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>> Revision septorhinoplasty is surgery on the nose
that's performed a second time
after a previous surgeon has operated on the nose.
Septoplasty is the name for the surgical procedure
to correct a deviated septum.
The term deviated septum is a common term
that we hear in society,
and it basically means the cartilage and bone
that separates the left and right nostril has been crooked,
and usually, that's from trauma from an accident,
or potentially, you were just born with it.
Generally, the symptoms of that are fixed obstruction
or inability to breathe either on the left or right side,
and sometimes, it involves both sides of the nostrils.
A rhinoplasty is a term that is used to describe any surgery
that changes the outside appearance of the nose.
Sometimes, that could be for cosmetic reasons,
such as taking a bump down on the top of the nose
or making the tip of the nose get rotated up,
but it could also be done for reconstructive reasons
for people who had previous cancer or trauma
where the bridge of the nose has fallen,
such as in a case of saddle nose deformity,
which is a case where essentially the bridge
of the nose has completely collapsed.
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Revision septorhinoplasties are certainly technically
more challenging to perform for a surgeon,
mainly because there's significantly more scar tissue
and swelling,
as well as the original anatomy.
The cartilage and bone of the nose has been altered,
and oftentimes,
you don't know exactly what was done previously,
and so many times,
it's a surprise once you opened up the nose to see
what you find.
In addition, cartilage is sometimes needed
to rebuild the nose,
and many times, that cartilage is not available
because of previous surgery.
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So patients who are good candidates
for revision septorhinoplasty are patients who continue
to have nasal obstruction after previous surgery.
Those patients need to be, obviously,
evaluated with a thorough endoscopic exam
or with a little camera in the nose.
If the patients have persistent deviated septum
or something called nasal valve repair,
where the side of the nose is collapsing in
when they breathe,
those patients are generally good candidates
for revision functional nasal surgery
or surgery to help them breathe better,
but oftentimes,
patients who continue to have trouble breathing
after nasal surgery may have other reasons
for not being able to breathe,
such as allergies or inflammation,
and so it's not always a surgical issue,
which is why it's important to be evaluated
by an experienced doctor.
Patients who are good candidates
for revision rhinoplasty are patients who are still unhappy
with the shape of the outside appearance of the nose
but also have appropriate expectations
of what can be achieved surgically
with the revision surgery.
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In revision rhinoplasty and septoplasty,
it's unclear what previous surgery was done in many cases,
and so oftentimes when you've had a previous septoplasty,
cartilage from the nasal septum,
which is good strong cartilage that we use
for rhinoplasty and for septoplasty,
may be removed from the previous surgery.
Therefore, we have to go
to other sources to get to cartilage.
Oftentimes, this may be cartilage from the ear,
the back of the ear, which won't have any effect
on the actual appearance of the ear afterwards,
or sometimes cartilage from the rib
if we need a significant amount of cartilage,
and in some cases, we can use cartilage from a cadaver
that has been treated, which is also quite safe
and is also an option in certain patients.
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Insurance sometimes will pay
for revision septorhinoplasties.
Oftentimes, insurance companies will pay
for the functional component,
which is the component of nasal breathing.
So if you continue to have nasal obstruction,
most insurance companies will cover that part of it.
If patients want and change the external appearance
from a cosmetic standpoint,
that is generally not covered by insurance.
There are few exceptions in cases of severe nasal deformity,
such as saddle nose deformity,
where the entire bridge of the nose has collapsed,
where insurance companies will pay for cases like that.
Each case is certainly unique,
and our office usually works quite closely
with the insurance companies to see what can be approved
to try to minimize the cost to the patient.
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Patients should look for surgeons who mainly focus
on the face and neck.
Revision rhinoplasty is generally considered one
of the hardest plastic surgery procedures that's performed,
mainly because of the complexity of the anatomy
and the complexity of the healing of the nose afterwards.
It often takes one to two years
for these revision nasal surgeries to heal,
and the external appearance
of the nose will certainly change for years to come.
So I would advise that patients who are interested
in a revision rhinoplasty seek a plastic surgeon
or a facial plastic surgeon that focus much
of their practice on revision rhinoplasty,
as this is certainly a very complex surgery.
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