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Making Revision Rhinoplasty Too Complicated
By admin | February 19, 2010
Are We Making Revision Rhinoplasty Too Complicated?
Today a patient came to see me in consultation. He was a young adult who had a history of sustaining a broken nose and having delayed in having it repaired. Finally, unhappy with the appearance and the breathing, he had reconstructive surgery done by a plastic surgeon who was not specialized enough to render the result that might have been achieved. He waited for one year and then had a second surgery by a more specialized surgeon. This “first revision rhinoplasty” according to the operative report was quite complex and intricate. It involved transplanting tissue from the scalp and cartilage from the ear into the nose. Apparently the surgery took five hours. The patient said that it took nearly “two years” for all the swelling to go away. I was somewhat astonished by that initially, but then after reviewing the operative report, and seeing all the maneuvers, techniques and manipulations that were performed, it made sense the operation would take that long.
Before and after photo of another patient of Dr. Kotler who in another state, sustained two prior, yet unsuccessful operations to improve appearance and breathing. Dr. Kotler was able to create a natural nose that worked normally and relieved the patient of her blocked nose and sinus headaches.
Unfortunately for this patient, it did not render satisfaction and thus we are going to have to perform another operation on him. If it were not reasonably predictable that the outcome will be better, I would not consent to perform the surgery. I think it is very important that the “odds” of success be taken into account when performing yet another revisional rhinoplasty surgery.
My assessment is that the operation can be done more simply, efficiently and that this in itself will allow faster healing.
The issue of healing is of major concern for the patient. Because he works with the public he cannot afford to be away from work for weeks and months because the nose and face are so swollen.
Interestingly, and coincidentally, his experience is not unique. Later in the day as I was reviewing a medical magazine, I noticed an article on a young woman who required two revision rhinoplasty operations. Her surgeon noted that “one year post procedure she will be about 30% healed, and only 40% healed after two years.” That is a long time line. Most patients are not happy with the prospect of healing that takes so long.
My point is that it may be that when the operations are done, the techniques involved are just too complicated, too complex and too prone to take so much time to heal that the patient sits in a state of suspended animation for a period far longer than they would like.
Topics: Cosmetic Plastic Surgery, Cosmetic Surgery, Revision Rhinoplasty | No Comments »