SECONDARY RHINOPLASTY

Conventional rhinoplasty is the most frequently performed type of cosmetic surgery in Greece; however, it must be noted that it may often lead to secondary rhinoplasty and, on rarer occasions, to nose repair.

Fastidious nose surgeons consider it the most difficult type of cosmetic surgery for justifiably demanding patients.

Plastic surgery is a medical specialty that requires surgeons to follow the medical procedures to the letter: diagnosis, preparation of a surgical plan (based on their knowledge of anatomy and tissue behavior), immaculate surgical conditions and postoperative follow-up.

The aesthetic features of a so-called elegant and normal nose (bridge, nasion, tip, columellar, nostrils and nasolabial angle), the features of the neighboring structures (upper lip, eyes, forehead, cheeks and chin), the patient’s view of what is aesthetically pleasing, as well as racial and local features must be taken into account during diagnosis.

A positive surgical outcome basically requires proper diagnosis, working knowledge of the local anatomy (bones, cartilage, subcutaneous fat, septum and skin texture of the nasal structure), knowledge of the biological behavior of tissue and preparation of a surgical plan.

The surgical skills and flair of the surgeon then come into play and are absolutely necessary for a successful rhinoplasty. The postoperative course is nearly always smooth, but strict adherence to the 10-day postoperative framework is a must.

Respiratory control must be taken into account during diagnosis and any anatomical damage (nasal septum deviation, sinonasal cavity hyperplasia, nasal valve) should be corrected during the surgical procedure.

Respiratory problems following a rhinoplasty or an unsatisfactory result may be due to a diagnostic error, inadequate knowledge of the local anatomy, wrong surgical plan, lack of surgical skills or, on rare occasions, surgical complications.

Secondary rhinoplasty is a complex medical procedure that requires considerable surgical skills and a good grasp of the problem. In the case of revision surgery, and provided it is required, the surgeon must not hesitate to use any of the plastic surgery techniques available, even if the procedure eventually turns into a major operation. Due to the previous procedure, the anatomical elements may have been damaged and scars may obstruct the surgical preparation. Therefore, adequate time (eight to ten months) must pass between the primary and secondary procedures, so that the scars may heal. The medical process must include medical history, diagnosis of the problem, surgical plan and surgery, all of which must be followed to the letter.

The deformities of a primary rhinoplasty are more often than not medically induced and in some cases, the problems are very difficult to resolve. To correct them surgeons must enlist their talent and imagination, and use various techniques. The deformities that arise from a primary rhinoplasty cannot be easily identified, while it is even harder to propose foolproof solutions. Usually, a general problem is diagnosed (supratip deformity, open book fracture, etc) and the course of the surgery is decided. Any cartilage deficits that require restoration must be assessed and the source (ear pinna, septum, ribs) must be selected. In addition, any bone deficits must also be assessed and a graft must be collected from the external skull lamina. On very rare occasions, the previous surgery was incomplete, so the revision surgery is simple and follows on the footsteps of the conventional rhinoplasty. Vast experience on the part of the surgeon, proper diagnosis and the multitude of techniques available can offers solutions to even the most difficult cases.