Secondary rhinoplasty or ‘revision’ rhinoplasty is indicated when the results of the original rhinoplasty are unsatisfactory. Rhinoplasty is a difficult procedure both to learn and teach. The visibility is poor for the student, while the anatomy – always delicate and complex – is difficult for the surgeon to display. Furthermore, results that may initially look good may deteriorate with time and result in conspicuous deformities as long as five years later. Of all aesthetic surgery, rhinoplasty is the one procedure where the experience of the surgeon is most vital, because it is only by seeing the long-term results in one’s own patients that one learns the pitfalls and dangers of the various surgical maneuvers. You may be familiar with the results of ‘over-operated’ noses among your friends or in the celebrity gossip pages of the tabloid newspapers. The possession of fame, alas, does not guarantee wise lifestyle choices, as we are frequently made aware. However, some of these individuals may well have looked good in the months following their operations only to have their appearance degenerate with shrinkage, scarring and distortion due to overly zealous resection of nasal cartilage and lining.
Beware the surgeon claiming to perform a ‘new technique’ of rhinoplasty unless he or she has been performing it for at least five to ten years! Secondary, or ‘revisionary’ rhinoplasty is even more demanding due to the inevitable scarring and possible damage created by the first operation. Within six months of surgery postoperative swelling compounds these problems. For this reason, secondary rhinoplasty is seldom performed until after six months have passed. Again, experience is essential both in assessing the nasal deformity from a functional and aesthetic standpoint, deciding whether surgery is indicated, then, as necessary, planning and executing the appropriate operation.
In over 30 years of practice I have been able to see what works and what doesn’t in rhinoplasty. I have re-operated on my own rhinoplasties as well as those of others. I have operated on the noses of Plastic Surgery colleagues. As a rule I am a believer in the old axiom that ‘less is more.’ The fewest maneuvers, the least dissection and the most conservative approach preserve the best features of existing nasal anatomy and modify only that required to get a good result. The classic rhinoplastic turned-up ‘button nose’ – which shrivels even more with the passage of time, giving a snout-like appearance – is still all too common, and, unfortunately, difficult to fix. It is always preferable to have the operation performed correctly in the first place, but failing that, selecting an experienced surgeon for the secondary rhinoplasty