Reconstructive Rhinoplasty

A secondary and reconstructive rhinoplasty is a nasal corrective surgery, which is performed to restore both the form and the function of a nose after a previous surgery. Reconstructive surgery is considered a specialized field in plastic surgery.

Common complications that require reconstructive surgery:

• Nasal airway obstruction
• Collapse of the nasal cartilage or bone
• Abnormal look of the nose
• Collapse of the internal and external nasal valves
• Asymmetry
• Excessive or insufficient reduction of the nasal hump
• Partial reshaping (the cosmetic changes have not been enough)
• A sharpened or flattened nasal tip
• An extremely tight nasal tip (Pinocchio nose)
• Too many scars inside and outside the nose (thick scar tissue)

The necessary changes for a reconstructive surgery can be done with either a “closed” or an “open” procedure. Usually, an open rhinoplasty is suggested when many structural changes are required. The minor corrections can be done with closed rhinoplasty. A closed rhinoplasty is when only an internal incision is made to access the nasal structure. In an open rhinoplasty, incisions are made in between the nasal cavities (columella) in order to be able to lift the skin and have a more direct visualization of the structure that is going to be reformed. The decision to perform a closed or an open procedure is the surgeon’s to make. Either of these procedures have their own pros and cons.

In a corrective surgery, cartilage graft (part of the septum, nasal or rib cartilage) is used to improve the form and function of the nose.

Why reconstructive surgery is more challenging than the first surgery?

In some cases, the minor complications from the first surgery can be easily fixed. But the more serious complications require more expertise and skill compared to the first surgery. Because the initial anatomy is intact and the skin over it is smooth, but following the first surgery, a part of the nasal skin will be full of scars, and as a result, it’s going to be hard to reposition the cartilage and the bone.

What is the best time for a reconstructive surgery?

A reconstructive surgery should be done 9 months or a year after the first surgery, so that the nasal tissue has softened and the surgery can be better done. A secondary surgery must be done by an experienced surgeon. Obviously, this kind of surgery requires precision, more time and adequate skill.

Reconstructive surgery considerations

The decision to have a reconstructive surgery should be made with reason and presence of mind. A reconstructive surgery can be more complex compared to the first surgery and may need a surgeon who has a good perception of the nasal structure and surgical techniques. In addition, the reconstructive surgery may take longer and cost more.

Some people refer to their first surgeon for the reconstructive surgery, and some look for a new surgeon who is specialized in reconstructive surgery. The decision depends on the surgeon’s expertise and the understanding between both of you. To return to the first surgeon just because it will cost less, may not be the right decision. It’s preferred to visit a surgeon who understands where has gone wrong and how should it be fixed (which can be the first surgeon or a new surgeon).

The most important step to a successful reconstructive surgery is an open and honest dialogue about your expectations and goals with your surgeon. Ideally, You should have an honest and thorough conversation with your surgeon before your first surgery in order to decrease the need for a reconstructive surgery. However, there are cases that require a corrective surgery. If you are in need of a corrective surgery, first you should precisely explain why you are not satisfied with the first one.

During the consultation appointment for a reconstructive surgery, your surgeon examines your skin, the strength of the cartilage, bone structure and also the remaining cartilage, because in most cases, a cartilage graft is required. Grafts can provide the nose a better look and support the nasal air passageway; the two reasons people consider a reconstructive surgery.

The procedure of a reconstructive surgery

The procedure varies with different individuals. There may be complications in any part of the nose, such as the top third, the middle third or the tip of the nose.

Reconstructive surgery can be performed with local or general anesthesia. It may take longer than the first surgery. Sometimes, it may take 4 hours, while the first one takes between one to two hours.

The goal of a reconstructive surgery is to restore the form and function of the nose. In some cases, in order to restore the symmetry, it may require to add or remove cartilage. If cartilage needs to be added, it can be provided from the septum of the nose, ears or ribs. In most cases, adding to the cartilage is to open the air passageways, to improve the look of the nose and its symmetry.

In a reconstructive surgery, the incision can be made either inside the nose (closed surgery) or outside the nose, between the two nasal cavities (open surgery). The upside of a closed surgery is that it’s less invasive and less damage is done to the nasal tissue, because the surgeon opens just the parts that need repair, while an open surgery requires incision and autopsy. If many scars are left on your nose from the first surgery, the closed procedure is preferred and has less risk. However, some surgeons prefer the open procedure, as it provides a better visualization and access in complex surgeries.

Look for a surgeon who you can trust and also thoroughly explains the procedure. To choose a surgeon just because he does the procedure the way you want is not reasonable.

A reconstructive surgery is not the same for everyone and is exclusive for each individual.