Secondary Rhinoplasty is always more difficult and requires more expertise than primary Rhinoplasty surgery due to the fact that the normal anatomy is no longer intact and the tissue planes present before the first surgery, now include scar tissue. This makes it difficult to separate and reposition the remaining cartilage and bones. While scar tissue can make matters more complex, using the proper techniques can accomplish significant improvement, and sometimes dramatic results, for revision Rhinoplasty patients.
As a Facial Cosmetic and Reconstructive Plastic Surgeon - Otolaryngologist Head and Neck Surgeon, Dr. Solomon fully understands the anatomical causes of each complication and their external effects on appearance. Knowing the source of a problem guides both the underlying, technical repair and the outward, aesthetic outcome. As a patient’s unique anatomy and appearance are associated in complex ways, it is essential for a skilled Reconstructive and Cosmetic Facial Plastic Surgeon to understand such intricacies and to know the consequences of performing any given alteration. As Dr. Solomon makes primary Rhinoplasty and revision Rhinoplasty a large focus of his practice, he has developed a high degree of skill and judgment in combining the science of surgery and the art of aesthetics.
Visit Dr. Solomon’s online revision Rhinoplasty photos and please ask to see more case photos similar to your own case when visiting the office in Toronto, Ontario, Canada.
What is a ‘natural-looking’ nose?
A natural-looking nose, from a surgical perspective, means a nose that has soft transitions between the different aesthetic subunits of the nose. The nose is divided into different parts: the bridge, the tip, the alae and the columella, to name a few. In a natural-looking nose, the nasal subunits are separate structures but the transition between them is soft and absent of extreme angles or sharp lines. In some rhinoplasty cases, the nose becomes unnatural looking as the transition between different portions of the nose look man-made. A primary aim in Rhinoplasty surgery, therefore, is to create smooth transitions from subunit to subunit while always taking into account the patient’s goals, overall facial features and nasal characteristics.
Common Concerns of Patients Considering Revision Rhinoplasty
Anxiety. Dr. Solomon understands that the prospect of experiencing an additional Rhinoplasty surgery may evoke feelings of anxiety, fear and caution. These emotions are understandable and may even be beneficial in helping patients to proceed carefully when finding a Facial Cosmetic and Reconstructive Plastic Surgeon with whom they are comfortable.
A large part of becoming more comfortable with making the decision to proceed with surgery involves learning about the underlying reasons for the current nasal condition and what can be done to improve it. As an experienced Facial Plastic Surgeon-Otolaryngologist Head and Neck Surgeon specializing in Cosmetic and Reconstructive Rhinoplasty, Dr. Solomon is highly skilled in identifying problem areas and knowing which refinements are possible.
Frustration and Confusion. Some revision Rhinoplasty patients are not sure exactly which improvements are needed for their nose, they only know that they are feeling bothered by its current condition. Other patients have more clear ideas of what they would like a revision Rhinoplasty to accomplish. Dr. Solomon understands that it can be confusing and frustrating to find a Cosmetic Facial Plastic Surgeon who will provide realistic and honest nasal appraisals and up-to-date surgical recommendations. For these reasons he encourages all patients considering revision Rhinoplasty to come in for a consultation to discuss individual concerns, review patient history and to view other case photographs. Dr. Solomon uses advanced computer imaging software during consultation as a very helpful way to develop surgical goals with his patients and to add an extra step of reassurance.
Breathing Issues. Dr. Solomon assesses concerns with nasal function in a number of ways to establish the nature and severity of the problem. With published research in nasal airflow and outcomes in facial plastic surgery, together with focused training in Otolaryngology-Head and Neck Surgery and Cosmetic and Reconstructive Facial Plastic Surgery, it has been Dr. Solomon’s experience that improvement in nasal function can be achieved in most cases. However, there may be limitations depending on a patient’s individual situation.
Secondary Revision Rhinoplasty Surgical Goals
Since secondary revision Rhinoplasty patients have had previous nasal surgery, in which issues regarding appearance and/or function have developed, Dr. Solomon's surgical goals are to create a nose that looks natural, functions properly, and is in harmony with other facial features. To accomplish these objectives, it is necessary to reconstruct and reshape the supporting framework of cartilage and bone then to redrape the overlying skin to give the nose its new shape and improved function.
The patient's wishes in regard to the desired changes are always considered, but there are limiting factors. Skin texture and thickness, the amount of scar tissue from the previous surgery and the facial proportions and contours play important roles in what can, and should, be achieved. Each patient presents with a unique combination of factors which together require a unique surgical plan. The complexity of revision Rhinoplasty cases demands the expertise of a Rhinoplasty Specialist. Dr. Solomon, a double board certified Facial Cosmetic and Reconstructive Plastic Surgeon - Otolaryngologist Head and Neck Surgeon based in Toronto, Ontario, Canada, will discuss the corrective possibilities and outline the advantages and disadvantages of each, based on the patient’s individual situation.
Rhinoplasty and Nasal Reconstruction
In cases where the underlying nasal structure requires reconstruction, amendments can be accomplished by using cartilage grafts from a patient’s ear, nose or another part of the body. While Dr. Solomon generally prefers using a patient’s own tissues if at all possible, in some revision Rhinoplasty procedures he may consider the use of implant material such as Medpore or Gore-Tex. Both materials are used extensively worldwide and are surgically reliable. In some cases, using implant material is a desirable alternative especially when a patient has little tissue to use as a result of prior Rhinoplasty surgery or if the patient does not accept the downside of removing cartilage from their ear or rib. The risk of Gortex and Medpore implants will be discussed with you in detail If you are a candidate for its use. The greatest issue with these materials is the possibility of infection or rejection of the implant.
Cartilage grafts from the ear are good for nasal tip grafts but often lack strength and support needed for some reconstructive revision Rhinoplasties. In cases where several ample and sturdy grafts are required, rib cartilage may be the most ideal source of cartilage. The downsides of rib grafts is that there is some discomfort associated with the procedure and the patient has to accept an incision on their chest. Cartilage grafts, especially rib, may potentially shrink or bend with time.
New! Visit Dr. Solomon’s Educational Library to view illustrated videos on nasal procedures. |
