Dr. Hakan Gündoğan

Rhinoplasty Revision

Rhinoplasty Revision

Rhinoplasty Revision (Secondary Rhinoplasty) is a surgical procedure to repair form and function of the nose after previous nose surgery. 

After initial (primary) rhinoplasty surgery, patients may be unhappy with the appearance of the nose or have difficulty breathing, or both.

The need for this secondary surgery is great because rhinoplasty is one of the most difficult plastic surgeries to perform.

What is the difference between primary rhinoplasty and Rhinoplasty Revision (secondary rhinoplasty)?

The patient who has never undergone surgery has advantages over the patient who has already had several nasal operations.

In primary rhinoplasty; the skin is not scarred, the skeleton is present and easier to examine, and the nasal septum, whether deviated or not, is present and provides excellent building material to reshape the external nose if that is needed.

Why Rhinoplasty Revision is difficult?

As a secondary surgery to correct primary rhinoplasty, Rhinoplasty Revision tends to be an even more complicated procedure.

The nasal septum, which is the prime building material for nasal surgery, has often been partially or completely removed. The cartilage and bone that create nasal shape have already been altered and are scarred or deformed; and the skin has become thicker and less pliable. The airway is often significantly impaired.

Because the nasal septum is often missing, plastic surgeon must find building materials elsewhere, always from the patient’s own body. There is no substitute for the patient’s own cartilage and bone.

Artificial materials, like silicone, are always a bad idea in the nose, particularly the nose that has previously undergone surgery. They rarely provide a lifetime solution, and although they seem like an easier plan at first, in the overwhelming majority of cases they are ultimately doomed to fail.

The patient’s graft material may come from the cartilage of the ear, from the rib, or from the outer layer of the skull. Which donor sites are best depends upon the problem, the age of the patient, the patient’s wishes, and many other factors.

Rhinoplasty Revision can be just as successful as the primary rhinoplasty, although because the initial problem is worse, there is a higher chance that second operations or minor touchups may be needed to produce the best result. 

For most secondary rhinoplasty patients, Dr. Hakan Gundogan constructs a new supporting nasal structure to provide a proper shape. Such major reconstructions are very difficult and require an accurate understanding of three-dimensional nasal contours.

When a patient undergoes a Rhinoplasty Revision (secondary rhinoplasty) procedure, scar tissues develop that can complicate subsequent reconstructions.

Patients must understand there is tremendous variability in secondary rhinoplasty deformities. Some patients have problems that are difficult to correct. This is why some noses can be effectively corrected and others carry a higher risk of problems or persistent deformity.

Why previous Rhinoplasty has failed and needs a Rhinoplasty Revision surgery?

The need for Rhinoplasty Revision is generally due to excessive removal of bone, cartilage, and lining of the nose usually ends up with:

• Collapse of the lateral wall

• Pinched or over narrowed nasal tip

• Pinched middle nasal vault

Dr. Hakan Gundogan always tries the preservation of nasal tissues as much as possible with minimal excision

Dr. Hakan Gundogan employs rhinoplasty techniques that enhance the preservation of nasal structures with minimal excision of supporting tissues. Excessive removal of supporting structures can result in a pinched, upturned tip with nasal obstruction – an “operated look”. 

Dr. Hakan Gundogan may use cartilage grafts taken from behind your ear or from rib to increase the strength of the nose. This minimizes undesirable changes that can otherwise occur.

Rhinoplasty Revision should maximizes the nasal function.

There must be no need to compromise your nasal function for a better-looking nose. Nasal function is critical and it must be considered as important as your aesthetic outcome. In fact, after surgery you will breathe better and have improved nasal function over the long term. 

Problems that can be corrected in Rhinoplasty Revision:

Parrot’s Beak Deformity:

When the area of the bridge above the nasal tip is too high, it can create an appearance similar to a parrot’s beak. This deformity can occur when:

• Too much cartilage is left after surgery;

• Too much soft tissue is removed, so the skin does not flatten out properly and excess scar tissue forms; or

• Plastic surgeon did not leave enough support for the tip, causing it to droop and making the bridge area above it appear to project too much.

Nasal Profile Problems:

This problem can arise when a surgeon attempting to correct a bump on the nose fails to smooth out all the bone and cartilage. A “scooped out” profile can occur when the surgeon has removed too much bone.

Inverted V Deformity:

This deformity is known as the “collapsed dorsum” or the “Middle Vault.” It occurs when the center of the nose collapses after the surgeon removes a bump but fails to provide adequate support for the central part of the nose structure.

Deviated Nose:

A deviated nose is one with a twist in the upper or middle portion or in the tip. This problem is difficult to correct with rhinoplasty and may persist after surgery. It can also be a problem created during surgery, when the surgeon’s efforts to remove a bump or correct other problems cause the nasal bones to shift.

Tip Deformities:

When the area of the bridge above the nasal tip is too high, it can create an appearance similar to a parrot’s beak. This deformity can occur when:

• A tip that projects too far from the face is a common problem in rhinoplasty after a prominent bump has been removed.

• An over-shortened appearance of the nose and a tip that is rotated upward revealing the nostrils can occur when too much of the supporting structure has been removed.

• A nasal tip that droops with the end of the nose collapsed downward can be caused by removal of too much cartilage supporting the nasal tip.

• A pinched tip can result from tissue collapse after removal of too much cartilage.

• The nose can appear to come to a single point when a surgeon pulls a suture too tightly between the two points of cartilage that form the nasal tip.

Nostril Deformities:

When the area of the bridge above the nasal tip is too high, it can create an appearance similar to a parrot’s beak. This deformity can occur when:

• Collapsed nostrils can occur when too much of the tip cartilage is removed during rhinoplasty.

• The columella (structure separating the two nostrils) can hang down too far and the nostrils can retract, creating a snarl-like appearance, if too much of the structures that support the nasal tip have been removed.

• The inside of the nostril sidewall may be too visible when the surgeon has removed too much cartilage and excess upward scarring occurs inside the sidewall.

Rhinoplasty Revision Surgical Process:

The surgical techniques used in Rhinoplasty Revision will depend on the nature and extent of the problems being corrected. It can range from a simple procedure performed to remove excess bone or cartilage in the bridge to a complicated, delicate operation in which the nose is completely restructured.

Rhinoplasty Revision performed on a patient who has had too much tissue removed is the most difficult type of nose surgery. Such a procedure typically requires the use of tissue grafts harvested from the ear, the rib, or the temple region to restore the structures of the nose.

Incisions for Rhinoplasty Revision may be confined to the inside of the nose (closed rhinoplasty), or an additional incision may be made across the columella (open rhinoplasty). In some cases, open rhinoplasty is the preferred technique because it allows for better access, direct visibility, and overall superior results. 

Recovery after Rhinoplasty Revision:

There tends to be less post-surgical bruising and swelling with Rhinoplasty Revision than with the primary rhinoplasty. Pain and discomfort can be controlled with prescription medication. Most patients are able to return to work in approximately one week, although strenuous activities should be avoided for two to three weeks after surgery.

You will have a nose splint and sutures (in open procedures), which will be removed within approximately six or seven days after the procedure. Although it can take up to a year for swelling to subside completely, bruising will have faded in approximately ten days.