Name of the Procedure:

Rhinoplasty, secondary; intermediate revision (bony work with osteotomies)

Summary

Rhinoplasty, commonly known as a "nose job," is a surgical procedure designed to change the shape or appearance of the nose. A secondary or revision rhinoplasty is a follow-up surgery to correct or improve results from a previous rhinoplasty. Intermediate revision involves work on the bone structure using osteotomies (surgical bone cuts).

Purpose

This procedure addresses issues from a previous rhinoplasty that didn’t produce the desired outcome, including both cosmetic concerns and breathing difficulties. The goal is to refine the nasal structure, improve facial harmony, and restore or enhance nasal function.

Indications

• Unsatisfactory results from a prior rhinoplasty
• Breathing problems due to nasal obstructions
• Asymmetry or deformities of the nasal bones
• Patient dissatisfaction with the cosmetic appearance of their nose

Preparation

• Fasting: Often required for at least 6-8 hours before surgery.
• Medications: Adjustment of current medications as advised by the surgeon.
• Diagnostic Tests/Assessments: Preoperative evaluation including physical examination, medical history, and imaging studies (e.g., X-rays).
• Smoking: Patients are usually advised to stop smoking several weeks before the procedure.

Procedure Description

1. Anesthesia: Administered under general anesthesia or sedation to ensure patient comfort.
2. Incisions: Small incisions are made either inside the nostrils (closed surgery) or across the columella (open surgery).
3. Osteotomies: The surgeon makes precise bone cuts to reshape the nasal structure.
4. Bone and Cartilage Adjustment: Adjustments or grafts may be performed to achieve the desired shape and support.
5. Closure: The incisions are closed with sutures.
6. Splinting: The nose is often splinted to maintain the new shape during initial healing.

Duration

The procedure typically takes 2-4 hours depending on the complexity of the revisions needed.

Setting

Performed in a hospital, surgical center, or outpatient clinic equipped for advanced surgical procedures.

Personnel

• Surgeon: Specializing in plastic surgery or otolaryngology.
• Nurses: Assisting preoperatively, intraoperatively, and postoperatively.
• Anesthesiologist: Administering anesthesia and monitoring the patient’s vital signs.

Risks and Complications

• Common Risks: Swelling, bruising, infection, adverse reaction to anesthesia
• Rare Complications: Persistent asymmetry, nasal obstruction, prolonged bleeding, numbness, dissatisfaction with aesthetic outcomes

Benefits

• Improved nasal appearance and symmetry
• Enhanced breathing functionality
• Boost in self-confidence and satisfaction with facial appearance
• Realization of benefits varies; swelling may take several months to fully subside

Recovery

• Post-Procedure Care: Keeping the head elevated, avoiding strenuous activities, and taking prescribed medications for pain and inflammation.
• Follow-Up: Regular appointments with the surgeon to monitor healing.
• Recovery Time: Initial recovery takes about 1-2 weeks, with full recovery over several months.

Alternatives

• Non-Surgical Options: Dermal fillers for minor corrections but limited duration and effect.
• Other Surgical Options: Considering different types of rhinoplasty if initial and revision rhinoplasties were unsatisfactory.

Patient Experience

• During Procedure: Anesthesia ensures no pain; the patient will be asleep or deeply sedated.
• After Procedure: Possible discomfort, swelling, and bruising; pain management with prescribed medications; nasal congestion due to splints and swelling.
• Comfort Measures: Cold compresses and prescribed pain relievers.