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.

The use of the open approach has been proved as very useful in most cases, as it offers the enormous advantage of complete anatomical exposure. The far better view of the situation obtained with respect to the closed approach makes it possible to formulate a precise diagnosis. Another key advantage regards suturing and ensuring the stability of grafts. Revision rhinoplasty is often a work of actual architecture, aimed at rebuilding a structure that was damaged during previous surgery. Just as bricks must be laid with mortar to hold them in place, grafts must be firmly secured if the structure is to avoid collapse.

To conclude, the expert nasal surgeon must be capable of using both the closed and the open approach, and of recognizing which will provide the best results for which patients.


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