A revision rhinoplasty surgery, or “nose job,” poses some unique challenges due to the presence of scar tissue that makes the skin harder to work with. Also, surgeons often deal with patients who are confused and deeply disappointed in the initial results, further adding to their predicament.
Nonetheless, great results or at least a good amount of improvement can be still achieved with proper patient selection and careful surgical planning.
The success rate of revision rhinoplasty also lies in the plastic surgeon’s experience, training, and level of artistic skills, which can be assessed by looking at his before-and-after photo gallery.
A revision rhinoplasty might pose more challenges when performed in ethnic patients, who in general have thicker skin and weaker underlying framework—i.e., small bones and floppy cartilage—than Caucasians.
One of the most common reasons why ethnic patients ask for revisions is the ethnically inconsistent result. Inexperienced and imprudent doctors do not recognize and respect the cultural and racial standards of beauty, and use techniques that are only suitable for Caucasians.
Too much augmentation and excessive tip narrowing often destroy the ethnic features, much to the disappointment of patients. To address these problems, a competent doctor will assess the underlying anatomies, the facial features and their distance from one other, and the patient’s cosmetic goals.
Oftentimes, grafts harvested from the septum or wall between the nostrils, bowl of the ear, or ribs are needed for structural support and improved contour. Compared with synthetic implants, they are better tolerated by the body and have a significantly lower risk of protrusion and adverse reaction.
Nonetheless, the thick skin of ethnic patients means that they are less susceptible to implant visibility, while Caucasians are generally advised to stay away from synthetic materials because their thin skin can easily show what is underneath.
In general, revisions result in longer recovery and more swelling and bruising compared with primary surgeries, although the degree of intervention (breaking bones and disruption of tissue) will still largely determine the downtime.
In revisions performed in patients with markedly thick skin and who require extensive work, the final result could even take up to two years. However, most will see a significant improvement at six months or sometimes earlier if the swelling has been controlled.
Since prolonged swelling is common among revision rhinoplasty patients and those with markedly thick skin, some doctors recommend them to have a small amount of steroid injection (Kenalog) to improve healing.