Revision Rhinoplasty in the New York Times
Recently, the New York Times published an article that focuses primarily on revision rhinoplasty surgery (http://www.nytimes.com/2009/10/29/fashion/29Skin.html). I am glad that this was published, as it highlights a few issues regarding facial plastic surgery, and rhinoplasty in particular. Revision rhinoplasty is a significant portion of my practice in San Francisco, so I thought I put a few pertinent issues down in the blog.
First, surgery of any kind is not without risk. Even something that may seem straightforward may not turn out exactly as planned. The reasons for this are not always obvious. For example, it may seem a simple issue to remove a ‘bump on the nose’. However, for every action we perform in rhinoplasty, there are often non-obvious consequences that require remedy. In this case, if we remove the so-called ‘dorsal hump’ without any other changes to the nasal structure, we could end up with an awkward-looking nose (open roof deformity). To prevent this, we often must ‘break the bones’ of the nose to ‘close’ this open roof. These maneuvers themselves can have consequences on nasal shape and breathing…..and so the list goes on.
Now, the above example was relatively simple one…in more complicated maneuvers (hump reduction + tip changes), the variables increase. One can imagine that this is why we often call rhinoplasty one of the most difficult procedures in facial plastic surgery, and one that requires experience.
In the case of revision rhinoplasty, the complexity level increases exponentially, as we are operating on a nose that has been operated on before. Thus, every aspect of the surgery is more difficult: the initial opening of the nose is more difficult (scar tissue), developing a plan is more difficult (because we often don’t know with certainty what we will find ‘under the hood’, so to speak) and execution requires more skill (we may have to retrieve ‘grafts’ from other parts of the body, such as the ear or rib). Most importantly, once again, is experience, as this increases the likelihood that the surgeon has seen similar situations before and knows how to deal with the unexpected.
Recovery from revision rhinoplasty in the short-term is usually not much different that primary rhinoplasty. However, I find that the minute swelling that occurs in rhinoplasty takes a bit longer to resolve in revision cases—at least 1 year.
For more information on rhinoplasty, visit www.sfrhinoplasty.com