Rhinoplasty alone is one of the most difficult operations in plastic surgery. As a surgeon, I must deal with the fact that the nose is a three-dimensional organ composed of not just soft tissue, but cartilage, bone, muscle, skin and the internal lining. Special consideration must be paid towards not just cosmesis but the functional aspect of the nose.
That being said, revision rhinoplasty deals not only with these complexities, but with the fact that another surgeon has been where the revision rhinoplasty surgeon is venturing. There may be significant scar tissue, cartilage grafts, implants, over-resected cartilage, and functional disasters. Some may say, revision rhinoplasty “is like a box of chocolates, you never know what you are going to get.”
I, therefore, prefer the open rhinoplasty approach to revision rhinoplasty regardless if the initial surgery was done open or closed. I can see exactly what was done previously and am more able to precisely place cartilage grafts, camouflage grafts, and address complexities that may be encountered. There are rare occasions where a closed approach might be ideal if there was only a nasal hump to reduce or if a small soft tissue graft needed to be placed in the tip.
Dr. Funk is a double board-certified facial plastic surgeon specializing in revision rhinoplasty in Houston, TX.