Revision rhinoplasty in Hamburg
Major challenge: severe scarring and loss of structure
Revision rhinoplasty poses a major challenge for a rhinoplasty surgeon due to the frequent extensive scarring and loss of structures. Therefore, it should only be performed by surgeons who specialize in nasal procedures and who have years of experience in performing this challenging surgery.
I have regularly performed this sort of surgery for over twenty years and have developed several techniques to improve the final outcome, so I would be pleased to offer you an in-depth discussion about a realistic possibility of improvement.
The right time for revision rhinoplasty
When deciding on the most appropriate time for a revision rhinoplasty, it is always important to consider the biological stages of wound healing. It is important to be patient even if you are dissatisfied with the outcome of the previous operation and wish to make a quick change. This is where you can benefit from the surgeon's experience, our experience.
In most cases, a revision surgery can be considered at the earliest one year after the previous operation.
Reasons for this include:
- The organic processes of wound healing take at least a year before they are accomplished. Any premature intervention reduces the possibility of a favorable result.
- The swellings have not subsided yet. Consequently, from a surgical point of view, it is difficult to estimate precisely which excess tissue should be removed and which areas should be remodeled.
- The scars in the outer layer of the skin are still too stiff, so that it is not possible for some patients to perform the necessary stretching of the skin if their noses are too short.
Therefore, a revision rhinoplasty is only recommended when the healing process is complete or almost complete.
Reasons for aesthetic revision rhinoplasty
Nose tip asymmetry and pinched nose
A nose tip asymmetry or massive retractions of the nostrils with the appearance of a "peg nose" or pinched nose. Such an expression can occur due to uneven or overly excessive removal of cartilage as well as constriction of the nasal tip by sutures.
The scarring can be so severe in seldom cases, especially in patients with thin skin, that the delicate wing cartilages become twisted. Basically, the cartilaginous grafts from the nasal septum, auricle or rib are used in this case to provide both stability and structural shape.
Collapsed nasal bridge
A collapsed nasal bridge occurs most often in patients with short nasal bones following the ablation of a major hump in the absence of any stabilizing measures. The so-called lateral cartilages in the middle of the nose retract with all the aesthetic and functional consequences.
The resulting clinical picture is known in international literature as the Inverted-V, since the nasal bridge appears to have the shape of the inverted letter V when viewed from the outer front. Patients frequently complain of nasal obstruction and breathing difficulties.
Reconstruction of the nasal bridge is mostly performed by using cartilaginous rods ("spreader grafts"), which re-establish the contour of the nasal bridge.
Drooping nose tip
A drooping nasal tip may often occur several months after surgery as a result of failing stability of the nasal tip.
The method of choice is the implementation of a cartilaginous graft that serves as supporting structure for the nasal tip.
Crooked nose
There can be several causes related to a crooked nose, such as insufficient detachment of anatomical structures of the nose during rhinoplasty in the case of a pre-existing crooked nose.
There may also be a shift to one side in the course of the healing process due to severe, asymmetrical scarring. The treatment involves the implementation of balancing measures in the cartilaginous and bony areas.
Very high nose top
An overly high nose tip is a fairly common consequence of rhinoplasty. The angle between the mouth and nose is exceptionally large and appears unnatural due to the fact that a large part of the lower nasal septum has been removed. It is possible to see into the nostrils in the most extreme cases. The treatment involves the insertion of cartilaginous grafts intended to lengthen the nose.
Nasal bridge is too low - "Ski slope nose"
If a disproportionate amount of tissue is removed from the bridge of the nose during the operation, in some cases combined with an excessively high tip of the nose, this is referred to as an "artificial-looking" or "ski slope nose". The treatment consist of: This frequently requires the extraction of rib cartilage.
Irregular nasal bridge
An irregular nasal bridge may occur as part of the healing process and due to graft displacement or overconfidence on the part of the surgeon, most frequently one who is not very experienced, in such a way that the surgically induced irregularities are covered by the skin mantle.
In this case, flattening and, if indicated, camouflage with the body's own material is recommended.
Saddle nose
A saddle nose can develop when the necessary support from the nasal septum is missing due to excessive cartilage removal. The "load-bearing wall" of the nasal bridge must be treated with great care. In this case, a reconstruction of the nasal bridge with the patient's endogenous cartilage is required.
Pollybeak deformity
Most often, a "parrot beak nose" or pollybeak deformity occurs when the upper, bony bridge of the nose is excessively ablated and there is still excess tissue in the middle, cartilaginous part of the nose. The method of choice is compensation in the upper part of the nose with the body's own material and an additional ablation of the excess part.
Respiratory impairment
Occasionally, we see pre-operated patients in our clinic in Hamburg who have sacrificed their respiratory function in favor of their appearance. One of the primary objectives of rhinoplasty (also called secondary rhinoplasty) is therefore to restore normal breathing.
The example in the picture demonstrates a nose with collapsed nostrils on both sides and a crooked nasal septum. The patient complained of nasal obstruction especially during inhalation.
It is a great disappointment for every patient when the first nose job has not delivered the desired effect - and there are many reasons for this. There are cases where, despite the surgeon's best efforts, the optimal result cannot be achieved since the healing process cannot be controlled and the nose may change for the worse over time.
Sometimes one of the key factors for failure is the surgeon's lack of experience with a surgical procedure or with a more complex nose. And finally, the dissatisfaction may also be related to the patient's unrealistic expectations, as it is seldom possible to achieve a geometrically ideal nose, as some would like.
We can discuss the realistic prospects of success together after a detailed consultation and examination of the inner and outer nose.
