Revision Rhinoplasty – OP. DR. CENK TEKER





    Revision Rhinoplasty


    Revision rhinoplasty allows you to eliminate aesthetic or functional problems experienced after rhinoplasty.


    The face is the most prominent area, and the nose is the most protruding and central point of the face. Therefore, surgical intervention or other errors due to the healing process cannot be tolerated when it comes to the nose. Consequently, it is not surprising that rhinoplasty is among the most frequently revised surgeries.


    The main point in the revision rhinoplasty decision is that the patient is unhappy with the result of the nose surgery. Simple aesthetic concerns, asymmetric improvements, volume surpluses and defects, functional disorders such as breathing, infections, suture reactions, and adhesions that we call synechia are the main reasons that require revision rhinoplasty surgery.


    Simple revisions can also be eliminated by closed methods, as well as more significant problems are usually destroyed by open rhinoplasty with the use of rib cartilage.


    To decide on revision rhinoplasty, it is necessary to wait at least one year after the last nose surgery. The basic idea of rhinoplasty is to make a nose that will not need revision surgery.


    What is Revision Rhinoplasty?


    Revision rhinoplasty is the medical term we give to the condition that rhinoplasty operations are repeated with any justification. Rhinoplasty revision surgery, unfortunately, ranks first among the most frequently applied aesthetic procedures (revision surgeries).


    Revision rhinoplasty patients are usually psychologically tired people who have had a hard time due to the disappointment experienced after the first surgery. For this reason, they approach revision surgery under the influence of this bad experience, which is very understandable. 


    Let’s look at it from the positive side. Revision rhinoplasty operations are the only way to eliminate a rhinoplasty that you don’t like the result of being the biggest regret of your life.


    Why Is Revision Rhinoplasty Performed?


    Revision rhinoplasty is performed to eliminate the dissatisfaction caused by previous nose surgery, whether aesthetic or functional disorders.


    The main complaint that makes the patient unhappy is the central issue of revision rhinoplasty.


    Immediately after aesthetic nose surgery, the patient may not like the result, some aesthetic or functional problems may have become noticeable over time, or it is possible that following aesthetic and/or functional deformations may occur later, such as:


    Not being satisfied with the new nose shape after aesthetic nose surgery

    Aesthetic deformities and functional deficiencies that develop due to cartilage tissue insufficiency after nose surgery

    Collapse/deterioration of the anatomy of the nose

    Difficulty breathing after nose surgery, constant nasal congestion

    Infection, discharge and similar health problems caused by a surgical error


    When Should Revision Rhinoplasty Be Performed?


    Revision rhinoplasty, in principle, should be performed at least one year after the first nose surgery if there is no severe and/or odorous infection or similar emergency.


    Why is it essential that at least a year has passed since the first rhinoplasty was performed before the revision?


    For the image, which is not aesthetically pleasing to the patient, to be able to be reshaped, edema after rhinoplasty should be reduced

    The fact that the nose shape is seated before revision rhinoplasty is one of the essential conditions for revision surgery and positively affects the result

    It is necessary for at least a year or so for the wounds to heal, for the tissues that make up the anatomy of the nose to survive the trauma of surgery

    Revision rhinoplasty, which is usually performed by an open method, prevents the appearance of surprises during the operation so that the surgical wounds are completely healed before surgery


    Risks of Revision Rhinoplasty


    Revision rhinoplasty surgeries are usually more difficult procedures than aesthetic nose surgeries that will be performed for the first time. The most significant risk is the possibility of “unsuccessful revision rhinoplasty”, which leads to highly annoying situations both from the point of view of the patient and the doctor.


    The risk of revision rhinoplasty is specific in each case, based on the reason the nose surgery is resorted to, the complaint arising from the first surgery, and the extent of the deformity.


    In What Cases  Revision Rhinoplasty Performed?


    Revision rhinoplasty is not always done to eliminate big mistakes or improve bad results. Deformities/errors that are very diverse and vary in degree of discomfort develop after aesthetic nose surgery.


    Minor complaints and severe problems in the aesthetic image are the subjects of revision rhinoplasty. To compensate for the functional problems that occur after nose surgery, it is also necessary to plan revision nose surgery in the same way.


    The following are common conditions that lead to people who have previously had a rhinoplasty having to have a rhinoplasty again:


    Aesthetic deformity of the tip of the nose and/or nose

    Asymmetry of the tip of the nose and nostrils

    Curvature of the nasal hump

    Droopy nasal tip 

    Deformity of the inner nasal bone

    Accumulation, growth of soft tissue in the inner nose

    The image of the nasal hump bridge

    Thick nose bridge

    Unchanged edema in the supratip region of the tip of the nose

    Built-in edema after nose surgery

    Deformities that remain after wound healing

    Infection that does not recover after rhinoplasty

    Foreign body reactions

    Stitch reactions


    How Is Revision Rhinoplasty Performed?


    Revision rhinoplasty surgery is planned precisely for each case according to the patient’s complaints from the previous nose surgery. In necessary points, it is performed by transplanting cartilage tissue from the ribs or ear, using closed or open revision rhinoplasty surgery and techniques called piezo, micro drill, classical conventional rhinoplasty or combined rhinoplasty where these methods are applied together.


    The methods and techniques to be used are decided on a case-by-case basis after a detailed examination. It is essential to identify and analyse the problem before revision surgery. Patience and psychological stability become more critical in the recovery process.


    Open Revision Rhinoplasty


    The most common method of revision nose surgery is open revision rhinoplasty surgery. It is made with a V-shaped incision from the area we call the columella-columella under the wings of the nose.


    In the case of revision rhinoplasty, except for minor problems, what can be done with the closed technique is limited.


    As in the following cases, it is inevitable to open the nose in revision surgeries that require a redesign of the cartilage structure, and this is the correct approach:


    Displacement of grafts after rhinoplasty

    Aesthetic deformities that occur due to impact, accident, or trauma after aesthetic nose surgery

    Infectious wound conditions

    Faulty nose surgery


    Closed Revision Rhinoplasty


    Closed revision rhinoplasty, which we perform with an incision made through the nose, is a highly advantageous method for eliminating minimal defects. Thanks to the fast technique, it is possible to correct minor aesthetic distortions and solve cartilage or soft tissue problems in the nose without opening the nose again.


    Cases where we often resort to closed revision rhinoplasty operations and get satisfactory results are as follows:


    Droopy nasal tip after rhinoplasty

    Minor asymmetries in the tip of the nose after aesthetic nose surgery

    Protrusion of the back of the nose after nose surgery

    Small touches in the form of a nose


    Techniques Used in Revision Rhinoplasty Surgery


    Usually, to achieve the best result, a way is followed in which many methods are used together. Therefore, the revision rhinoplasty doctor must master all these methods and techniques.


    When there are no deformities in the bone tissue, it is not necessary to use piezo or burr, and a secure method may be preferred for such revision rhinoplasty operations.


    Suppose the entire reserve of cartilage tissue was used during the first operation, and we need to reshape the anatomy of the nose. In that case, open revision rhinoplasty becomes the current method.


    The techniques we use in revision rhinoplasty surgeries that can be performed with open or closed rhinoplasty are as follows:


    Ultrasonic Rhinoplasty / Piezo Technique

    Piezo device is a bone shaping technique used during rhinoplasty and revision rhinoplasty operations. The piezo method makes it possible to form the bone without breaking it.

    Micro Driller Technique

    When we want to thin the bone without active crushing, the bone is shaped using high speed drills in the micro round technique that we resort to.

    Conventional Rhinoplasty

    The nasal bone is rasped and broken and reshaped in this technique, which we call classical conventional rhinoplasty. Although it is not used as often as it used to be, it is a nasal bone shaping technique applied in cases where it is necessary, which continues to be valid.

    Holistic Rhinoplasty

    Revision rhinoplasty protocols are usually performed using a combined rhinoplasty technique in which more than one technique is used together. Some piezo, micro drill and conventional rhinoplasty techniques are used together according to the content of the operation. 


    Before Revision Rhinoplasty


    Rhinoplasty surgeries are sensitive psychological processes from the beginning; this sensitivity reaches much higher levels before revision rhinoplasty. It is essential to listen to the details about the first nose surgery and its aftermath and to make you feel that you can empathise with the patient.


    After a detailed examination, computed tomography (CT) is requested when we need more information. 


    Then, the methods and techniques to be used in operation are decided, considering the patient’s priority expectations from revision rhinoplasty surgery.


    How to follow a path, spontaneous decisions to be made during surgery against possible contingencies, and all other details are evaluated mutually with the patient.


    After Revision Rhinoplasty


    The healing process of revision rhinoplasty varies from person to person depending on the content of the operation, but in general, it proceeds similarly as after rhinoplasty:


    Bruises and swelling after revision rhinoplasty are the conditions we expect

    After three weeks of revision rhinoplasty, edema is largely removed, but up to 1.5 years, the nose continues to shrink, edema continues to beat

    After revision rhinoplasty, it takes up to 1-1.5 years for the nose to fit

    The scar after revision rhinoplasty gradually becomes indistinct and becomes invisible to the eye if it is not looked at closely


    Rinophilosophia: If Possible, No Need for Revision!!!


    Of course, no doctor who performs rhinoplasty surgery wants their patient to need revision nose surgery. The philosophy of aesthetic nose surgery should be to perform surgeries that will not need revision.


    Because revision surgery is a cost again and going under the knife again.

    It is challenging for the patient to stay in case of revision surgery, but it is also necessary not to see it as the end of the world. Not demoralising and approaching the issue positively before and during revision nose surgery makes the process more accessible in stress management. It makes it easier for you to get out of the negative emotional dimension of the job and meet the right doctor.


    Thanks to advanced techniques, it is possible to solve many problems with revision rhinoplasty. As long as you go through the revision rhinoplasty pre-process based on open communication with realistic expectations and experienced hands operate…  


    The Best Doctor for Revision Rhinoplasty…


    The best doctor in rhinoplasty is a very relative discussion, but there are specific medical and aesthetic standards. Otherwise, we would not have decided that something is beautiful or healthy!


    We can answer questions such as who is the best doctor for revision rhinoplasty, how to find it, and how to decide based on this.


    A doctor who has mastered the physiology and anatomy of the nose has devoted themself to revision rhinoplasty surgery and therefore has a large number. Different case experiences are much less likely to fail revision surgery.


    Among the people who are not satisfied with the first rhinoplasty, the number of those who have undergone surgery with the same doctor is small. Often the search for a new doctor begins, and this process can be confusing. We can list some priority/essential points as follows:


    Keeping medical facts at the forefront

    Developing personalised aesthetic approaches

    Adding your interpretation to the current aesthetic trends

    Caring about open communication with the patient

    To see patient satisfaction as a priority


    Working with a doctor who is prone to cooperation to create a nose again by the facial contours and expression of a person, not according to aesthetic patterns, allows the patient to feel comfortable and safe during the revision rhinoplasty process.


    Revision Rhinoplasty in Turkey/Istanbul


    Revision rhinoplasty in Turkey is one of the aesthetic revision surgeries that we perform very often. Revision nose surgery in Istanbul has become increasingly popular thanks to many revision rhinoplasty patients coming from abroad.


    The increase in satisfying results has turned Turkey into a centre of attraction in revision rhinoplasty. In contrast, the high demand for revision rhinoplasty surgeries in Istanbul is precious in increasing professional experience in this field.


     Revision Rhinoplasty Prices


    Revision rhinoplasty prices can only be budgeted after a detailed examination of the content of the surgery that the patient needs and determining the methods to be used. Unfortunately, it is out of the question to give a general price.


    The cost of open revision nose surgery performed with cartilage tissue transplantation is different from the price of closed nasal tip revision completed with cartilage tissue transplantation.


    Revision nose surgery prices may be higher than the first nose surgery. This is because revision rhinoplasty is a surgically demanding operation that requires deep experience and care.

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