Revision rhinoplasty, also referred to as corrective or secondary nose job, deals with deformity of varying degree. In general, mild asymmetries such as small residual hump along the profile are best addressed after 6-18 months postop; the idea is to wait for all the residual swelling to subside.
Waiting is also ideal for patients with a markedly thick skin that makes them susceptible to protracted postop swelling in order to achieve a more favorable outcome, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Postponing revision rhinoplasty also ensures that the skin has fully shrink-wrapped to the new contour, and the patient becomes more “objective” in assessing the surgery’s results. Simply put, waiting prevents anyone from making hasty decision that could lead to more problems and frustrations.
However, there is no reason to wait when the issue involves gross deformities and abnormalities, especially when there is very little chance that they will improve even after all the swelling has dissipated. This is particularly true for twisted nose, collapsed appearance, and polly beak (the nose resembles a parrot’s beak due to its excessive convexity).
Function-related problems are also best addressed sooner than later to prevent further suffering.
In addition, patients with significant swelling caused by aggressive scar tissue inside the nose are best treated with steroid (Kenalog) injection as soon as possible, provided that the nasal framework is sturdy.
Steroid injection is commonly used in the supratip (right above the tip) to reduce persistent swelling, which is not uncommon in patients with thick nasal skin. However, the treatment should be used sparingly (i.e., highly diluted form and at intervals of 4-6 weeks) to minimize risk of skin depression, skin discoloration, and abnormal blood vessel formation.
In summary, the right or ideal timing for revision rhinoplasty will depend on many factors such as skin thickness, degree and type of abnormality or deformity, amount of postop swelling, stability of the framework, and presence of function-related problems. Simply put, the “usual” guideline of waiting 6-18 months is not always justified.