In revision rhinoplasty, I don’t just focus on the shape I want to achieve. It’s essential to understand which tissues support that shape, what structural support remains from the previous surgery, and how the healing process has affected those structures.
A previous surgery may have altered the amount of cartilage, the tissue planes, the ligamentous relationships, and the behavior of the skin overlying the nose. Therefore, the same external appearance may indicate different surgical requirements compared to a nose that has not undergone previous surgery.
At the beginning of the consultation, I listen to the patient’s concerns. Appearance, asymmetry, tip support, and breathing difficulties should be described separately. It is important to explain not only the possible changes but also the limitations imposed by the patient’s anatomy.
In the “Secondary Rhinoplasty” chapter of the second edition of my book, *Aesthetic Septorhinoplasty*, I discuss how cartilage support changes depending on the specific needs of revision surgery. The use of septal cartilage in the previous surgery may affect the available resources for the new surgical plan. [1]
For this reason, I do not believe it is appropriate to make sweeping statements such as “ribs are absolutely necessary for revision” or “no graft is needed at all.” The need for a graft is determined by evaluating the extent of the support deficit and the available sources together. Selecting a source also requires an assessment specific to that source.
In revision surgery, the quality of the tissue covering the underlying structure is just as important as the structure itself. Skin thickness, previous scars, and the way tissues adhere to one another can all affect how a change will appear externally. Shaping the tissue further does not always result in a better surface.
Our 2021 publication on dissection plans and soft tissue management discusses the handling of different tissue layers in rhinoplasty. In revision evaluations, it is also important to understand which tissue is located in which plane and in what relationship to other structures; one cannot always assume that the plan of the previous surgery remained unchanged. [2]
A minor irregularity on the bridge of the nose and a noticeable lack of support at the tip present different challenges. Camouflaging a surface is not the same as rebuilding the underlying support. First, it must be determined whether the problem lies on the surface, in the underlying structure, or in both.
The study on bone powder and chopped cartilage, of which I am a co-author, is a technical paper on the reconstruction of the dorsum. Such tools should be viewed not as standalone solutions to all revision problems, but as options that can be selected for the appropriate indication. [3]
The cause of any obstruction that began or persisted following a previous surgery should be evaluated. The septum, lateral wall support, valve regions, and intranasal tissues may each contribute to the problem in different ways. Simply altering the external appearance may not resolve the underlying functional issue.
For this reason, during the consultation for revision surgery, I define the aesthetic and functional goals together but separately. Once the necessary evaluations are complete, we discuss which issues can be addressed surgically and what realistic expectations should be set.
Not all asymmetry observed after surgery is necessarily a permanent problem. Swelling and tissue maturation can make it difficult to assess the situation in the early stages. On the other hand, if there is a specific complaint, it may be necessary to have it examined rather than simply waiting for time to pass. The appropriate course of action is determined by distinguishing between these two situations.
The goal of revision surgery is not to disregard the previous surgery, but to describe the realistic changes that can be achieved with the existing tissue. Previous reports and photographs may be helpful; however, the decision is based on the current examination. We cannot guarantee perfect symmetry, flawlessness, or that no further surgery will be necessary.
You can access the relevant publications and book chapters via the links below. The scope of the studies and the applicability of each technique should be evaluated on a case-by-case basis.
Barış Çakır · book chapter, pp. 649–693
Barış Çakır and his colleagues · co-authored article
Ali Rıza Öreroğlu, Barış Çakır, Mithat Akan · co-authored article
A treatment plan is developed by taking into account your nasal anatomy, your breathing difficulties, and your expectations.
Frequently Asked Questions About Revision Rhinoplasty.
Tissue maturation and the nature of the problem are evaluated together. It is not appropriate to prescribe the same waiting period for every patient. If there are new symptoms or significant complaints, it is necessary to consult with the surgeon rather than postponing the evaluation.
No. The amount of support needed and available sources, such as septal cartilage, are evaluated. Rib cartilage may be a useful source in some cases; the need for it is determined during the examination and as part of the surgical plan.
Not every minor-seeming difference requires surgery. The cause of the irregularity, the stage of healing, its impact on the patient, and the burden the procedure would entail should all be discussed together.
It is important; however, the number alone does not determine the difficulty or what can be done. The scope of previous procedures and the condition of the existing tissue and supports require a more detailed evaluation.
If available, surgical reports, previous photographs, and information regarding the procedures performed will assist in the evaluation. The absence of these documents does not diminish the importance of the current examination.
It depends on whether there are any structures that can be preserved. The previous surgery may have altered certain relationships. Preservation may be necessary in certain areas, while structural rearrangement may be required in others.
Following an appropriate evaluation, both objectives can be incorporated into the same treatment plan. First, the source of the obstruction must be identified, and the relationship between aesthetic changes and the airway must be explained.
No. These are limited by previous surgeries, tissue characteristics, and variations in healing. The purpose of the consultation is to clearly identify achievable goals and uncertainties.
You can request an appointment to discuss your personal expectations and options.