Published: 19/02/2013 by Dr Michael Zacharia
Cosmetic Surgery Magazine, April 2008 Rhinoplasty is a procedure to change both the internal function, and external shape of the nose. Unfortunately, some people have rhinoplasty performed by a "good intention" surgeon, but are unhappy with their final result. This is because the surgeon may not have taken away enough tissue to achieve the desired change in the nose, or, more commonly, the surgeon may have taken away too much tissue, thus having external nasal deformities that have become quite unsightly. As well as this there is the internal matter of nasal obstruction and sinus problems following some nasal surgery. Rhinoplasty is one of the most difficult cosmetic procedures to perform, and the surgeon needs to be skilled in this type of procedure. Having training in Ear Nose and Throat surgery and also external cosmetic surgery in the facial area specifically, this combination is quite powerful in achieving a good aesthetic and functional result. When it comes to a patient making a decision to have revision surgery, there are several considerations that must be made. First of all, the patient is apprehensive about having further surgery because they have invested time and money into having an initial procedure, and have not been satisfied. Often a patient will present who is not confident in their previous surgeon, and in fact, have elected not to return for a follow up visit because of their dissatisfaction. The inadequate result is often due to a combination of poor communication between the doctor and patient, and the patient and doctor, and also, either an over-conservative or over-zealous surgery being performed. The main point here is that at the consultation the patient should feel comfortable with the surgeon, and is confident that he or she can perform the changes they desire adequately. Sometimes it is a matter for the surgeon to tell the patient that certain things cannot be achieved, and, sometimes that the results the patient wants cannot be achieved For this reason, it is essential to have a discussion over digital photo imaging to be able to show the patient exactly what can and cannot be achieved. Often the patient, following previous rhinoplasty surgery, is concerned about the effects of the previous anaesthetic, and also the previous discomfort following surgery, and they are quite worried about making the same mistake again, having to spend more money to correct a problem that they were not expecting. Most patients will complain that they are either, not looking better following their rhinoplasty surgery, or that they are, in fact, looking worse than prior to initial surgery. Revision rhinoplasty surgery should be performed by a surgeon who is competent in rhinoplasty surgery in general. In the practice of Dr Zacharia, almost 50% of the surgery he performs are revisions. It is essential to understand the anatomy of the nose to be able to determine exactly what has gone wrong with the previous surgery. Sometimes there is a subtle change that is required to the external aspect of the nose, and/or more rigorous changes that need to occur with the internal aspect of the nose as well. It is important when performing revision rhinoplasty that the patient is made aware of the realistic outcomes of such surgery, and it is necessary that the surgeon understands exactly what the patient is concerned about after their previous surgery. Most importantly the patient should be aware of the difficulties of performing revision surgery. After primary rhinoplasty surgery the possibility of having a second procedure to correct any minor deformities is approximately 10%. After already having a rhinoplasty performed and then requiring a second procedure, the "touch up" revision rate increases to 20% to 25%. Quite often the revision rhinoplasty surgery is required through an external incision, to lift the skin envelope of the nose to reveal exactly what the previous surgeon has performed, especially if this information is not readily available to the patient. Revision Rhinoplasty is a very difficult procedure, both emotionally for the patient and technically for the surgeon but, more often than not, excellent outcomes both functionally and cosmetically, can be achieved as long as realistic expectations on the patient's behalf are communicated to by the surgeon.