David W. Kim, MD, Facial Plastic Surgery

REVISION RHINOPLASTY

Rhinoplasty, or nose surgery, is one of the most likely operations to require a revision (re-do) procedure. Because of his reputation as a rhinoplasty expert, Dr. Kim is often called upon to perform revision rhinoplasty surgery through his practice in San Francisco for patients who wish to improve upon their previous nose surgery results.

Depending upon the nature and severity of the problem and the techniques used by the previous surgeon, revision rhinoplasty can range from a minor surgery to one which is quite extensive. Dr. Kim has helped many individuals with disfiguring complications from previous nose surgery procedures. In such cases, use of cartilage grafting may be necessary, sometimes requiring obtaining cartilage from the ear or ribs. Understandably, these nose surgeries tends to be lengthier and more complex in these cases.

Background on Revision Rhinoplasty Surgery

Rhinoplasty is the most complicated operation in facial plastic surgery. Thus it is no surprise that nose surgery has one of the highest revision and complication rates of any facial plastic surgery operation. Because revision rhinoplasty seeks to correct problems created by previous rhinoplasty, the surgeon and patient must have a clear understanding of the nature of the complications created from the original operation.

Due to the vast breadth of approaches and techniques that may have been used in the earlier nose surgery, a broad range of problems for which one may seek revision rhinoplasty surgery exist.

Patients who seek revision rhinoplasty may present with any number of cosmetic complaints and nasal breathing difficulties. Small asymmetries or irregularities may occur as the result of minor errors of technique. These problems are relatively straightforward and more easily corrected than more serious problems. Large asymmetries, functional obstruction, and gross deformities are more likely to result from errors of judgment or lack of experience.

Pre-operative Evaluation

When Dr. Kim meets with a prospective revision rhinoplasty patient at his office in San Francisco, it is crucial that they discuss in detail the problems that led to the patient's visit. Previous operative notes, rhinoplasty diagrams, and pre-operative and post-operative photographs may help in determining the nature and time ­-course of the problems. Photographs may also reveal which problems resulted from the nose surgery and which problems predated the original surgery.

A thorough physical examination inspecting the state of the soft tissue covering and skin, the nasal cartilages, bones, and internal structures of the nose is critical. Based on all of this information, the patient and physician should prioritize goals and gauge how reasonable and achievable these requests are.

As with primary rhinoplasty, the use of photography and computer assisted imaging may be of great help in the discussion of cosmetic goals. Each specific problem should be discussed with regard to possible cause and prospects for repair.
fake