Rhinoplasty for the multiply revised nose
Unlike primary rhinoplasty, which is mainly a reduction rhinoplasty, revision rhinoplasty is basically a restructuring procedure aimed at rebuilding the dorsal and tip support. The revision rhinoplasty, being technically more demanding, presents a constant challenge to the plastic surgeon; this challenge increases greatly with every revision procedure that the patient receives.
The multiply revised nose is usually complicated by the distorted anatomy, excessive scarring, and decreased vascularity. As a result of the excessive fibrosis and decreased vascularity, the skin soft-tissue envelope of the nose becomes less contractile and redrapes poorly over the modified bony cartilaginous framework, thus showing less details of any modifications performed. These problems make the results of any subsequent surgery highly unpredictable. Apart from the technical problems encountered, these patients usually suffer from psychological implications of their repeated failed procedures, which makes their postoperative satisfaction even less likely. As a result of such complex technical and psychological problems, many experienced surgeons approach the repeated revisions with such anxiety that they either refuse to perform the procedure or do it with a great deal of reluctance.
In the current study, 68% of the cases suffered of variable degrees of nasal obstruction, which was most commonly caused by residual septal deviations. The most symptomatic type of septal deviations was that involving the dorsal cartilaginous septum in the nasal valve area.
The 2nd most common cause of obstruction, after the deviated nasal septum, was nasal valve problems including valve collapse and/or obliteration of valve area by adhesions.
The most common aesthetic deformities involving the upper two thirds of the nose included pollybeak (64%), dorsal irregularities (54%), dorsal saddle (44%), and the open roof deformity (42%).
The most common aesthetic deformities affecting the lower third of the nose included depressed tip (68%) and tip contour irregularities (60%).