Secondary rhinoplasty

The classic rhinoplasty procedure is the most commonly asked procedure in Greece and is specially mentioned since it often leads to a secondary rhinoplasty and rarely to a nasal reconstruction. The classic rhinoplasty operation is considered the most difficult operation to rightfully demanding patients.

The plastic surgery is a medical specialty and the surgeon must follow the medical procedure to the letter: problem diagnosis, determination of the surgical treatment plan having in mind the knowledge of the anatomy and behavior of the tissues, excellent surgery conditions and post-treatment observation.

Things that should be considered before making a diagnosis: The aesthetic characteristics of an elegant “normal” nose, the aesthetic entities involved in the nasal area (upper lip, eyes, forehead and zygomatic area, chin), the subjective perception of the patient of beauty and the racial and topical characteristics of the patient’s origin.

The correct diagnosis, the excellent knowledge of the anatomy, the knowledge of the biological behavior of the tissues and the making of a surgery plan are the requirements for a positive outcome of the operation.

The surgical talent of the doctor comes next, although it is required so that the patient will have a successful rhinoplasty. The post-operation course is almost always even, but the pre-defined time of the post-operation 10 day period is obliged to be followed.

The respiratory check must be included in the diagnostic approach and the surgical anatomical malfunction should be spotted and fixed during the operation.

A respiratory problem or a non-satisfactory result reveals a diagnosis error, insufficient knowledge of the anatomy, a wrong surgical plan or limited surgical talent and rarely a complication during operation.

The secondary rhinoplasty is a tougher procedure and requires a skillful surgeon with the right perception to the patient’s problem. If this is the case, the surgeon should not be afraid to use all techniques necessary even if the operation has to take longer time than calculated. The anatomical elements altered and the scars hinder the surgical preparation. A fair amount of time (eight to ten months) between the two sessions must be spent so that the scars could heal. The medical procedure must also be followed. The malformations of the first rhinoplasty are usually medically generated and present some problems that in some cases are difficult to be dealt with. The malformations that may occur in the first surgeon are not easily classified and specific solutions are even more difficult to be given. A rough diagnosis of the problem is given (supratip deformity, open book bones, etc) and the direction of the surgery is determined. The need for the rehabilitation of the lack of cartilage should be estimated and the source should be chosen (ear lobe, diaphragm). The need for rehabilitation of the lack of bone is recessed and the source can be located in the outer scull bones. Rarely the previous operation is incomplete, so the secondary rhinoplasty is simple and follows the steps of the classic rhinoplasty. The increased experience of the surgeon, the correct diagnosis and the constant expanding range of the techniques are capable of providing solutions to difficult cases.