The Functional Aspects of the Revision Rhinoplasty Nose

Session Description

Revision Rhinoplasty is widely regarded as the most difficult of all cosmetic surgeries. In addition to scarring and reduced vascularity that adversely impacts healing and graft survival, skeletal derangements such as missing, damaged, and/or misshapen cartilage or bone make salvage nasal surgery exceedingly difficult. Moreover, in addition to the plethora of cosmetic issues that typically accompany a complex revision rhinoplasty, the overwhelming majority of revision patients also present with symptomatic nasal airway obstruction stemming from a surgically weakened, collapsed, and scarified skeletal framework. Hence functional restoration and/or preservation is a fundamental treatment objective in virtually every major revision rhinoplasty. Typically this involves first reconstituting secure central skeletal support for both the tip and dorsum so as to lift and expand the collapsed nasal airway. This is then combined with strategic bilateral sidewall re-suspension from the newly projected nasal “backbone” so as to reconfigure tip dynamics by toning and tensioning the sidewall tissues for greater resilience against inspiratory collapse. Using this approach, large and bulky sidewall grafts can usually be avoided at the internal nasal valve region which may serve to enhance contour aesthetics, but which may also (inadvertently) constrict the nasal airway at its most vulnerable point.