Rhinoplasty alone is one of the most difficult operations in plastic surgery due to the need to shape a 3 dimensional object by carving, grafting, and manipulating cartilage, soft tissue, and bone. All the while, respecting or improving function or breathing is critical during this operation. Revision rhinoplasty is even more difficult as much of the remaining cartilaginous framework may be missing. Septal cartilage for grafting purposes may be missing. There is significant scar tissue under the skin making the dissection that much more difficult. Lastly, scar will be healing on top of old scar making the results not quite as predictable.
Revision septoplasty can also be quite difficult as there may only be fragments of septum remaining and the septal cartilage may be so warped or curved, advanced techniques may be necessary to straighten it. These include the use of spreader grafts, PDS plate, bone grafts from the bony septum to the cartilaginous septum, or ear cartilage. Sometimes the entire deviated septum needs to be removed, straightened and then replaced during revision septoplasty.
Dr. Funk is a Houston facial plastic surgeon specializing in revision rhinoplasty and septoplasty.