Rhinoplasty is a complex art. For the nose, form and function are closely interrelated.The Natural Rhinoplasty emphasizes your positive features, subtracts the negative aspects, and restores harmony in your appearance without the obvious look of surgery. Each nose is a unique sculpture
Revision Rhonoplasty:
Revision rhinoplasty is a surgical procedure designed to repair both form and function of a nose that has previously been operated on. Many people have difficult breathing from their nose or are dissatisfied with the cosmetic appearance of their nose as a result of prior nasal surgery.Revision rhinoplasty is a nose operation carried out to correct or revise an unsatisfactory outcome from a previous rhinoplasty. It is also known as secondary rhinoplasty. Occasionally there can be a third or even more surgeries. An unsatisfactory outcome occurs from 5 to 20% of rhinoplasties. There are two main reasons for performing secondary rhinoplasty. The first is purely cosmetic. A patient may be unsatisfied with all or part of a previous "nose job”. A nasal fracture may not have been reduced enough, or too much. A prominent or bulbous nasal tip may have not been addressed appropriately, or over-aggressively. The nose may looked pinched, it may look like a parrot’s beak, or like a boxer’s nose. There are many ways in which previous nose surgery may have left a nose aesthetically unappealing to a patient. The second reason is functional. The original nasal surgery may have been carried out to help with difficulties in breathing, and the outcome may have been unsatisfactory. Alternatively, the original surgery may have been performed for cosmetic reasons, but may have disrupted a normal physiologic mechanism involving the inspiration or expiration of air, making it difficult to breathe. Secondary rhinoplasty, and especially tertiary rhinoplasty, are extremely complicated procedures. This is self-evident because it is clear that even when the patient was operated upon for the first time, even when the tissues were “virginal,” and untouched the desired result could not be obtained.
How rhinoplasty is performed:
It can be performed under a general anesthetic or with local anesthetic. Incisions are made inside the nostrils (closed rhinoplasty). Sometimes, a tiny, inconspicuous incision is also made across the columella, the bit of skin that separates the nostrils (open rhinoplasty). The surgeon first separates soft tissues of the nose from the underlying structures, then reshapes the cartilage and bone. This is not a particularily painful procedure. Most people remain at home for a week. If there are external sutures, they are removed 4 to 5 days after surgery. The external cast is removed at one week. If there are internal stents, they are usually removed at one to two weeks. The periorbital brusing lasts two weeks. The swelling subsided over several months, the majority in the first one or two. Due to wound healing, there are minor and subtle shifting and settling of the nose over the first year.
In some cases, the surgeon may shape a small piece of the patient's own cartilage or bone to strengthen or change the structure of the nose. Usually the cartilage is harvested from the septum although if there isn't enough which can often occur in revision rhinoplasty, cartilage can be taken from the concha of the ear or rarely the ribs. In the rare case, again usually revision rhinoplasty, where bone is required, it is harvested from the cranium or ribs. Sometimes a synthetic implant may be used to reconstruct the nose. This is most common when agmenting the bridge of asian noses.
To improve nasal breathing function, a septoplasty may also be performed. If there is turbinate hypertrophy, an inferior turbinectomy can be done.
There are several complications that can arise in rhinoplasty, although it is usually considered to be safe and sucessful. Post operative bleeding is uncommon and often resolves without needing treatment. Infection is rare and can occassionally progress to an abscess that requires surgical drainage under general anesthetic. Adhesions, which are scars that form to bridge across the nasal cavity from the septum to the turbinates, are also rare but cause nasal obstruction to breathing and usually need to be cut away. A hole can be inadvertently made at the time of surgery in the septum, called a septal perforation. This can cause chronic nose bleeding, crusting, difficult breathing and whistling with breathing. If too much of the underlying structure of the nose (cartilage and/or bone) is removed, this can cause the overlying nasal skin to have little shape resulting in a 'polly beak' deformity. Likewise if the septum is not supported, the bridge of the nose can sink resulting in a "saddle nose" deformity. The tip of the nose can be over rotated causing the nostrils to be too visible and creating a 'miss piggy' look. If the cartilages of the tip of the nose are over resected, this can cause a pinched look to the tip. If an incision is made across the collumella (open approach rhinoplasty) there can be variable degree of numbness to the nose that may take months to resolve.
The cost of rhinoplasty varys regionally and between surgeons. If it is for functional reasons, like breathing correction, it can be covered by many health plans. For example in 2006, Ontario Canada the provincal health insurance carrier paid $480, while the cost for cosmetic rhinoplasty varied between $1000 to 10,000.
