Introduction

Revision rhinoplasty is required when a previous procedure has not been successful or when there have been changes over time, which has made the result undesirable.

Indications

Causes for these changes to occur are usually due to one of the following:

• Trauma to the nose after a rhinoplasty.
• Scar tissue causing contraction of skin over nose.
• Lack of support for the nose, causing changes over time.
• The original concern is not being addressed adequately.

Regardless of the cause, revision rhinoplasty is a very challenging procedure. The scar tissue involved is significant and often there is a related lack of normal structural support to the nose. Healing after revision rhinoplasty is also usually longer than a primary rhinoplasty, unless the problem is very isolated.

The common goals of revision rhinoplasty are:

• Improve breathing.
• Improve support of the nose.
• Increase the height of the nose (Dorsal augmentation).
• Refine the tip.
• Derotate the nose (move the tip of the nose more inferiorly).
• Remove polybeak deformity.

Dr Robinson has had advanced fellowship training in rhinoplasty including revision rhinoplasty. He understands that revision rhinoplasty requires longer than primary rhinoplasty and he will take the time required to get the job done correctly. He has been known to do a revision rhinoplasty for several hours because that was the amount of time required to do the operation appropriately.

Revision rhinoplasty requires rib grafting. Dr Dan Robinson has performed over 500 rib grafts from patients and now uses allograft (bone bank) rib to perform his rhinoplasties. More than 30% of the rhinoplasties Dr Dan Robinson performs are revisions of other surgeons.

Postoperative Results

Improve Breathing

After a previous rhinoplasty, it is very common that patients complain of problems breathing. Often this is because a rhinoplasty was performed without taking care to ensure that the structural support of the nose was kept intact or strengthened. Dr Robinson avoids this problem by ensuring he uses structural grafting to improve the strength of the nose during primary rhinoplasty.

The problems with breathing after a rhinoplasty without structural grafting usually get worse over time. This is because the skin collapses over the nose, which has very little support. The skin then moves when the patient breathes in and exacerbates the collapse.

The steps in revision rhinoplasty for a blocked nose differ between patients but the general procedure is as follows:

• Rib graft harvest / arrange for rib from the bone bank.
• Revision septoplasty.
• Extended structural grafts to the nose.
• Revision turbinoplasty (Reduce scrolls of tissue on either side of the nose).
• Revise the tip if required.
• Camouflage grafting to hide contour changes.
• Refine the nose.

It is important that you discuss all your concerns when you see Dr Robinson and he will discuss the procedure with you in detail. As with all revision rhinoplasties, your nose will likely need more cartilage, and this will need to be harvested from the rib.

Dorsal Augment

Dorsal Augmentation is a procedure used to build up the nose. The dorsal augmentation is done for patients who have what is called a saddle nose. A saddle nose has 3 main causes:

• Congenital.
• Post-surgical.
• Trauma.

Regardless of the cause of a saddle nose, the procedure involves building up the nose with graft material. Dr Robinson uses graft material to build up the dorsum of the nose to provide for the dorsal augmentation.

Gallery

You can view before and after patient photos in the Revision Rhinoplasty Gallery.

Related Information

Broad Nose
Blocked Nose
Broken Nose
Cleft Palate
Crooked Nose

To discuss if revision rhinoplasty is recommended for you, please make an appointment with Dr Dan Robinson.