Rhinoplasty is considered one of the most difficult interventions. It has been traditionally accepted that between 3 and 5% of patients undergoing this type of surgery should be reviewed.
We in Barcelona rhinoplasty according to the last revision carried out, we remain in these figures
During the last years, however, this figure has varied considerably so that it has been discussed in the last congresses in which I have attended and where it has been considered that currently the revision figures in rhinoplasty are between 20 and 30%
The causes of this increase in reviews are due to the fact that there are currently a greater number of surgeons who perform this type of intervention and also to the higher expectations of patients.
In Barcelona, following the majority criteria, we recommend waiting at least 1 year to perform a revision of a rhinoplasty.
The great majority of patients in whom secondary rhinoplasty must be performed present problems at the level of the lower third, the most frequent being a deviation of the nasal septum, a fallen nasal tip and a deviation of the carilaginous back and to a lesser extent also of the bony back.
The best way to avoid secondary rhinoplasty is to perform a conservative intervention that avoids difficult problems to solve.
When we face the correction of a secondary rhinoplasty we must assess what is most uncomfortable for the patient if it is basically a functional problem due to deviation of the septum or nasal septum, it is aesthetic or both at the same time.
When we plan a secondary rhinoplasty, we must understand what the patient dislikes or is most uncomfortable with and explain which is the most appropriate solution. In some cases, we should explain that it may be possible to improve but not completely correct the deformity.
At Barcelona Rhinoplasty we consider that in order to achieve a functional and aesthetically correct nose in the case of secondary rhinoplasty, we must proceed to restructure the lower third of the nose so that we have to get the appropriate support to respect aesthetics and functionality.
If a nasal skeleton does not have sufficient supporting integrity, it is distorted or collapses due to scarring forces.
Reorientation and repositioning of the tip cartilage produces a more favorable and predictable appearance.
The maneuvers that we perform in Barcelona rhinoplasty to stabilize the nasal base are columellar grafts, expansion grafts and also reinforcing grafts of the wing cartilages in the event that they are greatly weakened by excessive resection.
In the case of cartilaginous back deformities, they may correspond to a “supratip” or “parrot beak” deformation above the nasal tip in which a resection of the anterior part of the septum will correct this intermediate deformity. Deformities of the cartilaginous middle third are usually due to a unilateral or bilateral collapse at this level. the solution we usually use is the uni or bilateral placement of sutured spedader graft between the triangular cartilage and the nasal septum.
If the deformity of the nasal dorsum is in a “saddle” in Barcelona rhinoplasty, we perform its correction by obtaining an atrial cartilage graft that is fixed by suturing to the nasal dorsum.
In the case of the upper bony third of the nose, the deformity may be a minimal irregularity of the nasal dorsum that a scraping will be able to solve, or a deviation (laterorrinia) due to the inadequate or insufficient performance of laterobasal osteotomies, in which case we must assess whether we perform new osteotomies, we proceed to a scraping or we must place a graft that in this case is really difficult to maintain in the proper position due to the surgical difficulty of access.
We must consider that no matter how much experience the surgeon presents, he will always have a secondary rhinoplasty rate.
Another factor to keep in mind when performing this type of intervention is if the previous rhinoplasty was performed by another surgeon, with which we cannot know for sure what was performed or what type of complications occurred.
