Half the Rhinoplasty referrals in our practice now are for Revision Rhinoplasties.
Our observations:
By and large the practice of Cosmetic Nasal Surgery in Ireland is conservative and the unsatisfactory results from the patients point of view are commonly due to acts of omission rather than commision … meaning that most patients complain that enough was not done. This is not a bad thing as surgical intervention within a surgeons comfort zone is only to be applauded.
Cartilage depletion is thankfully not that common when the previous surgery was performed by Ireland based and Irish-trained surgeons who generally have a commendable conservative approach. This is also the reason why we do not see Frontal Sinus disease to the same extent as in some other countries where a large proportion of Sinus surgeons perform radical Endoscopic Sinus Surgery leading to scarred fronto-nasal duct area and consequent Frontal sinus complications..
Recently I have come across several candidates of Revision Rhinoplasty where the clinical situation is muddled by the use of Non-Surgical Rhinoplasty techniques employing fillers and injectables. Skin vascularity and subcutaneous tissue planes and their thickness in these cases are difficult to evaluate. At present I am employing a wait and watch policy to allow these tissues to settle down as the fillers get absorbed, before offering surgical intervention and Revision surgery. In an ideal world only surgeons equipped to perform primary and revision rhinoplasty would practice these non-surgical techniques so that they can offer the next step up when the fillers and injectables are inadequate or inappropriate.
Nasal valve compromise is a common finding in Revision Rhinoplasty.
One of the most respected rhinoplasty surgeons of our generation, a surgeon from east coast USA, once disclosed that he does not accept other surgeons cases for revision surgery as it exposes his reputation to work done by others.
Surgeons Reputation in Rhinoplasty surgery is built over decades and protected with Zeal … but the surgeons who have developed the requisite skill set needed to rectify mistakes, their own and others, should make them available to patients who suffer both functional and emotional distress if the primary surgery is not a success.
