What is Reconstructive nose surgery?

Reconstructive rhinoplasty is usually referred to a surgery that nose is disfigured in some way (primary surgery, accident, … ) and it’s necessary to perform another nose surgery. In another word Reconstructive means rebuild the nose, whatever that may mean for each individual case.

For some patients, this is done with a simple gel injection. For other patients, this may require a full open rhinoplasty surgery and complex reconstruction involving the entire nasal structure.

The difference between reconstructive surgery and primary surgery and how to do it

How is secondary nose surgery performed?

In this surgery, according to the existing problems, the following measures are performed:

• To remove the remaining hump, the nasal bone is cut enough to improve the shape of the nose and remove the hump.
• In noses where the tip of the nose is drooping, the cartilage is strengthened to eliminate the problem of drooping. In this case, a cartilage transplant must be performed, and if there is not enough cartilage in the nose, the cartilage is removed from the patient's eardrum or ribs.
• If the middle septum of the nose is deviated, it is smoothed with the help of surgical techniques to eliminate the deviation of the nose.
• The nasal tubes are also symmetrically shaped to make the holes look as uniform as possible.
• All factors that cause breathing problems should be identified and addressed.

What methods are used to correct the nose?

In reconstructive surgery, like the initial operation, two open and closed surgical techniques are used.

Open method:

 The advantage of this method is the open and wide field of view of the surgeon and the surgeon can make deeper changes without error and with more space. For this reason, this technique is a better method for rhinoplasty, which is more sensitive than the first operation. Also, if the surgery is performed delicately and carefully, no sutures will remain on the nose.

Closed method:

 This method is done in a closed way, i.e. without cutting and opening the nose. Rhinoplasty is one of the most difficult operations in the field of cosmetic surgery, which requires a lot of delicacy and precision. When the skin of the nose is not removed, the surgeon has very limited access to the structure of the nose and therefore cannot make many changes. Most specialists recommend open revision surgery to give the surgeon more access to the nasal structure.

Strengthen nasal cartilage

Use of graft (tissue transfer) in rhinoplasty

 In rhinoplasty, the doctor has to use tissue transfer from other parts of the body to strengthen the nasal cartilage. In primary rhinoplasty, the surgeon usually does this with the help of the nasal cartilage (also called an auto graft); But in the second surgery, if there is not enough cartilage in the nose, the surgeon will have to use cartilage in the ear or ribs. This does not cause any problems for the patient and the incision is very small and will not cause pain.

Use of artificial prosthesis for repair

 If the surgeon finds the amount of nasal cartilage insufficient and on the other hand finds that the thickness of the cartilage in the ear and ribs causes the nose to be deformed, the artificial prosthesis will replace the graft method. These prostheses are silicone and come in different qualities. A good surgeon chooses the best type of prosthesis to prevent problems caused by the prosthesis.

What is the difference between nose repair and primary surgery?

In the second surgery, the patient's condition is different, both in terms of the structure of the nose and in terms of mood, and for this reason, the doctor has to work harder. The most important differences between this surgery and the first operation are:

Nasal structure is damaged

 In the first operation, all tissues and skin of the patient are healthy and the ENT specialist can easily apply the desired changes. But in the second surgery, these tissues were changed and damaged. For this reason, the surgeon must be more delicate and precise so that the changes cause the least damage to the nasal tissue.

Dissatisfaction of the patient with the first operation

When a person wants to operate on his nose for the first time, although he is naturally anxious and stressed about the final shape of his nose, he has high hopes for the outcome of the surgery. However, most people who want to have rhinoplasty for the second time come to the operating room in a weaker mood and worry that the result of rhinoplasty will not be satisfactory again. On the other hand, these people may have been reprimanded or ridiculed by those around them for tolerating the inappropriate shape of their nose after the first operation, and as a result, they may have lost their self-confidence. A good reconstructive surgeon should give the patient morale and hope that the condition will improve.

Long duration of operation

 Another difference between the second operation and the initial operation is the long duration of surgery. Due to the complexity of the secondary operation, the surgeon needs more time to make changes. This may take up to 3 hours.

Longer recovery period

 Due to the difficulty of this surgery, the patient's body needs more time to heal the nasal tissue. Postoperative swellings may also take longer to heal.

When is the best time for a second nose job?

Cosmetologists and surgeons believe that after the first operation, the person must be very patient to determine the final result. Sometimes a person sees swelling and thinks that there are problems, while there is no problem with healing internal wounds and reducing inflammation and swelling. For this reason, it is recommended that a person wait at least 1 year for the final result to be determined, and then see a doctor to make sure there is a problem, and finally decide to have surgery.

What noses are most difficult for restorative or secondary surgery?

The hardest noses are those whose skin was damaged during the first surgery. It is very difficult and impossible to repair these noses in exceptional cases. However, you should know that even the most skilled surgeons can make mistakes, but you must be very careful in choosing the first surgery surgeon, because the best solution will be to prevent these possible problems.

Why is nose repair more difficult than initial surgery?

The nose had intact cartilage and tissue before any operation that was not damaged. When a person has surgery for the second time, the surgeon's job is much harder and more complicated because he or she has to work on skin and tissues that have been damaged before. Changes on these noses are more difficult. The specialist doctor must change and cut the tissues so that the soft tissue is not damaged.

How many hours does revision surgery take?

As mentioned above, the restorative operation is more difficult than the initial operation and therefore the surgeon needs more time to be able to create the ideal shape of the nose. This surgery takes between 3 to 4 hours. The duration of the first surgery is 1 hour and a half to two hours.

Should I see my doctor or another specialist for reconstructive rhinoplasty?

The answer to this question depends on several factors:

Your Expectations of Second Surgery

 For example, your first surgeon may only include a natural nose model, but you may decide to choose a fancy nose model for the second time.

Surgeon's skill level

 Whether the problems that arose after the first operation are due to the doctor's mistakes or your lack of care, plays a role in determining the doctor's choice.

Your budget for surgery

 When you see your first surgeon, the cost of surgery is much lower than the cost of seeing another doctor.

Should I pay for revision surgery again?

This question cannot be answered definitively, because if you see your doctor for a second operation, it is a completely agreed-upon issue. In cases where the negative side effects are due to carelessness, doctors agree not to pay for rhinoplasty. However, surgery or clinic costs must be paid.

If you see another doctor, the cost of reconstructive surgery will be higher than the initial surgery because it will be more complicated than the first operation.

Steps that the patient must follow before revision rhinoplasty

Once you are completely sure of your surgeon's choice, you should make an appointment with your doctor and then prepare the following:

• Atelier photos of different areas of the nose
• Perform a CT scan of the nose and sinuses
• Blood test

If the second rhino surgeon is another doctor, you should share all the information about your rhinoplasty with the reconstructive surgeon. For example, the surgeon will need your pre- and post-operative photographs, which will make the surgery more carefully planned.

Conclusion

In this article, we tried to answer all the questions that are in your mind about revision rhinoplasty. As we have said, correcting the shape of the nose after a single operation is a difficult and complex task and requires more precision and delicacy; this is due to the damage to the nose during the first operation. Due to the sensitivity of this operation, the necessary examinations should be done well before surgery and the best reconstructive nasal surgeon should be selected. If you are not careful in choosing a doctor as well as pre- and post-operative care, you may have to have surgery a third time later, which is much more difficult than the previous two operations.

Hopefully, by reading this article, you will get more information about secondary rhinoplasty and you will be able to get the best results with the right choice and a logical attitude towards this difficult cosmetic surgery.