Revision rhinoplasty

The emotional impact of a failed rhinoplasty can be devastating. Instead of the long-awaited improvement to the nose, whether functional, aesthetic or both, the patient can be left with a disappointing result, an unfamiliar face and, in many cases, nasal function worse than before.

The outer contour must be smooth and attractive, while the internal airway must be wide enough to allow comfortable nasal airflow. Once restructured, the whole framework must be strong enough to withstand the distorting forces that skin and soft tissue exert over the long term during healing.

In our practice we approach each case with the greatest empathy, technical precision and a personalised approach, rebuilding both nasal shape and nasal function to give the patient back not only their confidence but also a full quality of life.

Restoring a surgically damaged nose may look straightforward at first glance, but the medical and artistic challenge involved is considerable. In fact, in most cases it is far more complex than performing an initial rhinoplasty.

Fine, delicate skeletal components have to be recreated with three-dimensional precision to reinforce or replace structures that may be collapsed, twisted or even absent. Each component must be made with a mirror symmetry that matches its counterpart on the other side. The reconstructed structure must also be perfectly aligned on the vertical axis so that it looks straight.

The outer contour must be smooth and attractive, while the internal airway must be wide enough to allow comfortable nasal airflow. Once restructured, the whole skeletal framework must be strong enough to withstand the distorting forces that skin and soft tissue exert over the long term during healing.

For these reasons, restoring a failed rhinoplasty — commonly known as revision rhinoplasty — is widely regarded as one of the greatest challenges in aesthetic surgery.

In revision rhinoplasty, as in primary rhinoplasty, graft material is needed in 99% of cases.

• Graft material: The graft material is usually cartilage taken from the patient themselves (autologous), and it is used to replace damaged or absent skeletal tissue. Even in patients who want a smaller, more delicate nose, a cartilage graft can be essential to guarantee long-term functional and aesthetic results.
• Graft sources: There are three main sources of spare cartilage in the human body, each with unique characteristics of shape, size and consistency: septal cartilage, rib cartilage and auricular (ear) cartilage.

A distinctive feature of revision rhinoplasty is the unavoidable presence of soft tissue damage as a result of previous nasal surgery. The soft tissues covering the nasal skeleton — skin, muscle, fascia and fat — are inevitably injured during any rhinoplasty.

In fact, in many cases the limiting factor in revision rhinoplasty is not rebuilding the skeletal framework but the inflammatory reactions of the soft tissue. Even a well-structured nasal skeleton can be adversely affected by unfavourable inflammation and excessive scarring.

In patients with severely impaired circulation, such as those who have had multiple previous rhinoplasties, the likelihood of complications increases considerably. These complications can include:

• Graft resorption.
• Infection.
• Skin necrosis (tissue death).

The risk increases further if the patient has additional factors such as:

• Smoking.
• Cocaine use.
• Excessive inflammation.
• Diabetes.
• Taking medication or supplements that affect circulation.

In this group of patients, even the best surgical technique can be limited by poor circulatory conditions, which may lead to less satisfactory results. Smoking is not compatible with revision surgery or nasal reconstruction.