If you are reading this article, it means that you have had one or more previous nose surgery and you are not satisfied with the outcome. First of all, get well soon. I aimed to write an article about the revision rhinoplasty surgery to inform you correctly and from the first hand, as a surgeon who has made one of the highest number of revision rhinoplasty operations in Turkey. When I write this article, I did not keep it short by saying “anyway it will not be read”. The main reason is that I observed my patients who are in demand of revision rhinoplasty faced serious problems related with the lack of relevant sources about this subject.
I mention first to all my rhinoplasty patients that “Rhinoplasty surgery is one of the world’s most difficult operations”. Difficulty of the operation is not materially or for patients, it is mostly for doctors. Rhinoplasty surgery is becoming more comfortable with each passing day. There is no pain or ache. Bruising is almost not seen particularly with the help of Ultrasonic Rhinoplasty. Although it varies person to person, swelling is usually seen very rarely. So it is a really comfortable process.
We said it is difficult for the doctor … So why is it difficult?
Because this surgery is not a standard surgery and it requires a separate planning and analysis for each patient. This means that making the same nose for all patients is irrelevant now. Today, we are trying to design and make noses according to each patient’s skin, the facial proportions, style and requests as much as possible. And we are raising the bar for you every day.
In order to become a master in the rhinoplasty surgery, you need to be a good observer, a good listener, a good surgeon, a good designer and also be a patient person. Rhinoplasty surgery requires analyzing the bone, cartilages, the skin and surrounding tissues comprehensively and being able to handle them very well. So, we can say it is the most difficult and complex among all other plastic
5 sine qua non of a successful rhinoplasty surgery;
- The appropriate facial rates
- The compatibility with the gender
- Open airways
- Even after years, the absence of such views of nose as collapsed, fallen, turned, pinched or compressed with peg.
- Proximity and compatibility to the patient’s style and desire.
These are generally valid for revision surgery. But in revision surgery, the surgeon is limited with various factors such as the magnitude of the problem with the nose, the degree of anatomical defects, vascularisation of nose, blood supply of nose and how much the skin of nose is worn in the previous operations.
I said rhinoplasty surgery is difficult, but revisions are more difficult. There are three main reasons for this difficulty:
Technical difficulty: it is difficult to do revision rhinoplasty. Sometimes even removing the skin from skeletal structure can take 45 min. Apart from this if the integrity of anatomical structural is impaired in the first operation reconfiguring all of these structures takes hours and requires the surgeon to be both technically skilled and also very patient.
Psychological difficulty: Patients who search for revision rhinoplasty surgery are previously frustrated one or more times, psychology worn out, stressed and sceptical. Before surgery it is necessary to overcome the problem of trust in these patients and to build a new doctor-patient relationship. This can be maintained by patient through spending sufficient time with the doctor, talking about each subject, forming the expectations together with the doctor and understanding the significance of patience. The smallest complication in the postoperative can disrupt morale of some patients they can act like the worst thing in the world happened. However, revision surgery is a process and follow-up period should take at least two years. The changes in the nose should be examined for two years and required measures should be taken according to the situation.
Recovery challenges: No matter how well planned and how rigorously made, the surgeon’s prediction in revision rhinoplasty surgery is more difficult than a rhinoplasty surgery as a result of bleeding due to previous surgery, lymph flow, disorders related to blood flow in skin. So, recovery problems that cannot be estimated may cause problems related with nutrition of cartilage, the formation of small partial level differences, discoloration of the skin, failures that nose skin cannot fully adapt to nose and prolonged skin oedema etc.
After I explained all of these challenges, here are my recommendations and cautions to patients who want to get nose revision aesthetic surgery;
If you do not like your nose or think that you have a problem first contact your doctor. Any doctor does not want his/her patient to be unhappy. First you consult your doctor and if you cannot communicate well you start to search for a new doctor. Do not bring or tell your experiences about your former doctor and previous operation. You must focus on the future and difficult journey ahead of you with a new doctor. You should leave the evaluation of the history at the door of your new doctor.
Revision rhinoplasty surgery is a process. This process begins the moment you that your surgeon operated on and will take about 2 years. You must be very patient. Recovery lasts 2 years and may vary. So this is not an operation, this is a two-year recovery process. Surgery is only the beginning.
I follow my own patients each few months throughout the 2 years. You should absolutely go to your routine controls. These are significant for determining abnormalities in early phases.
No matter how you choose a good surgeon and the surgeon does this operation very well, revision surgery is unpredictable. Minor problems may occur and after the first year these may needed minor retouches that take 10 minutes to 45 minutes. These retouches are usually do not take long hours as in revision surgeries and do not require hospitalization. Talk about them to your doctor before your surgery.
Be positive. If you make the choice of an experienced doctor about nasal surgery the result will not likely to be worse than the present. Make yourself always good suggestion. I always tell my patients before this surgery: “We will be like a team after this surgery. Our goal is your happiness and health, so we always want to do better”. So you’re not competing with your doctor. After surgery, it is meaningless to make mutual defence. Please note that some revisions cannot give result at once, instead it may need several surgeries. A good relationship with your surgeon will improve your chances of success.
Do not ask for perfection, ask for better. Even though it is your first time, any nose surgery does not result with perfect nose aesthetics. Even the best noses we do can have minor defects. These defects are not the fault of the surgeon. These are the parts of Rhinoplasty operations. There is no perfect human face. The most important thing is to hide minor imperfections in your nose harmoniously with your face. Do not be a dumb of symmetry. None of the elements in human face and body that consists of left and right sides is symmetrical to each other. Asymmetry is the normal state of the human face and body. So then the both nasal bones or both nostrils are not necessarily symmetrical after rhinoplasty surgery. There is symmetrical or more symmetrical, but there is no symmetry in rhinoplasty in absolute engineering terms. Establish a good communication with your doctor in all conditions.