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- Secondary Rhinoplasty

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Secondary Rhinoplasty

When a procedure is done on a nose that has been operated on once, twice or more it is called Secondary Rhinoplasty. This is the result of the patient not being comfortable with the results and thus is full of distrust and must be heard very carefully to be able to determine if the patient’s objectives and expectations can be reached. The doctor’s visit, which normally is done with a new Plastic Surgeon, must be very realistic for the patient and the Plastic Surgeon so that another undesired result is not achieved. The Plastic Surgeon HAS TO BE very confident in being able to achieve the patient’s expectations so that the patient/doctor relationship does not deteriorate.

A nose that has been operated on will have internal scaring, diminished blood irrigation,
fibrosis and a different anatomical structure, so the diagnosis must be very precise to avoid unnecessary scaring or lesions and very complete to obtain the desired final result.

1)It is recommended to postpone the surgery at least a year since the last one so that the tissues can relax and there will be no residual edemas.
2)To know with accuracy what was missing or what was superfluous.
3)The Plastic Surgeon must identify if the patients expectations are real and attainable and has to be capable of delivering the required results.
4)The Plastic Surgeon must undo what was done wrong but keep what the prior Plastic Surgeon did well in order to avoid further scarring and lesions.
5)If needed only use fillings or implants from the patient such as bone or cartilage.
The most common tactic used for a Secondary Rhinoplasty is an Open Rhinoplasty so that the Plastic Surgeon can have a full view of the deformities and abnormalities and thus achieve a more accurate result. It is also recommended to start with undoing what was done in excess during the prior intervention in order to properly identify the actual anatomical structure of the nose. The next step is to start correcting from top to bottom (from the dorsum to the tip) which will aide and facilitate the proper execution of the corrective motions.It would be more complex to do it in reverse since we would have to pass above of the tip to improve the dorsum. If there are going to be implants on the dorsum, these implants must be sustained by transcutaneous sutures so that they will not move during the post-opt. Once the dorsum is finished we direct our attention to the tip and apply the proper planned correctives. We cannot forget to carefully observe the lateral walls of the nose since they might be affected by the work done in the dorsum and the tip.

Normally a Secondary Rhinoplasty is a very laborious procedure since the exact diagnosis will only be determined during the procedure and thus the Plastic Surgeon must be able to adapt to the actual conditions.

During the post-opt, the immobilization and the proper intake of antibiotics are extremely important to protect the implants from a possible infection and thus reabsorption. The patient must keep in mind that the reabsorption of the edema will take longer compared to a Primary Rhinoplasty.

A successful Secondary Rhinoplasty will open the doors to new challenges and the benefited patients will be our best spokesmen so that other people can believe in our specialty and dare to improve.