Revision septorhinoplasty

Revision septorhinoplasty refers to the need to perform surgery on a nose that has already been operated for residual aesthetic or functional problems. This can be referred to as secondary septorhinoplasty if there has been only one previous operation, tertiary if two interventions, quaternary if three, and so on.

Unfortunately, it is more and more common to operate patients that have already undergone septorhinoplasty. The main problem for which patients are not satisfied with the first operation is the innaturality of their nose following the operation, the so-called “redone” nose appearance, which was quite fashionable 20-30 years ago; but today has gone out of vogue.

No! Secondary septorhinoplasty requires a high level of competence and experience. The main problem is that the anatomy is subverted by the first operation and it is often a full-fledged operation of anatomical reconstruction of the nasal osteocartilaginous structures in required in order to restore a pleasant, natural and functional appearance to the nose. At times during primary septorhinoplasty some surgeons remove too much cartilage both at the septum and cartilage level. This can lead to two problems: the first is aesthetic-functional, as for example an excessive resection of the alar cartilages leads to pinching of the nasal tip and failure of the external nasal valve, resulting in difficulty in breathing; the second is that in revision  nosoroplasty of there is no nasal cartilage available for the grafts necessary to rebuild the nose and repair the damage. Therefore, it is often necessary to resort to cartilage sampling from the ear canal (with a small incision behind the ear without any residual deformity of the ear) or resorting to the removal of costal cartilage.

Perforation of the nasal septum is the most common treatment in nose surgery. Because of the vortexes generated in the nasal cavities when it is present, it is associated with severe nasal breathing difficulties. The surgeon recognizes the following two causes: the first is the iatrogenic one, the second is connected to the use of cocaine or nasal vasoconstrictors. It is possible to close any perforations of 3-4 cm in diameter with very complex techniques that require operations that last at least two hours.

In the case of secondary septorhinoplast, unless it is a very minor defect and the open approach is almost always necessary.

Yes. Although in some cases it is possible to resort to local anaesthesia and this may vary in relation to the preferences of the surgeon and the patient, general anaesthesia is recommended.