Secondary rhinoplasty

After one or several rhinoplasties, the surgery is always harder. Difficulties in correction of the deformities depend on several factors but always requires a solid rhinoplasty experience and a mastery of all the rhinoplasty techniques.

Minor defects

Because of healing process and soft tissues retraction, even after a good improvement, one can observe minor defects such as a minor prominence, subtle depression or asymmetry. Mostly, these minor defects are accepted by the patient who is satisfied. After discussion with the surgeon, if a touch up is decided, it will not be performed before 6-12 months. Sometimes it will be made under local anesthesia.

Major defects

Over the past two decades, surgeons have become more conservative in their technical approach. Better teaching through videos and live surgery, rhinoplasty courses, numerous rhinoplasty books and the use of the open approach have decreased the severity of problems observed after rhinoplasty. Nevertheless, major defects still occur. These defects may result from excessive and asymmetrical resections. They also result from a failure to understand the importance of the soft tissue environment, the dynamics of the nose and, of crucial importance, the quality of support of the tip, alae and middle vault, which have often been damaged.

Difficulties encountered during surgery will depend on the degree of nasal shortening, the extent and location of the bony and cartilaginous resections, the condition of the remaining cartilages, the tip support and the suppleness and thickness of the skin cover. Soft tissue can be scarred and adherent to the osteocartilaginous skeleton, a condition that often results from aggressive surgery on the muscular and subcutaneous layers, or aggressive defatting. The cutaneous layers may be adherent to the mucosal lining when the cartilaginous resections have been excessive. The lack of suppleness of the nostrils increases the difficulty of the exposure.

Saddle nose

Saddle nose or "boxer’s nose" refers to the appearence of the nose after loss of support of the nasal vault with collapse. It corresponds, on the profile view, to a depression of the dorsum and can occur after a traumatism or an over resection of the hump while a previous rhinoplasty. On the frontal view, it can also look like a "V" inverted deformity which is very unnatual and typical of operated nose. Correction of saddle nose will need to put the structures back in the good place and, if needed, cartilage grafts to fill the saddle.

Saddle nose after over resection of the hump. Secondary rhinoplasty and correction of the deformities with graft.

Polly beak deformity

Polly beak deformity is a complication of rhinoplasty defined by the typical appearance of a dorsal nasal convexity resembling a parrot’s beak. This dorsal hump is located in the supratip region of the nose which then "pushes" the tip downward causing under-rotation. Mostly but not exclusively, it occurs after a inadequate resection of the septum. Crrection will need a complement of resection.

Polly Beak deformity. Secondary rhinoplasty and correction of the deformities by resection of septum.		Polly Beak deformity associated to saddle nose. Secondary rhinoplasty for correction by both resection of cartilage and graft on the dorsum

inverted "V" deformity

In this deformity, the lower edge of the nasal bones are visible to the naked eye through the skin. This edge of line forms an upside-down or inverted "V". It can occur after inadequate support of the midlle portion of the nose or after an inadequate fracture of the nasal bones. Correction often needs cartilage graft and can also increase breathing of the patient.

Inverted "V" deformity. Secondary rhinoplasty for correction with graft.

Tip and alar deformities

Nasal tip deformities are caused by over, under and asymmetric resections on the alar cartilages. This kind of deformity can occur a fex month after the rhinoplasty or a long time later, since these very skinny cartilages go on moving and changing during all the life. Correction will generally also need cartilage grafts and will always necessitate an open approach.

Tip and alar deformity with collapse of both alar. Secondary rhinoplasty for correction by open approach necessitated cartilage grafts.

Where are the scars after a rhinoplasty ?

After a rhinoplasty, there will always be scars inside the nostril. Furthermore, often, there will be a scar under the columella (thin part of the nose situated between the two nostrils).

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