Secondary or Revisional Rhinoplasty
Rhinoplasty is the most complex surgery of plastic surgery. It requires many years of training and constant practice.

That is why it is very important that it shouldn´t be performed several times, since each new surgery carries risks of poor results and increased fibrosis.

A rhinoplasty that is performed a second time is called secondary.

Secondary rhinoplasties (or tertiary, quaternary) involve greater difficulty and often the need for grafts to correct defects.

These grafts can be obtained from the same septum (septum) if it is present or if it is not enough, it is necessary to use costal cartilage (this rib is only the cartilaginous part, and it regenerates after a while).
Is it very complex?
Revisional surgery patients challenge the skills of the Specialized Rhinoplasty surgeon. The search in general is for aesthetic and functional improvement.

If you are thinking of a revision surgery, you should think that the Dr must be specialized in primary, revisional rhinoplasty and also like challenges, since the complexity is even greater and many surgeons prefer to perform only primary or simple cases.

Perhaps it has happened to you to make a consultation and be told that nothing can be done anymore, there is always a way to improve, if we make a good diagnosis.

We must bear in mind that revision surgeries are reconstructive surgeries, so the result will not be a 10, since we depend on previous scars, previous defects and fibrosis. But everything possible will be done to leave it as close to what the patient desires under the possibilities previously discussed.
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At a technical level we have some examples of post-surgical defects:

1. Polly -break
2. Pinched Nose
3. Bossae
4. Saddle Nose
5. Nostril asymmetry
6. inverted V
1.Polly break Nose
It occurs when after a rhinoplasty, the dorsal hump appears convex, this can be caused by several factors, but the most common:

-Overresection of the hump (bone-septum) (the tip is apparently excessive, but it is caused by a low dorsal hump)

-Lack of projection of the tip (flattened tip) (loss of height at the tip due to overresection of the tip or lack of support)

-Depressed Nasal radix

Correction: Dorsal graft +/- Nasal tip graft
2. Pinched Nasal Nose
In the past, many resective rhinoplasties were performed (removing a lot of cartilage), this left the nasal structure very weak.

A frequent deformity was due to excessive resection of the external alar crura (the outermost part of the cartilage of the tip).

What gave a weakness and over time a fall of the wall of the nostrils, leaving a nose with the appearance of a small central ball and wide base. With depressed lateral walls.

Correction : Nasal tip graft on lateral walls
3. Bossae
When the resection of the cartilages of the tip is not symmetrical or anatomical, the edges of the cartilage can be seen in an unnatural and artificial way. It can also occur due to abnormal fibrosis.

Patients with thin skin are at higher risk of suffering from it.

Correction: Nasal tip grafts +/- fascia graft for masking.
4. Saddle Nose
Saddle nose is a deformity in which the middle part of the nasal dorsum has lost support of the septum, either due to an accident, boxing, substance abuse (cocaine) and damage from a previous rhinoplasty.

The septum does not have enough strength and the nasal middle part sinks.

Correction: Grafts in the nasal mid-dorsum, either from the septum itself if there is enough, or rib cartilage.
5. Nostril asymmetry
After a previous rhinoplasty, asymmetrical overresection of the tip cartilage, or after an unsuccessful alectomy , the nostrils may remain asymmetrical.

Depending on the defect it can be very difficult to correct.

This asymmetry can affect breathing if they are very closed, affecting the external nasal valve.

Correction: In case it is a defect due to excessive resection of the cartilage of the tip, it can be corrected with grafts.

In case it is after a nasal base reduction , we must evaluate if there is enough skin to symmetrize, in that case a unilateral resection can be performed.

In case there is not enough skin, sometimes skin and cartilage grafts must be performed to open the nostrils and have adequate breathing.
6. Inverted V deformity
In this type of deformity, a V is seen in the middle of the patient's nasal dorsum , this happens due to an excessive resection of the same or of the triangular cartilages (which define the lateral nasal walls).

It also happens when in a sudden movement in the previous surgery, these cartilages move from their place and must be repositioned.

This deformity can also affect breathing due to collapse of the internal valve.

Correction: Long nasal dorsum grafts for correction of the dorsum: spreader type graft . Upper lateral cartilage suture to nasal septum.
Frequently Asked Questions (FAQ)