Revision rhinoplasty surgeon

Revision rhinoplasty and surgical super-specialization

The number of patients turning to revision surgery specialists to correct the outcomes of primary rhinoplasty has steadily increased in the last decade. Primary rhinoplasty is a highly complex operation, whose aesthetic or functional results are sometimes inadequate or unsatisfactory. Rhinoplasty revisions are even more challenging, and their correct execution demands many years of experience and solid technical capabilities – in short, a surgical super-specialization.

The surgeon must be prepared for greatertechnical challenges, especially when dorsum and/or tip lack structural support. Revision surgery often implies longer operating times, with a higher risk of side effects and complications that may also have implications for the donor sites.

After 25 years of exclusive dedication to primary and secondary rhinoplasty, in addition to several prestigious academic collaborations, Dr. Pietro Palma has become one of the leading international experts in this field, as well as one of the most renowned rhinoplasty surgeons currently engaged in treating complex cases.

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Why select a specialist in revision cases: causes of failure and dissatisfaction in primary rhinoplasty

Recent widespread use of cosmetic surgery has been associated with a paralleled increase in secondary rhinoplasty operations. Common causes of failure in rhinoplasty include factors such as the complexity of the primary operation, and an unpredictable healing process that is beyond the control of the most skilled hands. Another complicating factor may be the surgeon’s inexperience, especially if combined with an excess of self-confidence. Therefore, the surgeon may not take on cases for which he/she is not fully prepared nor to try to satisfy a patient’s unrealistic or risky requests.

Despite his long experience and the super-specialization in rhinoplasty, Dr. Palma may still advise against surgery after the exploratory interview. This happens in about 2% of the patients. Not all patients who request rhinoplasty should be considered for surgery. Advice against surgery may stem from psychological reasons, or the desire to prevent further damage to the nose.

Underestimating the complexity of rhinoplasty and its aesthetic and functional repercussions can create a series of risks. The inexperienced surgeon may face technical pitfalls for which he/she is inadequately prepared. Furthermore, patients may unwittingly expose themselves to unnecessary risk of complications.

Dangers in primary rhinoplasty originate from a rough and hasty pre-operative analysis, and from excessive surgery. For example, the routine use of so-called ‘structural’ cartilage grafts increase the risk of complications and make subsequent corrective surgery even more difficult.

Revision rhinoplasty surgeons often face elaborate procedures and challenging situations, due to the loss of structural support of the dorsum and/or tip. Septal cartilage is the ideal material for almost all graft procedures. Unnecessary removal of septal cartilage during primary rhinoplasty for structural grafts creates a significant absence or poor quality donor material that is crucially important in revision cases.

Alternative sources of cartilage include the outer ear or rib cartilage. Consequences of using these sources include prolonged operating times, increased technical difficulties, and higher costs, in addition to the risks of complications and unpleasant side effects in the areas harvested.

Dr. Pietro Palma: revision rhinoplasty surgeon in Milan

A certain margin of unpredictability characterizes all surgery – and especially in revision cases. Even the most capable specialist cannot guarantee the achievement of 100% of the set objectives: many variables can alter the delicate equilibrium of the nose. Therefore, rigorous assessment and utter respect for the wholeness of its form and function are prerequisites to any operation. The individual characteristics of the organ require an accurate anatomical-functional diagnosis and a sophisticated computerized photo-analysis. Furthermore, the surgeon should make every effort to understand the emotional state of the patient.

Precision, technical expertise, and empathy are the keys to minimize post-operative failure, dissatisfaction, or complications. They also help to prevent the need for revision rhinoplasty. Only surgeons with substantial experience can tackle complex procedures such as rhinoplasty. Dr. Pietro Palma has been working with selective focus on nasal surgery (corrective, functional, plastic) for the past 25 years, specializing in primary/secondary rhinoplasty and septorhinoplasty.

No rhinoplasty is routine. The professional skills and the personality of the surgeon in revision cases are of paramount importance. Every secondary rhinoplasty is a special case in itself. The surgeon utilises all the skills acquired over the years to deal with unexpected intra-operative anatomical situations with the utmost precision. Dr. Palma is a super-specialist in secondary rhinoplasty, and inventor of Hybrid Rhinoplasty™. He is available for interviews with patients at Clinica del Viso (tel +390263611932 – or Casa di Cura La Madonnina (tel +3902.58395555 –, both situated in Milan and easily accessible from all over Italy and abroad.


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