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Revision Rhinoplasty is performed to correct problems still present despite a primary Rhinoplasty or that develop as a result of previous rhinoplasty surgery.

Problems may be minor and easily corrected or major, making secondary surgery complex. No matter the problem Revision Rhinoplasty is almost always more difficult and requires more expertise than primary rhinoplasty surgery.

The reason revision surgery is difficult is due to the fact that the normal nasal Anatomy has been altered and scar tissue has filled tissue planes. This makes it difficult for your surgeon to separate and reposition the remaining cartilage and bones. Frequently revision surgery relies on grafting to rebuild portions of the nose that have been damaged form prior surgery. Using proper techniques your surgeon may be able to achieve significant improvement and sometimes dramatic results with secondary rhinoplasty surgery. As Revision Rhinoplasty is much more complex it generally should be done by a specialist surgeon who performs rhinoplasty frequently.

Often patients that require revision rhinoplasty surgery have both functional and cosmetic problems with their nose. The goal of surgery is to produce a nose that appears natural, functions properly, and is in balance and harmony with other facial features. To accomplish this goal, it is necessary to reconstruct and reshape the supporting framework of the nose. Skin quality, scar tissue present and the limited amount of workable cartilage left in the nose are all factors that will affect the outcome of the revision procedure.

One of the commonest problems from primary Rhinoplasty includes a “Polybeak deformity” where a beak like appearance results from the initial rhinoplasty. This can occur in a number of scenarios. Generally this problem occurs if the nasal tip droops relative to the bridge of the nose. This can be avoided if the nasal tip is adequately supported from the initial operation and if the appropriate reduction in the nasal bridge is carried out. While this sounds like a simple problem to avoid it is one of the commonest deformities from primary rhinoplasty. Patients with thicker skin are more at risk of developing a “polybeak nose”.

Another common deformity is nostril arching and pinching of the nasal tip. These problems generally occur from excess removal of nasal tip cartilage. Certain types of noses are at more risk of this deformity. This can be avoided if your surgeon is able to recognize who is at risk of developing this problem, maintain adequate tip cartilage and ensuring support to the nostrils at the time of the initial operation. Correction of this deformity can be difficult and can require cartilage grafts from ones nose, ear, or rib to correct.

Another problem which can occur from rhinoplasty surgery is called an ” inverted V deformity”. This is when the front on view of the nose takes on a look of an “inverted V”. This can occur if too much cartilage is removed from the middle of the nose during the initial rhinoplasty. This problem can be associated with breathing problems. Surgical correction can be accomplished when cartilage “spreader grafts” are placed to widen the central portion of the nose. Another severe deformity known as a “saddle deformity” can occur if the bridge of the nose collapses from the initial rhinoplasty surgery. Correction of a saddle nose also requires rebuilding the nose with either cartilage grafts or synthetic implants.

Nasal congestion, skin damage, and irregularities along the nasal bridge are other complications that can occur from primary rhinoplasty. Revision surgery, surgical implants, injectable fillers and laser-light therapy are options to deal with these problems.

In general Rhinoplasty is a complex operation which has the potential for complications. Patients must realize this before pursuing rhinoplasty surgery. If a patient does develop a complication from primary rhinoplasty surgery a skilled and experienced rhinoplasty surgeon will often be able to enhance the result with revision surgery.

Q & A with Dr. Philip Solomon

Dr. Philip Solomon know for his Rhinoplasty and facelift practice located in Thornhill. Dr. Solomon has patients from across Canada seeking him out for Rhinoplasty and revision Rhinoplasty surgery. His clinic is in old Thornhill in a beautiful renovated home. Dr. Solomon is on teaching faculty at U of T Dept of Otolaryngology Head and Neck Surgery Division Facial Plastic Surgery and is currently the Chief of Surgery at York Central Hospital. Please visit www.solomonfacialplastic.com or email askanexpert@revivemagazine.ca.

Q: Can you tell me about gortex use in rhinoplasty surgery and what are the risks associated with it?

A: Gortex implants known as polytetrafluoroethylene (PTFE) have been used extensively in a variety of surgical procedures for years. Its use in rhinoplasty dates back over 20 years. Gortex is used in rhinoplasty as an alternative to cartilage grafts. It can be used to build up areas of the nose or to camouflage areas of asymmetry or irregularity possibly resulting from prior nasal surgery or trauma. In rhinoplasty cases where building of the nose is required patients will be offered both cartilage grafts and gortex implants. The advantages and disadvantages of grafts and gortex will be outlined to each patient on a case by case basis. The biggest risk of gortex use is infection or extrusion of the implant which is felt to be between one and three percent incidence.

Q: Does computer imaging help with Rhinoplasty surgery?

A: I use computer imaging in my practice to help patients see what can potentially be achieved with surgery. While the surgical results are not guaranteed to be the same as the imaging they usually are close. The process of going over a patients images before surgery is helpful as it allows the surgeon and patient ensure they share a common goal. If there is a major discrepancy between a surgeons and patients desired surgical outcome the imaging can identify this before a patient goes under the knife.

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