REVISION RHINOPLASTY
BY ZIAD KATRIB, MD FACS
Introduction To Revision Rhinoplasty
Revision Rhinoplasty is generally considered to be the most difficult of all plastic surgery operations. This is due to many factors, including:
Previous structural damage
Scar tissue from previous surgery
Unpredictable healing
Unpredictable swelling
Increased infection risk
Need for much more grafting
Previous structural damage
Scar tissue from previous surgery
Unpredictable healing
Unpredictable swelling
Increased infection risk
Need for much more grafting
It is very common in revision surgery to need other materials (See Donor Materials). This is due to the terminal damage that is often discovered in the revision nose. This may include removal and reconstruction of the bottom of the septum (caudal septum), replacement of severely damaged tip cartilage, and/or rebuilding the entire bridge if it has been overly removed.
The more surgeries that a patient has had, the more difficult, and more unpredictable this operation can become. This is due to a larger scar tissue burden, decreased blood supply to the tissues, and the need for more aggressive grafting.
It can take 2-3 years to fully heal from a Primary Rhinoplasty (see Recovery), and often even longer for a Revision Rhinoplasty. Perfection is never achieved in Primary surgery, and certainly not in Revision surgery. However, major functional and cosmetic improvements are routinely accomplished.
How A Revision Rhinoplasty Works
Revision Rhinoplasty often requires large amount of time and grafting. While an average Primary operation may take 2-4 hours, a Revision often requires 4-6 hours or possibly longer. Due to a depletion of the septum after one or numerous previous operations, rib grafting is often required. This may be from the patient (autologous), versus fresh frozen (cadaveric).
After previous surgery has been performed, there is a degree of scar tissue present in a Revision. This requires meticulous operative technique both to work under, and also to possibly remove a degree of this tissue. The degree of scar present is typically related both to the patients genetics, and to the number of operations that have been performed.
Rib grafting is required in roughly 95% of Revision Rhinoplasty. Dr. Katrib currently performs roughly 120 Revision surgeries per year, and harvests roughly 115 rib grafts per year. This is performed through a small (~18mm) incision roughly 4cm below the right breast fold. This can cause some soreness that typically lasts 1-4 weeks depending on the patient. This causes a degree of stiffness to the nose, but allows for a very strong and durable result long term.
How The Recovery Works
Similar to Primary Rhinoplasty, internal nasal splints and an external splint are placed for 1 week. Upon removal, the nose is taped daily for 6+ weeks, depending on the degree of swelling.
If excess scar tissue forms in the nose, steroid injections may be needed post-operatively. This is needed in 5% of revisions.
In order to minimize infections after surgery, both antibiotic ointment and antibiotic soaks are performed two times a day for 2-3 months. Oral antibiotics are also utilized in all cases.
For local patients, follow up is typically at 6 weeks, 4 months, 1 year, and 2 years. For out of town patients ideally an in person visit at both 3 months and 1 year is preferred.