Secondary Rhinoplasty

Secondary rhinoplasty: correct unpleasant or inadequate surgical looks from prior operations

What happens when nose surgery has failed in meeting the patients’ expectations? When the outcomes of primary rhinoplasty do not satisfy aesthetic or functional requirements, patient and surgeon face the crucial decision about whether to operate again. The demands for surgical revision have gained momentum in the last 10 years. The main reasons behind this notable increment in revision rhinoplasty can be found in imperfect, incorrect, or incomplete preoperative assessments on the one hand, and in the use of improper techniques on the other, like over-resection or thoughtless use of cartilaginous grafts in primary surgery.

However, no surgeon is entirely safe from unhappy patients: even the most experienced specialist cannot have 100% of the results in 100% of patients. This rule applies to all surgery (and generally to every human activity) and even more to rhinoplasty, where a few millimeters make the difference between success and untoward result. Rhinoplasty surgery requires superior and mature skills in pre-operative analysis and operational procedures, along with a mental attitude to perfectionism. To master all the intricacies of rhinoplasty and septoplasty, the surgeon needs to acquire a full set of advanced analytical and operative skills through a long and specific pathway.

The anatomical targets identified in the pre-operative evaluation often need tailored surgery, especially in revisions. This is why Pietro Palma coined the formula YOUnique Rhinoplasty, a patient-specific surgical approach. The Italian rhinoplasty specialist has more than 25 years of experience in rhinoplastic surgery and has been a leading figure in the most prestigious world’s facial plastic surgery organizations. Contact Dr. Palma at the Clinica del Viso or Casa di Cura “LA MADONNINA” to decide whether to correct the results of one or more previous operations.

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Primary and secondary rhinoplasty: highly complex specialized surgery

Patients who experience their first nasal plastic surgery undergo a primary rhinoplasty. If the results of the procedure are inadequate from the aesthetic or functional point of view, a secondary rhinoplasty (or tertiary, quaternary etc., depending on the number of previous operations) may be necessary to correct them.

There is no such thing as a “routine rhinoplasty”. Each nasal surgery has specific complexities and requires high specialization: the surgeon must be able to appraise the uniqueness of each nose. His or her expertise and skills must be put to good use to correct derangements of the internal and external osteocartilaginous framework, as well as problems of the external skin and intranasal lining.

Achieving the best possible results with minimally invasive techniques must be the goal of the surgeon in primary rhinoplasty. Such a conservative and non-destructuring approach offers wide safety margins, increases the predictability of the final result and makes easier any potential revision surgery in the unfortunate event of an untoward result.

Reasons behind the increase in requests for secondary rhinoplasty

Poor preoperative analysis, faulty or inappropriate surgical techniques, and use of routine procedures not tailored to individual anatomies are the main factors behind the increased requests for revision rhinoplasty.

To face a challenging procedure such as rhinoplasty, the surgeon needs extensive experience, in-depth specialization, advanced pre-operative analysis skills, and a wide range of operative abilities. Analytical inadequacy can lead to approximate, misleading, deficient, or incorrect pre-operative assessments. Less experienced surgeons may identify rhinoplasty with the hump removal, while the harmony of the profile results from the combination of different anatomical factors, including the mimic musculature of the nose.

If the use of the same approach for each patient is illogical and ill-judged, the improper use of so-called structural cartilage grafts in every primary case also can lead to dissatisfying outcomes. In primary surgery, structural grafts should be limited to specific and selected situations. In any case, the invasiveness should be proportional to the extent of the defect: different anatomies may require different approaches.

Each variable is to be analyzed in detail and corrected with precision; thus, we can get a natural result and minimize the occurrence of post-surgical problems requiring further correction with a secondary rhinoplasty.

Complex secondary rhinoplasty: absence or insufficiency of septal cartilage

Deficiency of septal cartilage is perhaps the main challenge in revision cases. Revision rhinoplasty featuring absence/insufficiency of septal cartilage usually implies greater technical complexity, possible side effect at the donor area sites like ear or rib, longer operating times and consequently higher costs.

Nasal septum cartilage is ideal for almost all revisional procedures requiring graft material. Avoiding unnecessary grafts in primary rhinoplasty will save most of the septal cartilage, the most precious material in revision rhinoplasty.

Today, minimally invasive techniques available in nasal surgery make structural grafts superfluous in the vast majority of cases of primary rhinoplasty.

Secondary rhinoplasty in Milan with Dr. Palma

The disappointing outcome of previous nasal surgery may require a further counseling with an expert rhinoplasty surgeon to appraise whether to correct it with a secondary (or tertiary, quaternary, etc.) rhinoplasty. The inexperienced surgeon might underestimate the technical demand of such a challenging surgical procedure, hence problems and complications of varying extent and severity can easily follow.

Personality and skills of the surgeon always make a difference: there is no routine in rhinoplasty, especially in revisions. Each secondary rhinoplasty is a unique, patient-specific case. Precision is essential to achieve the goals, from pre-operative analysis to the execution of technical maneuvers. The surgeon must possess a vast repertoire of techniques and abilities, acquired and refined through years of relentless practice to identify and handle unexpected intraoperative anatomical situations – almost the rule in secondary rhinoplasty.

From the planning to the execution, secondary rhinoplasty requires maturity, versatility, and judgment of a super-specialized surgeon. For more information on secondary rhinoplasty, you are welcome to arrange an interview with Dr. Palma at the Clinica del Viso (Piazza Repubblica, 21 – Milan – Tel +39 0263611932) or Casa di Cura “LA MADONNINA” (Via Quadronno, 29 / 31 – Milan – Tel +39 0258395555).


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