Revision Rhinoplasty Explained in 10 Points

1. Except emergency situations, it is suggested to be made at least 1 year after the first operation.

The reason: The completion of the healing and formation process.

2. It would be appropriate if the same surgeon does the operations.

Reason: the surgeon who did the first operation has full knowledge of the process and the tissues that are operated.

3. A piece of cartilage could be taken from the ear or ribs of the patient to be used as patch.

Reason: The cartilage inside the nose could have been used up during the previous operations.

4. The formation after the surgery takes place later compared to the previous operation.

Reason: With each additional operation, wear and tear in the tissues may increase; recovery and formation could take place later.

5. The filling materials used for correction purposes cannot be used appropriately for each and every nose.

Reason: Filling materials are not permanent. They may cause reaction in some patients and each additional filling could make the nose bigger.

6. Each revision operation in the nose is a technically difficult procedure, which is prone to complications.

Reason: Suture materials, tissue patches, bone filaments and formations, tissue adhesions and skin thinning used in each operation are factors that increase the difficulty of subsequent surgery. Adaptation weakness, lack of attention and smoking may cause these difficulties to increase exponentially.

7. Together with the mental preparedness of the patient, his/her psychological state should also be revised before surgery (coaching)

Reason: There should not be any confidence issue left unresolved between the patient and the surgeon. Successful results can only be obtained in procedures that are followed with mutual trust, understanding and honesty. Otherwise, expecting the results to be obtained immediately after surgery and focusing on natural swelling and redness, that is transient negative effects, could be exhausting for both sides. To avoid such situations, both parties should spend some qualitative time and listen to each other carefully.

8. No photo-shop program can ensure a standard procedure and a guaranteed result.

Reason: The results obtained by computer programs could often be misleading and result in disappointment both for the doctor and the patient as such results are given meaning and importance according to the patient’s level of consciousness, knowledge and perception. Just like no two surgeries, done by different surgeons, can get exactly the same result, no surgeon can either have the same result from his/her two different operations. Therefore, these programs should be preferred only for certain patients. On the other hand, a patient who has a 3D image of the sample postoperative results will be able to have the Judge to accept the photograph as a “work contract” in a possible legal situation where she/he is not content with the results. . It is necessary to pay attention to this obvious risk especially after the revisionary aesthetic nose operations.

9. The aesthetic nose operations which are made as a result of a request for a basic change in formation after the first surgery cannot be considered as revision.

Reason: If the first operation is made without due examination of the facial profile, the second operation, which will be made to give a new formation to the nose as the patient did not obtain the look and the harmony that he or she was expecting in his/her face, cannot be called a revision. In order to help these patients, it is necessary to explain to them the fact that the problem could be related to shape and the proportions of other organs and tissues over the face and it would be essential to make a new and integrative evaluation in line with “gestalt” perception principles. The chin tip or cheekbones are the most common facial structures that are used for correction of the perception of nasal appearance.

10. Revision operations for the nose cannot be performed by every surgeon.

Reason: Just like in all aesthetic surgeries and interventions, the certificate of expertise for rhinoplasty should be given not to the ones who have only completed the basic education and is capable of carrying out a surgery, but to the ones who have the knowledge, expertise and leadership to cope with unexpected problems that can be encountered during the surgery. Such an unexpected problem may necessitate a revision surgery. Therefore, one of the appropriateness of the same surgeon, who did the first operation, of doing the second one is open to interpretation and may not be true for all cases.