The re construction of patients who have had nose surgery before is called “revision rhinoplasty surgery”.

 Previous surgery performed only due to breathing problems: (septoplasty)

Before rhinoplasty became popular for aesthetic reasons, surgeries were performed more often to correct breathing and without changing the external appearance of the nose. The basic principle of these surgeries are to remove the curved nasal cartilage by entering through the nose. In this case, when the patient decides to have a repeat operation, there may not be a sufficient amount of cartilage in the nose. Therefore it may be necessary to take cartilage from the ear or rib. These revisions are more difficult than working on a non-operated noses.

Revision of patients who have had one rhinoplasty before:

 Since the cartilages in the nose has been used in previous surgery, it may be necessary to take cartilage from the ear or rib in these patients. Other time it may not be necessary. The need for additional cartilage is only evident in surgery.

Depending on the previous surgery, the skin adheres tightly to the underlying bone and cartilage tissue. Therefore, it is necessary to wait for wound healing (when performing revision surgery) in order to better separate the nasal skin from the underlying bone and cartilage. The ideal period for this 1 year. However, revision surgery can be performed from the 6th month depending on the skin structure.

Due to the old surgery the nasal skin is damaged. For example, if you think of nasal skin as a quilt, skin thickness changes in damaged areas. Therefore, even if the doctor performing the nasal aesthetics shapes the underlying bone and cartilage tissue well-  if the skin overlying it is of different thickness all over the nose, there may be depressions due to small skin weakening in some areas.

Revision of patients who have had 2 or more nose aesthetics before:

The risks (1- the need for cartilage, 2- the adhesion of the skin, 3- the deterioration of the skin quality) are valid for these patients. These risks are much more likely to occur after having 2 or more surgeries.

Why are so many doctors opposed to revision surgery?

 There are several reasons for this:

1- The experience of the doctor is not sufficient for revision surgery. This is very normal because revision surgeries require a lot of experience.

2- It is impossible to achieve perfect results in revision surgeries. It is easier to obtain good results in patients who have never had surgery before. Although the result is better than before in revision surgeries, it may not meet the expectations of the patients.

3- Patients who want revision surgery for small and vague problems cannot predict the difficulty of the surgery. Sometimes patients want to have their perfect and flawless noses reopened without being aware that the final result will be less desirable than before. In this case the surgeon will refuse to operate in order to protect the patient and avoid doing any harm.

How should patients decide if they want revision surgery?

My advice when deciding to undergo revision surgery is as follow; If you have a pronounced curvature in your nose that can be seen at first glance, a severe nose drop and/or a serious nasal collapse you may consider a repeat surgery. However, do not undergo surgery for small problems because the risks are too high with revision surgeries. The minor problems may not be worth the risks.

Assoc. Prof. Dr. Salih Aydin

Otorhinolaryngology Specialist

Faculty member, Istinye University Faculty of Medicine