There are various reasons for revision rhinoplasty, including the border of the implant being visible, a deviated implant, the patient’s own dissatisfaction, looking too obviously operated, etc.
For revision rhinoplasty, finding the cause as well as understanding what the patient feels and thinks about the current condition is important. To break out of a vicious circle of revision surgery, the revision rhinoplasty should be performed by experienced rhinoplasty experts.
The CDU medical team consists of senior surgeons with 23 years of clinical experience and a high understanding of implant characteristics, gained by researching the most popularly used rhinoplasty implant (SOFTXiL).
The Most Propitious Time for Revision Rhinoplasty
Patients may consider revision rhinoplasty when the outcome is not desirable or there is a functional issue such as breathing problems, pain, etc.
We understand that dissatisfaction may cause anxiety or worry. However, during the surgery, the skin and tissues are irritated. During the early stage of recovery, even though the wound outside seems fully recovered, swelling remains on the nose and the inside of the wound is not recovered yet.
Therefore, it is better to wait long enough (at least six months) for the wound to mature and for the swelling to resolve before deciding on revision surgery.
When do I need to have early-revision surgery?
There are some cases that require early-revision rhinoplasty: infection, deviated implant, or the possibility of implant protrusion.
Infection after rhinoplasty can be detected right after surgery with the naked eye, or it can develop later over time. There are many causes of infection such as a low-quality implant, an unhygienic surgical environment, surgery performed in an inappropriate way, the patient’s lifestyle, or the body’s adverse reaction to foreign materials. In this case, immediate treatment with medication or early correction is required.
Symptoms of Infection
2. Deviated implant
If the implant is deviated right after surgery, early correction is required.
Before the tissues around the implant heal and scar tissues form, the implant position can be corrected easily.
3. Skin on the nose is reddish and there is a possibility of implant protrusion
When the length of the implant is too long or an L-shaped implant is used, the implant puts a lot of pressure on the skin. Over time, the skin may become thinner and the implant can break the skin and come out.
In this case, immediate revision surgery is required. The skin needs to be reinforced with artificial dermis and the implant should be swapped with a shorter one or removed.
Various Cases of Revision and Solutions
1. Deviated implant
When the implant seems deviated, the centerline of the face or the nasal bone structure needs to be checked.
If the face or the nasal bone itself is asymmetrical or deviated so that the centerline is deviated, the implant should follow the centerline or the bone to achieve bilateral symmetry.
2. When the implant is movable
If the implant is inserted right under the skin, not the periosteum, the implant can be movable. In this case, the symptom can be easily corrected by changing the position of the implant to underneath the periosteum.
3. Visible implant through the skin
When an inappropriately sized implant which does not align with the nasal bone and cartilage is used, the skin is too thin, or the skin loses its elasticity, the border of the implant may be visible.
4. The implant is too high or too low
When the initial surgeon’s design is not balanced in the face, the height can be dissatisfactory, or the implant can seem too low to the patient after swelling resolves.
5. When the tip is too bulbous
The ideal nose needs to be harmonious from the bridge to the tip. When only a radix graft is performed, the tip seems comparatively low or flat as the bridge becomes higher.
Alternatively, when the cartilage is too weak to support the implant, the tip can collapse, becoming bulbous.
6. When the tip droops down
When an inappropriate implant is used, the cartilage on the tip is weak, or the cartilage on the tip is absorbed, the tip can droop down.
7. When the tip rotates upwards or is distorted
This can be a symptom of nose contracture. The cause of contracture varies, so the cause should be accurately discerned through consultation with an experienced rhinoplasty surgeon and revision rhinoplasty should be performed.
8. When the tip skin becomes reddish or white
This may be due to blood circulation issues caused by thinned skin. If this is not corrected at the right stage, the implant or the cartilage can protrude from the skin.
9. Illegal injection on the nose
The illegal injection can’t be removed completely, but we can try to remove most of the illegal injection and try to perform revision surgery, avoiding the use of foreign materials.
Q&A About Revision Rhinoplasty
CDU’s Signature Technique Preventing Tip Droopiness
Tip droopiness is quite a common complaint from patients after tip plasty or rhinoplasty using autogenous tissues. Autogenous tissues such as ear, septal, rib cartilage or dermofat are often used because body tissues have considerably lower rates of infection.
However, they have a high absorption rate once they are grafted into the body, and the rate differs depending on the individual’s physical characteristics.
To prevent tip drooping, CDU uses a different technique, achieving an effective result in a less invasive way.
One thing people overlook is the implant. The quality of the implant determines the possibility of infection, satisfaction, and shape.
2. Wrapping-edge Augmentation
Autogenous tissues have a tendency to be absorbed into the body. Furthermore, once an implant is attached to alar cartilage, the gathered cartilage can become detached due to pressure, creating a gap. The implant can go into the gap, which causes the tip to widen and tip droopiness.
By wrapping the implant edge with ear cartilage, the top part of the ear cartilage is not easily absorbed into the body, so the height is maintained as it is attached to the implant. It also protects the skin on the nose tip from the implant. The bottom part of the cartilage and the alar cartilage are adhered each other, so the alar cartilage does not break out easily.
3. Alar Sculpting Suture
When the alar cartilage is gathered using the best technique, the tip can achieve its best height. Generally, when the skin is thicker than usual or patients would like to achieve a dramatic result, rib cartilage (the hardest of any autogenous cartilage) can be considered.
The shape and result may be good, but the tip may be stiff. Furthermore, surgery requires general anesthesia and leaves scars where the cartilage is harvested.
However, at CDU, with the doctors’ 20 years of experience, an ideally defined and high tip can be created without using a lot of cartilage or rib cartilage.