In general a revision rhinoplasty, or secondary “nose job,” is more technically demanding than a primary procedure because the baseline of the nose has already been altered. The presence of scars further complicates things, making the skin thicker and harder to work with.
Because of the challenges of revision rhinoplasty, renowned Los Angeles plastic surgery expert Dr. Tarick Smaili emphasizes the importance of choosing the right doctor—i.e., someone who is board certified and has been doing the procedure on a regular basis that has given him an in-depth knowledge of the “roadblocks” ahead.
One of the most common reasons for revision rhinoplasty is to correct the “noticeably” asymmetric nostrils, which not only result in unnatural appearance but possibly breathing problems.
Most cases of asymmetric nostrils are caused by over-aggressive removal of the cartilage, which provides the form and support. But with a structure whose stability has been compromised, various problems can arise immediately after surgery or at a later date.
The “universal” approach is to preserve the structural integrity of the nose, which is done through correct grafting techniques. A graft is any tissue taken from one area of the body—such as the bowl of the ear, septum or wall between the nostrils, a piece of rib or hip, etc.—and is then used to improve the appearance and function of the nose.
Aside from the repair of collumela or wall separating the nostrils, many patients with asymmetric nostrils following a nose job will also need the alar or the lateral surface of the external nose—i.e., the area that flares out forming the nostrils—to be restructured with grafts.
But for some patients, a more viable approach is to undergo a septoplasty, a nose surgery wherein the columella is straightened, thus eliminating the crooked appearance and breathing problems.
Another possible solution is to use spreader grafts, which are particularly helpful when there is a depression on the upper lateral cartilage, leading to one side of the tip to “dip” or the nostril to appear smaller than the other side.
Because revision rhinoplasty patients are already dealing with disappoints, it is more important than ever to use 3D computer imaging technology that allows a more open discussion between them and their plastic surgeons. According to studies, this tool can increase patient satisfaction rate because it paves way for better communications.
Meanwhile, recovery after a revision rhinoplasty generally takes longer than a primary nose job’s, with the residual [unnoticeable] swelling taking up to two years to fully dissipate.