When performing secondary or “revision” rhinoplasty, the open approach is preferred. Given that a secondary rhinoplasty is often more challenging because of scar tissue from the previous surgery, the open approach will afford the necessary exposure to correct the issues at hand. Common indications for need of rhinoplasty revision include:
Under Resection: The nose is still too big with residual dorsal hump, too long, or with overprojection. Sometimes there is a fullness above the tip call a poly-beak or supra-tip deformity. ( see photo)
Over Resection: The nose is collapsed with pinched or retracted nostrils, pointy tip, or “ski slope” dorsum. This can easily lead to nasal collapse upon inspiration.(see photo)
Asymmetry: There exists asymmetry of the paired structures of the nose, deviation of the tip, upper lateral cartilages, or bony pyramid.
Difficulty Breathing: Often associated with over resection or residual septal deviation.
Tools for Performing Revision Rhinoplasty
Tips Grafts: a flattened piece of cartilage that is placed at the tip of the nose to render a more pleasing tip aesthetic. Usually derived from the septum.
Dorsal Grafts: Onlay grafts of cartilage or other tissue to correct ski slope deformity. Derived from septum, ear, or rib.
Spreader Grafts: thin strip-like grafts placed along dorsal septum to support internal nasal valve. Derived from septum or rib.
Ear Cartilage: Cartilage from the ear can be harvested using a posterior incision with a non-visible scar. The bowl of the ear is harvested so as not to change ear projection.
Rib Cartilage: Autologous rib cartilage is used when the patient needs significant amounts of cartilage for correction of a deformity, or there is insufficient septal cartilage. The preferred approach is using the 5th or 6th rib harvested through an infra-mammary crease incision.
Dr. Reagan at True Beauty is an expert in performing Nasal Reconstruction. Causes of Nasal Deformities include skin cancer, disease, or trauma. The deformities can range from small (<1cm) tip defects to complete loss of structure (total nasal reconstruction). Structures to be reconstructed include skin, support, and lining.
Dr. Reagan is an invited speaker by the UC San Diego Plastic Surgery Division on the topic of Nasal Reconstruction. He has also presented on the topic at Scripps Memorial Hospital La Jolla Grand Rounds. His lecture is included for your education. (see Nasal Reconstruction powerpoint presentation).