A combination of experience, architecture and art

Revision rhinoplasty is one of the most technically difficult operations in nasal surgery due to the existence of problems arising from previous surgery that make it more difficult to treat and handle the patient. On one hand, the bone and cartilage structures are weakened and distorted, and the soft, covering tissues are scarred and adherent. On the other hand, the patient often presents psychological problems, scepticism and diminished confidence in the surgeon.Revision rhinoplasty requires a combination of experience, architecture and art, as well as careful preoperative planning in order to restore balance between the functional and aesthetic aspects. All this entails a deep theoretical knowledge of the subject as codified in the literature and outstanding surgical dexterity.

In most cases, the open approach is extremely useful. In the last 20 years, the open approach to the septum and nasal pyramid, using a small incision in the columella, has become increasingly popular among surgeons. The possibility of defining anatomical deformities under direct inspection of the osteocartilaginous architecture and the opportunity to easily fix the grafts are only some of the advantages that have allowed the great diffusion of this approach. In addition, after a short time the columellar scar, if some special procedures are performed, is practically invisible. The latter offers the enormous advantage of complete anatomical exposure and allows for accurate diagnosis due to better visualization of the deformity than the closed approach, which has been used since the dawn of rhinoplasty. Another essential advantage that the open approach provides is the ability to suture and stabilize the grafts.

In conclusion,revision rhinoplasty is often a work of architecture that requires the reconstitution of a scaffold altered by previous surgeries. Just as you can't put bricks together without cement to stabilize them, in the same way you need to secure grafts in a stable manner to prevent the structure from collapsing.