Corrective rhinoplasty or revision rhinoplasty for a failed nose surgery or a nose that has undergone multiple previous interventions. This is always one of the most complex challenges in cosmetic surgery. Unlike an original nose that has never undergone surgery, a nose that has been surgically altered multiple times often suffers from soft tissue fibrosis, deformation of the supporting cartilage framework, and a severe deficiency of natural connective tissue.
1. Assess the quality of soft tissue and the degree of capsular contracture.
With each surgery, the subcutaneous connective tissue layers are damaged, forming fibrous scar tissue. The surgeon needs to carefully assess the thickness of the covering skin, the elasticity, and the flexibility of the nasal tip. If the soft tissue is too thin or severely contracted (short, upturned nose, retracted nostrils), placing a single artificial material carries a very high risk of skin perforation or recurrent implant exposure.
2. Examine the old filler material and the degree of invasiveness.
The doctor needs to clearly identify the type of material currently present in the patient's nose: artificial silicone cartilage, resorbed autologous cartilage, clumping filler, or previously used liquid silicone. The degree of adhesion of the old material to the underlying bone and septal cartilage needs to be carefully assessed to develop a safe removal plan, avoiding further damage to surrounding healthy structures.
3. Assess the structural integrity of the nasal bridge and anatomical septum.
The nasal septum and septal cartilage are the "foundation" that supports the entire shape of the nose. In cases of multiple rhinoplasty surgeries, the septal cartilage is often fractured, destroyed, or severely deviated due to previous dissections. Dr. Nguyen Quoc Dinh emphasized:
“"If a strong nasal bridge cannot be re-established using autologous cartilage with good load-bearing capacity (such as rib cartilage or septal cartilage), all attempts to lengthen the nasal tip or raise the nasal bridge will fail over time."”
4. Examination of ventilatory and airway function
Besides aesthetic considerations, the respiratory function of the nose cannot be overlooked. Excessive narrowing of the nasal valve or mucosal adhesions after previous surgeries can cause shortness of breath and chronic nasal congestion. The surgeon needs to carefully examine the nasal cavity, inferior turbinate, and septum with endoscopy to incorporate functional corrective surgery in a single procedure.
5. The appropriate time to undergo rhinoplasty revision surgery.
- In case of signs of acute infection or skin perforation: The implant material needs to be removed immediately, the inflamed area cleaned, and tissue recovery should be allowed for 3 to 6 months.
- In cases where the nose is stable but the aesthetic result is unsatisfactory: The ideal time to intervene is from 6 months to 1 year After the most recent surgery, when the scar tissue has completely softened and the nourishing blood vessels have regenerated stably.
Advice from Doctor Nguyen Quoc Dinh
Multiple rhinoplasty procedures require surgeons to possess strong microsurgical expertise, extensive clinical experience, and a thorough understanding of nasal anatomy. Patients should absolutely avoid intervention before tissue has fully recovered and should undergo a direct examination to have a 3D CT scan performed, thereby developing the safest and most sustainable recovery plan.
