Revision Rhinoplasty is necessary to those whom have done rhinoplasty before. The ideal candidate for a revision rhinoplasty is a patient who is suffering from inverted V-deformity, Polybeak deformity or any other deformity that needs improvement.
We categorize these patients into two groups:
1. Patients whom their cartilage and underlying bone had been overresected than what it should be. In which I usually do revision for tip deformities that are resulting from previous surgeries. Severe tip deformities are done with autologous cartilage grafts. However, reconstructing the decimated nasal tip is very challenging and risky so therefore a professional revision specialist is important to consider. Beyond tip deformities, there are patients who complain about previous hump or the density of the width of the nasal bone. Treatment in this group is relatively easy as a few techniques can include rasping the bone, adding autologous grafts, osteotomy, resection of fibrosis around the tip, and majority of the patients will be very satisfied post operation.
2. Overresection of the nose including saddle nose deformity on the dorsum, is due to the dorsal overresection and pinched nose. Due to the overresection of the tip cartilage and alar base, revision in this group is much more difficult and the result is less satisfactory in comparison to the previous group. In order to reconstruct such nose in this group, the surgeon must utilize cartilage either from the ear, rib or fascia from temporal area to improve the deformity. Diced cartilage is another way to improve saddle nose deformity. We should be very diligent with patients in this group as the process of healing is much slower and in the first stage of post-operation, there will be significant edema.