Revision Rhinoplasty Procedure
Revision Rhinoplasty refers to a variety of surgical techniques aimed at correcting both functional and aesthetic issues either not addressed or caused by the primary nasal surgery. With any cosmetic surgery, a touch-up or revision procedure is sometimes necessary. Even in the hands of the best surgeon, the need for revision sometimes occurs. And because rhinoplasty is a complex operation, it has a higher revision rate than other cosmetic procedures.
Many of the cases that have come to Dr. Binder for revisions after a primary or secondary procedures have certain factors in common; extensive cartilage loss and weakened structures. This is often due to poorly trained or inexperienced surgeons using the traditional reductive approach to rhinoplasty focused on making the nose smaller by removing cartilage. Removing too much cartilage can leave the nose with insufficient structural support creating breathing and other problems. This presents the revision surgeon with the challenge of restoring the lost tissue.
Dr. Binder has a reputation for successful facial reconstruction of some of the most severe facial trauma cases. His techniques and innovations developed for rebuilding badly damaged facial structure are part of the reason he is sought out for challenging revision rhinoplasty cases. But working on these cases is also what ultimately led him to develop his “structure” approach for Primary Rhinoplasty based on preserving the structural integrity of the nose. Structure Rhinoplasty is now becoming the standard approach for nasal surgery. (more on Structure Rhinoplasty).
In special cases, Dr. Binder may choose to utilize the open approach in primary and revision surgeries. However, sometimes the nose simply can’t be "opened" for the 3rd or 4th time without an increased risk of complications. This growing group of patients that have had several open nasal procedures present a new and formidable challenge to the revision rhinoplasty specialist. In these situations, only a few surgeons have the ability to apply the revision closed structure rhinoplasty techniques to effectively treat the problem. This is another reason Dr. Binder strongly believes that the revision rhinoplasty specialist must have the ability and expertise to perform both open and closed rhinoplasty.
Dr. Binder generally favors the stable and more predictable results of Closed Structure Rhinoplasty. Many new surgeons opt for the open technique to access the nasal skeleton for easy viewing. It is generally considered a simpler technique that requires a shorter learning curve for the surgeon, but has some potential drawbacks. In some cases, the open technique has the potential of causing significant scarring on the outside of the nose across the the columella (the delicate island of tissue between the nostrils) where the initial incision is made to expose the inside of the nose. The open technique also has an increased potential for skin shrinkage, longer duration of swelling and long-term unpredictability than the closed structure technique.
The first step toward achieving a satisfactory result with any surgical procedure is clear and open communication between the patient and surgeon. During the consultation, Dr. Binder will conduct a thorough a physical examination and review of your history, including any problems related to breathing. A step by step explanation of the problem and the procedures will be provided. Dr. Binder’s believes that the consultation should also be an educational experience for the patient. He feels that the details of the procedure should be carefully explained to the patient regarding not only how but why certain methods should or should not be used for each individual case. Our supportive staff, who have worked with Dr. Binder for over 16 years, will also explain the details of postoperative care, as well as address any insurance matters.
With the exception of very simple revisions, the length of time required to perform Revision Rhinoplasty is generally 2 ½ - 3 ½ hours. With Dr. Binder’s closed approach, all incisions are made inside the nose. In the exceptional cases where wide alae require reduction in width, parts of the nostril can be removed, leaving a fine scar along the nostril base that is usually inconspicuous upon healing. Following surgery, soft packing placed inside each nostril is removed a day after surgery. A small comfortable splint is worn for 5 to 6 days to protect the nose and ensure rapid healing. The splint is not placed to retain the shape of the nose, but is merely used for protection and to minimize postoperative swelling.
Revision Rhinoplasty is usually performed under general anesthesia and always under the strict supervision of a Board Certified Anesthesiologist. Minor revision cases can be simply performed under local either I.V. or local anesthesia.
When the splint is first removed, most patients can see visible signs of improvement right away. Another advantage of the closed technique is that it causes much less swelling postoperatively than open techniques. It is important to realize that it usually takes up to six months before the nasal tip swelling decreases enough to allow the nose to assume the refinements that ultimately define it’s permanent shape and form. The essence of the Structure Approach to Rhinoplasty is that it produces changes that not only improve function with an underlying physically stronger nose, but are so natural and balanced that no one will be able to visually recognize a rhinoplasty procedure was ever done.
Following most revision or primary rhinoplasty surgeries, the patient is up and about the next day and can usually perform most sedentary tasks. There may be minor discomfort and stuffiness for the first few days postoperatively with minimal bruising and swelling. Proper follow-up care is an essential part of our overall philosophy, so we will observe and direct our patient's recovery process for 6 to 12 months to ensure that healing continues correctly.