SECONDARY RHINOPLASTY

Secondary rhinoplasty is one of the most complicated procedures in cosmetic surgery. It is a corrective surgery that aims to fix defects that were not adequately addressed during the first rhinoplasty or when the first rhinoplasty led to complications, such as decreased breathing ability, nasal collapse, an overly upturned or drooping nose. Often these defects are due to excessive cartilage removal and require taking cartilage from the ears or a rib.

This procedure is reserved for specialists in reconstructive nose surgery, which is one of Dr. Lyor Hanan’s areas of specialization.

If after an initial rhinoplasty you notice:

• Recurrence of a bump
• Nose deviation
• Dropping nasal tip
• Decreased breathing ability
• Bulbous nasal tip
• Pinched nose
• Overly thin nose
• Too visible nostrils
• Overly upturned nose

You may then be eligible for secondary rhinoplasty.

The first consultation is crucial to asses if you still have septal cartilage left or not. It will dictate if we need to harvest rib cartilage or not. Another very important consideration is also the skin quality and thickness, in case the skin is really impaired or thin, we may need some extra material like temporal fascia which is harvest through a tiny incision into the hairs. This extra layer graft will be added underneath the nose skin in order to make sure the skin will heal properly.

The first step involves administering general anesthesia, then completely clean the patient’s face.

The second step is the incision. Dr. Lyor Hanan uses both closed tip rhinoplasty techniques with a hidden incision inside the nose, and open techniques where a discrete incision is made at the columella (the strip of skin separating the nostrils). Through this incision, the nose skin is gently elevated. At this stage, a diagnosis is made regarding the presence or absence of cartilage. If cartilage is missing, Dr. Lyor Hanan takes a piece of your own septal cartilage, or if he needs more material he will harvest from your rib cartilage through a small 3 cm incision under the breast. This piece of cartilage is then precisely carved to replace the missing or damaged cartilage from the previous procedure.

The third step is the reconstruction of the nasal bridge, which is often deficient in secondary rhinoplasty. The nasal valves and septum are often damaged. They are then repaired by reinforcing the nose with custom-carved cartilage strips. Finally, the nasal tip is reshaped and fixed in the proper position.

The fourth step is closing the incisions. This closure is performed using dissolvable sutures that disappear after a few days to weeks.

Recovery is generally straightforward, with little pain, and Steri-Strip dressings covered by a splint remain in place for up to 7 days after surgery.

There may be bruising (ecchymosis) that disappears after a few weeks.

Return to work is possible after 7 days.

There is generally no nasal packing inside the nose.

The sutures are dissolvable and therefore disappear on their own.

Regular post-operative follow-up at 1 week, 1 month, 3 months, 6 months, and 1 year is extremely important for your surgeon. It allows them to photograph your nose at different stages and therefore best evaluate the result.

The final result can take up to 12 months to be fully visible. However, you will notice significant improvement in the defects from the first rhinoplasty. The results of secondary rhinoplasty carry a higher risk of imperfections or irregularities than primary rhinoplasty.

The cost of secondary rhinoplasty depends on the difficulty of the procedure and the planned operating time; it costs at least 40 000 AED.