for patients with collapsed noses. Such tests help support better diagnosis, because they can help separate the patients with nasal collapse from those who are having issues of blockage due to allergies or other conditions. Similar tests will be taken six months, one year and two years after the operation to measure the outcomes of surgery.

It may be necessary to have certain imaging tests as well. You may also need to take specific medications or adjust the medications you are currently taking.

Dr Marcells will give you a set of instructions about preparing for your revision rhinoplasty. Follow those instructions closely. If you have any questions or need clarification of the instructions, we will be glad to help.

Among other things, giving up smoking well ahead of the surgery helps make your recovery fast and uneventful.

You will be asked to stop taking aspirin, anti-inflammatory drugs and certain other medications. Following this instruction and avoiding herbal supplements during this time helps control the risk of excessive bleeding.

After the surgery

You will most likely find a splint or plaster cast taped to your nose to hold it in place, protect it and help it heal correctly. Sometimes soft internal splints or cotton pads are packed inside the nose. These must remain in the nose for at least a week following the surgery, until your nose has stabilised.

You will be asked to stay in bed for a while after surgery.   Your head must be kept raised above the level of your chest to help reduce bleeding and swelling. Your nose will be congested due to swelling as well as with cotton stuffing.

As with primary rhinoplasty, it is normal to experience a little bleeding and drainage of old blood and mucus from your nose for a few days after the operation. This can also happen after removing the dressing.  A small gauze drip pad taped below the nostrils will control this discharge. You will be shown how to change the pad. It may be necessary to do a nasal wash with saline every few hours for a few weeks. This helps ensure that debris does not collect inside the nose, blocking it up.

You will be given instructions to further reduce the chances of bleeding and swelling. Following them will help your nose heal faster. You must avoid jogging, aerobics and other strenuous activities for some time after a revision rhinoplasty. You should not swim until your nose is fully healed. Avoid blowing your nose, chewing heavy food and expansive facial expressions such as smiling or laughing, especially until the bleeding subsides. Brushing your teeth carefully to limit movement of the upper lip is another point to remember. Before the surgery, have on hand clothing that fastens in the front. Avoid pulling shirts, tops and sweaters over your head, as it may knock the nose. Avoid resting sunglasses or spectacles on your nose for at least a month following surgery because they put pressure on the nose. Instead, use cheek rests or tape the glasses to your forehead.

After any type of rhinoplasty it is natural to experience some bruising around the eyes, including on the eyelids. You may also feel numbness in this area. Both typically subside within two weeks. In some people, it may subside in as little as three days; in rare cases it may last up to six months. You may use ice packs or cold compresses to reduce swelling and discolouration around the eyes. Beyond this, there may still be some subtle, barely noticeable swelling.

Most people undergoing rhinoplasty are able to enjoy their enhanced appearance within a month after surgery, but in some cases the healing process can be extremely slow. Recovery times, naturally, vary from person to person. In some cases, swelling, especially in the nose tip, may not subside for as long as six months. The last swelling to go away will be on the tip of your nose. In rare cases, the swelling will take a year to subside and for full healing to occur.  Only then will the final shape of the nose become apparent. Your recovery period depends on the extent of changes that have been made and the way your body heals.

Most people are able to resume normal social activities two to three weeks after revision rhinoplasty.

Revision rhinoplasty is usually an outpatient procedure, so you will need someone to drive you home after the surgery. Make sure to also have someone there to stay overnight.

During your recovery, follow the postoperative instructions given to you by Dr Marcells. If anything appears to be out of line or unexpected, call us immediately.

Your instructions will include contact numbers to use in an emergency. Do not hesitate to use those numbers. Having your mind at rest is important for uneventful and speedy healing. If a call can put your mind at rest, go ahead and make that call.

Potential risks and complications

Every surgical procedure carries some level of risk, including the risk of infection and adverse reactions to anaesthesia.

Potential risks and complications that can arise from a revision rhinoplasty include:

  • Recurring nosebleeds
  • Difficulties in breathing through the nose
  • Numbness in the nose and in the surrounding area
  • Uneven or asymmetrical results
  • Scarring
  • Persistant pain, discolouration or swelling

Dr Marcells will discuss how these risks specifically apply to you.

‘Revision’ essentially means that something has not gone completely according to plan in the initial operation and needs to be fixed. If primary rhinoplasty offers only limited scope to a surgeon, revision surgery, with so much less tissue to work with, offers even less scope. This is why your choice of revision rhinoplasty surgeon is an extremely important decision. It is equally important to check accreditation status of the facility used for the operation. Making these two choices wisely and ensuring that you have a thorough discussion of your medical records prior to surgery can help avert a lot of unnecessary risk.  It is, however, impossible to entirely eliminate risk in  surgical procedures, and revision rhinoplasty is no exception.

Now it’s your call

People undertake revision rhinoplasty to correct aesthetic issues and/or functional issues arising out of a previous rhinoplasty operation.

Unless your operation is considered a medical necessity, as in the case of reconstructing collapsed noses, revision rhinoplasty is considered to be an elective cosmetic surgery and is not typically covered by Medicare Australia or by private health insurance companies.

For more information

If you need more information or wish to make an appointment with Dr Marcells, please contact us on 1300 555 095, or by using the contact form below.

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Meet Dr Marcells

MBBS (Syd), FRACS (ORL-HNS)
Past President – Australasian Academy of Facial Plastic Surgeons

Dr George Marcells is known for excellence in facial plastic surgery and is considered a true master of rhinoplasty. He performs advanced surgical techniques to restore balance and harmony to the face and can also resolve functional issues such as breathing difficulties.

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