Results and Revision Surgery

RESULTS

Rhinoplasty Revision Surgery

Cosmetic surgery is not essential surgery. It is elective: a voluntary or luxury procedure undertaken to enhance appearance. Because it is elective, a patient may experience a disappointing result as a catastrophe. For example, scar tissue – a development entirely beyond the surgeon’s control — can in isolated cases, affect an otherwise good result. At the Nose Clinic, we perform ‘revision’ surgery, a minor procedure, to correct these marginal deviations after the nose has healed – 12 months later. The surgeon does not charge a fee, however the patient is responsible for the attendant theatre costs. How often do disappointing results occur at the Nose Clinic? In our experience, marginally disappointing results (that we can rectify with revision surgery), occur in approximately 10% of cases.

Optimum-bell-curve

We use the bell curve principle to illustrate this. The peak of the curve represents 90% of all results. In these cases, the patients are happy and the surgeon is confident that he or she has done a good job. On the left side of the peak (where it falls off sharply), are ‘errors of omission’ — instances where fractionally too little tissue, cartilage, or bone has been removed from the nose.

Surgery to correct a saddle depression of the nose: a good result.

ERRORS OF COMMISSION

To the right of the curve appear the results that we refer to as ‘errors of commission’. Here the surgeon has removed fractionally too much tissue, cartilage or bone from the nose. The solution may require human tissue grafting material to strengthen the underlying structure.

In such cases the Nose Clinic undertakes to correct the error of omission or commission in order to achieve the desired result. The surgeon will charge no fee, although the patient will be responsible for the attendant theatre costs.

REVISION SURGERY

A clear distinction has to be drawn, however, between the minor touch-ups that we are happy to undertake, and the major revision surgery we undertake for patients who have undergone surgery elsewhere, with unsatisfying or disappointing results.

Some 46% of the Nose Clinic’s patients consult us specifically to redo previous nasal surgery conducted elsewhere by another surgeon. During these procedures, we often find evidence of clumsy procedural ineptitude. As with any field of highly developed and specialised expertise, nasal surgery requires specialised training, skill, dedication, constant exposure to new techniques and developments, and regular, almost daily practice. General cosmetic surgeons simply cannot offer the level of specialisation provided by the Nose Clinic, and in cases where a revision is required, patients come to us because their appearance has been negatively affected or their breathing severely impeded by previous surgical procedures.

We also encounter patients who have undergone several procedures, either repeatedly with one surgeon or with several different surgeons elsewhere at another clinic or hospital. Over time, these flawed results frequently deteriorate, resulting in ugly deformities. Scar tissue may form around the old incisions, and the solution here often involves human tissue grafting in order to strengthen the underlying nasal structure and tissue.

In these cases of revision surgery, the Nose Clinic assists patients in rectifying the effects of previous inaccurate diagnoses and gross procedural blunders by other surgeons. Such problems can usually be linked to limited experience and insufficient expertise in complex nasal surgery. This is yet another reason why we recommend that patients choose their surgeons carefully and check out their credentials meticulously, and that they should sometimes be prepared to pay a little extra for the expertise that will make all the difference to their looks, self-esteem and satisfaction.

‘Rhinoplastic surgery is more than a technique,’ says Eugene Tardy Jr (MD, FACS, Professor of Clinical Otolaryngology, University of Illinois Medical Centre), ‘it involves an artistic concept and the ability to envision the result of the operation. The surgeon must become expert at nasofacial analysis and mental image visualization of an intended result. Mastery of a single approach or technique poorly equips the surgeon to properly manage the myriad nasal abnormalities that exist. Strict adherence to basic principles will not necessarily produce the ideal result. It is essential that an understanding of dynamic nasal structure transcend the components of static bone and cartilage.’

(Tardy, Eugene Jr. 1997. Rhinoplasty: the art and the science, Volume 1 M. WB Saunders.)