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Rhinoplastytoronto.ca - A Resource for Patient Information Provided by Richard Rival, MD, FRCS

Revision Rhinoplasty

Revision or secondary rhinoplasty corrects problems arising from previous rhinoplasty surgery. Usually the problems Toronto rhinoplasty patients experience are minor and can be dealt with by the original surgeon. The revision rate for rhinoplasty even in the best of hands is from 5 to 10%. If however, there is a major deformity it may be better to pursue your second surgery with a surgeon who is experienced in revision rhinoplasty such as Dr. Richard Rival.

To find out how you can benefit from revision rhinoplasty, request a consultation with Dr. Rival at one of his three Toronto-area cosmetic surgery offices. If you are interested in a facial plastic surgery procedure other than rhinoplasty, visit our main site at www.rivalcosmeticsurgery.com.

Richard Rival, MD, FRCS

Board-certified in Facial Plastic Surgery and Otolaryngology, Dr. Rival devotes his practice exclusively to enhancement of the face and neck, with a focused specialty in rhinoplasty.

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Dr. Rival
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Why Is Revision Rhinoplasty So Complicated?

The second (or third or fourth) nose surgery is usually much more challenging for the surgeon. Multiple nose jobs in Toronto often alter the normal anatomy of the nose, remove cartilage, and can even compromise breathing. The revision rhinoplasty surgeon must carve out the normal structures which are usually encased in scar tissue.

How Is Revision Rhinoplasty Done?

The most common and most challenging need for revision rhinoplasty occurs when too much tissue was removed during the previous surgery. There is often a need to rebuild the structure of the nose and therefore grafts (pieces of cartilage either from the nasal septum, ear or rib) are sometimes required. Some surgeons prefer to use implants (synthetic materials) for this purpose. Some of the more common materials used are gortex, medpore and hard silicone. In recent years, injectable fillers such as Restylane®, Artecoll®, and RADIESSE® have been used to fill in small defects left after rhinoplasty. Dr. Rival's general philosophy is to always use the patient's own cartilage if it is available. There are however rare situations where an implant or injectable is the preferred option.

Revision Rhinoplasty Cases

Revision Case 1: Minimal Tissue

This patient had over-aggressive
resection of the nasal bridge and tip. His bridge and tip were reconstructed with cartilage from his nasal septum and ear.

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When the nasal tip cartilages are over-resected this can create a very pinched narrow appearance from the front view.

Revision Case 2: Pinched Tip

This patient had a very pinched tip after rhinoplasty. After revision rhinoplasty her nose appears softer and more round
which has also helped with her breathing.

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Sometimes revision rhinoplasty is done to remove excess tissue that wasn't adequately reduced at the original surgery.

Revision Case 3: Leftover Tissue

This patient had a persistent bump in the lower part of her nasal bridge that was reduced as part of her revision plastic surgery.

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Sometimes the excess tissue or bump is a build up of scar tissue. Patients with thick skin are particularly vulnerable for this to happen. Dr Rival uses a careful post operative routine of taping and steroid injections to help control this.

Revision Case 4: Scar Tissue Build Up

This patient had an excess build up of
scar tissue on her bridge that created a rounded look that we call a pollybeak.
The scar tissue was removed and careful post-operative care has produced this 2-year result.

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Often when a rhinoplasty is poorly performed there is a combination of problems including under- and over-resection and scar tissue contracture.

Revision Case 5: Multiple Problems

This patient had too much bone removed from the upper part of the nasal bridge, but not enough cartilage removed from the lower part of the bridge. The tip cartilages were over reduced therefore they underwent contracture producing retraction of the rim of the nostrils. Her revision plastic surgery involved reduction and placement of grafts to support her tip and lower the nostril rims.

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The ultimate goal in revision rhinoplasty is to create a more natural looking nose and often one that functions better. While improvement is usually possible this must always be balanced by the possible risks and complications of each individual case.

Revision Case 6: Out of Balance

This patient underwent previous rhinoplasty surgery elsewhere. He had a bump reduced in the upper part of the bridge but this left him with a nose that was out of balance. Revision plastic surgery was performed to correct the tip and lower part of the bridge.

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