4 reasons you may need a revision rhinoplasty

Rhinoplasty remains one of the most popular procedures in the UK and ranked first for male patients in the most recent UK plastic surgery figures from the British Association of Aesthetic Plastic Surgeons (BAAPS).

However, it’s estimated that between 15% to 20% of all rhinoplasty procedures performed are revision surgeries whether due to aesthetic concerns or functional problems that arise after surgery.

Rhinoplasty is one of the most challenging plastic surgery procedures, with three connective tissues—bone, cartilage, and skin—encompassed in one structure. The nose is very unforgiving of even minor irregularities, and there is a functional aspect that must always be considered.

Revision rhinoplasty reasons

“Revision rhinoplasty may be required for several reasons and at different stages after surgery,” Mr Annakan Navaratnam explains.

1. Breathing difficulties

One revision rhinoplasty reason is if the patient had a cosmetic operation, because they wished to change a certain part of their nose, but the primary surgeon hadn’t considered the functional aspect

Often, I’ll see patients who wanted a smaller nose or a hump removed from the bridge, but, as a result, the nose no longer works as well as it should.

They often report having problems with nasal blockage, which isn’t necessarily immediately noticeable. It can become an issue one year, two years or even five years after surgery because the nasal structure must reform, and when it takes its new form, they only then notice these symptoms.

A classic reason is patients having a de-hump, so having the hump removed, but the middle part of the nose has not been reconstructed adequately, which can lead to problems. You may hear of issues such as an inverted V deformity, whereby the middle part of the nose, the upper lateral cartilages, haven’t been reattached to the septum properly. Or there’s been a narrowing in that area, causing nasal blockage.

Many of these patients never had an issue previously but now do due to changes for aesthetic reasons. Rhinoplasty patients should be very aware of this when they speak to their surgeon and appreciate that surgery can impact function if it is not done correctly.

Even if surgery is performed properly, this can happen. Many rhinoplasty patients desire a smaller nose, which will always have an impact in terms of narrowing the nasal pathways, affecting nasal airflow, and often resulting in a nasal blockage.

As a surgeon, I always counsel patients that we must aim for a result that maintains both the function and the aesthetics of the nose.

2. Aesthetic concerns

A common complication after rhinoplasty is a saddle deformity, often referred to as a boxer’s nose. This is where the middle part of the nose drops because it hasn’t been reconstructed adequately or too much cartilage has been resected inside the nose.

Another issue is that the nose tip has been raised too much. One of my favourite sayings in rhinoplasty is that every action has a reaction. So, if you lift the nasal tip up, you don’t just change the tip; you alter the rest of the nose. That’s why you always need to think about rhinoplasty and septorhinoplasty in the context of the whole nasal structure and the context of the entire face as well.

Very recently, I’ve had two cases in which I’ve reconstructed the middle part of the nose as a revision procedure. If too much cartilage was removed in the initial operation, you must also consider where we harvest the cartilage to reconstruct the nose. In a revision rhinoplasty, we often need to take it from the ear or the rib.

3. Ageing changes to the nose

Another reason for revision rhinoplasty is the natural ageing process. Over time, the connections between the cartilage structures in your nose weaken, and your skin changes, becoming thicker and thinner in different areas. The nasal tip often drops down, and you may get a pseudo hump appearing.

There’s also a process of bone reabsorption that occurs naturally, especially in the mid-face. Your nose is based on a foundation of bone from the maxilla and pre-maxilla, and over time, that area recesses. This can subtly alter the shape of the nose or make it appear larger.

Revision rhinoplasty performed later in life has added complexity, and the results are slightly more unpredictable, which I counsel patients about before they decide to proceed.

4. Botched surgery abroad

I am increasingly seeing patients who have gone abroad for surgery and will have had Goretex or silicone implants placed inside the nose, which has led to significant infections and erosion of the nasal structures. Or there’s not been adequate post-operative care after the surgery, and there’s been a complication.

Those patients have already gone through quite physical and psychological trauma and will need quite significant reconstructions of the nose using rib cartilage or cartilage from elsewhere as well as other tissue materials to reconstruct.

Choosing a revision rhinoplasty surgeon

Revision rhinoplasty is typically a much more complex procedure, and many ENT, plastic, or maxillofacial surgeons who offer primary rhinoplasty will not perform revision rhinoplasty. It requires an advanced skill set, the use of a wide array of different techniques, and a highly customised approach.

To discuss any concerns you may have, call  +44 (0)203 627 2918 or email secretary@annakan.co.uk to arrange a revision rhinoplasty consultation with Mr Annakan Navaratnam.