Rhinoplasty Revision – Is Simpler Better Than Complex?
Recently we saw a patient who was a student at a local university. One year ago he had rhinoplasty performed and was very unhappy with the results. He certainly had ample reason to be dissatisfied. The nose was just terribly unsightly. It was crooked, asymmetrical. There was a gouge on the left side. It had been over-shortened, overdone, and had entirely changed his ethnic appearance. He brought in photographs to show me what he looked like prior and it was shocking how radical the change. Very poor judgment and substandard craftsmanship by the surgeon
I told the patient it was my opinion that much of what he disliked could, in fact, be improved without surgery. By using a combination of filling injections and perhaps some shrinking injections, that he would have a much improved nose which would have a better “fit” with his ethnicity. The common denominator was that, at his surgery, too much was done. And when too much is done, often the most practical answer is to use filling injections under the skin to essentially plump up the skin. To replace the over-removed portions of bone or cartilage underneath the skin. The results of the injections resemble the results of having surgical procedures which would involving grafting or transfer of tissue from one part of the body to the other. Often, in such complicated revision rhinoplasty cases, there may be more than one operation necessary to achieve a satisfactory result.
The patient was a little incredulous that I thought that I could achieve a satisfactory result –without any surgery – so I then did a “saline demo.” We inject sterile saline, the same solution in intravenous fluids, underneath the skin that mimics the result of the final permanent filler injections. It made an amazing difference. The nose was not perfect. I would have liked to have seen some minor changes otherwise but they would require surgery. But to achieve an 80% or 90% improvement without having surgery is impressive. And, practical and inexpensive compared to one or more trips to the operating room.
The patient related to me that he had seen another surgeon who told him he would require a seven-hour reconstructive surgery and that cartilage or bone would have to be taken from his chest and transplanted or grafted to the inside of the nose. Disregarding the cost and the duration of surgery and all the other inconveniences and burdens, the question is whether or not the end result would be satisfactory. Often, transplanted tissue can shrink or twist or partially disappear and this adds another level of complication and the need for even further surgery.
I think there is a place for simplicity that when an office procedure can do the work of surgery, it should certainly be considered. It’s not always the only treatment that is needed, but injections can do much of the work.
Before the operating time is reserved, the patient’s common sense might say: “Why not?”. Because there is great value to simplicity, economy and predictability.
