Dr. Joaquim Suñol - Aesthetic Plastic Surgery

Secondary Rhinoplasty

The shape of the Nose depends on:
  • Skin: It may be too thick or too thin. The very thin nasal skin coverage makes evident and clearly identify the shape of the cartilage and bones of the nose through it; any minimal irregularity or small asymmetry becomes very evident. Instead, a thick skin nasal mask allow asymmetries and irregularities of the cartilage or bones of the nose and allows better camouflage the defects.
    You can not change the type of skin of the nose of a particular patient, although in treating Rhinophyma (nose globulosa) is possible to obtain very good results the skin thinning of the tip of the nose has been overgrown by disease, by dermabrasion.
  • Cartilages: Shape, Hardness and size of nasal cartilages: Tip or Alar Cartilages, from Nasal Dorsum o triangulars and septum.
  • Bones: Shape, size and previous fractures of the Nasal and Maxilary bones.

To evaluate and see the final aesthetic result after an Aesthetic Surgery of the Nose or Rhinoplasty it is necessary to patiently wait for all tissues of the nose to be healed completely. They can stay inflammation scar remains for months or even years.

The degree and duration of post-operative edema may vary
depending on multiple and varied factors:
  • According to the surgical technique: open or closed rhinoplasty.
  • The exact number and location of cartilage grafts placed.
  • The number, type of suture material (resorbable or permanent) and conforming exact location of sutures.
  • The location of osteotomies and instrumentation used to treat bone: chisel, saw and scrape manual or mechanical.
  • The type of post-surgical dressing: plaster, plaster cast, thermoplastic type Aquaplast.
  • The use or not of intranasal splint.
  • Post-operative treatment: anti-inflammatory and lymph drainage.

It is not recommended reoperation or to operating again a nose that has been operated less than a year ago. If operating in a nose that still have remnants of inflammation of a previous intervention, it is likely that the results are not what you want, and tissue resections that should not be resected or excised may be wronly carried out.

The normal healing caused by a first operation of the nose causes the re-operation or secondary surgery more difficult, because the tissues in the area are not as elastic as they were before and are now more friable and resistant to being folded or changed so. Also, the duration of postoperative edema is much higher in a secondary rhinoplasty in a nose operated for the first time since their tissues have already had to heal internally before and are now scarred, although anything unusual may be noticed from the outside.

Often, the surgical technique used by the first surgeon can be very difficult or impossible to recognize from "outside" to the naked eye: the alterations caused in the alar cartilages of the tip, in trianguares nasal septum or valve, the presence or absence of permanent sutures or cartilage grafts, meshes or aponeurosis or collagen may be evident only in the operating room.

If in the first nasal surgery the septum has been removed partially to treat a pre-existing septal deviation, it is possible that if secondary nasal surgery it may be necessary to have a certain amount of cartilage to graft and restore normal nasal structure, and the surgeon must obtain it from other areas of the body, such as the cartilage of the ear or the ribs, and so to have nasal graft material to provide the volume and strength necessary to obtain the desired and planned result . Obtaining the cartilage of the ear leaves a residual scar behind it, which often go completely unnoticed; obtaining costal cartilage (rib) leaves a permanent scar about 4 cm in length, which may be inapparent or so, depending on the patient ..

It is during the course of secondary surgery when it will be possible to view and find out what exactly are the changes and the real state and the residual shape of the cartilage of the nose, as well as the number and exact position of all stitches that were placed in the first operation and that might cause cartilage malposition or its unwanted folds unnaturally. The skill of the surgeon is the key to restoring the naturalness of all components of the nose and get the desired result, which must always be as natural as possible result (not note it has been operated).

After a primary nasal surgery, the most common disorders that require
a secondary nasal surgery are:
  • Polly Beak deformity : Excess projection of supratip (area above the tip).
  • Inverted V deformity: Collapse or retraction of the triangular cartilages at their junction with the nasal own bones and the nasal septum.
  • Short Nose: nasolabial angle increased excessively.
  • Columela hidden or too visible.
  • Retraction of the nasal or nostril holes in the side view.
  • Nasal tip asymmetries.
  • Asymmetries of the nasal pyramid by previous nasal fractures.
  • Lack or excess of nasal tip projection and / or the nasal dorsum.
  • Visible Irregularides the back of the nose (if they are palpable but not visible it is not required any reoperation).

Rinoplastia: anatomia segun Jack Gunter - Dr. Joaquim Suñol - Cirugia Estetica Secundaria

At your consultation, Dr. Joaquim Suñol - specialist in Aesthetic Plastic Surgery Secondary - can advise on your particular case and explain all the pros and cons, the risks and complications that can occur to you, sio you can have all available information about the solution to your problem and you can decide freely to be re-operated or not, without any kind of commitment.