Revision Rhinoplasty

Revision rhinoplasty is a follow-up surgical procedure to the nose after a previous rhinoplasty surgery. The first nose operation is commonly referred to as primary rhinoplasty.

Although most people are happy with their primary rhinoplasties, sometimes, for a variety of reasons, they seek revision surgery. This sometimes occurs even with people who are satisfied with the aesthetic outcomes of the first surgery.

Aesthetic concerns, functional issues or, in many instances, both, drive the need for a revision rhinoplasty. The more common issues from primary rhinoplasty have to do with having too much removed from the nose structure or having too little taken off. Symmetry is another common issue. Unusually, excessive scarring may also lead to problems requiring a revision procedure.

What a revision rhinoplasty can do for you

As with primary rhinoplasty, revision nose surgery is a procedure that helps improve the shape, contours and function of the nose. Revision surgery is essentially a follow up to a previous operation, intended to make or correct aesthetic or functional issues that may have cropped up since the primary rhinoplasty.

Sometimes the original procedure may not have produced the precise results expected, either by the surgeon or by the patient. In such cases revision rhinoplasty involves minor corrections and tweaking to fine tune the results of the previous operation.

In other instances, functional issues that did not previously exist arise after the surgery. This is possible because rhinoplasty is considered to be one of the most difficult cosmetic surgical procedures to master. Any change in form can cause a related change in function.

Common aesthetic corrections during revision rhinoplasty

Some of the common issues that are corrected during revision rhinoplasty include:

  • Asymmetry of the nose tip or a pinched appearance
  • Pointy, uneven or unnatural appearance of the nose tip, commonly due to cartilage protrusion
  • Nose bridge crooked, irregular or off–centre
  • ‘Saddle nose’ deformity, when the bridge looks scooped out
  • ‘Polly-beak’ deformity, when the upper bony bridge is over-resected and the lower cartilaginous part of the bridge is not proportionally low enough
  • An ‘inverted V’ look to the sides of the nose, which happens when too much of the middle third cartilage has been removed. This can make nasal obstruction worse.

Common functional problems corrected during revision rhinoplasty

Often the revision rhinoplasty has to correct both aesthetic and functional issues at the same time.

The most common functional issue we correct during revision rhinoplasty is nasal obstruction. Nasal obstruction can be the result of a number of factors, including a deviated nasal septum, the thin wall that separates the two sides of your nose. Many people have deviated nasal septa without knowing it. When the septum is deviated, the two sides of the nasal cavity are different, and the smaller cavity is prone to obstruction. When nasal obstruction is serious, a deviated septum can be the main reason for needing a primary rhinoplasty.

Changes that are made to the nose during a primary rhinoplasty can result in making the deviation problem worse—if it was not considered serious before—creating nasal obstruction where none previously existed.

Other causes of nasal obstruction include excessive internal scarring and nasal valve collapse due to excessive tissue removal during the previous rhinoplasty procedure. Each of these issues needs to be dealt with in a different way during revision surgery.

The nose is a delicate organ, and even minor changes can result in changing its functional or aesthetic aspects. This is why rhinoplasty has very high revision rates compared to other types of cosmetic surgery.

Revision rhinoplasty requires skilful blending of science and art.  Good outcomes require a surgeon with extensive knowledge as well as wide-ranging experience —not merely qualifications.  Dr Marcells is a master of rhinoplasty, highly skilled and experienced in performing both primary and revision procedures.

What revision rhinoplasty can’t do

As with any surgery, your expectations from revision nose surgery should be realistic. Do not expect a complete transformation after surgery. Revision nose surgery essentially tweaks existing aesthetics or corrects impaired function. It will enhance your appearance somewhat and, in many cases, help you feel better about yourself and your appearance. But although you may see vast improvements, the changes are often completely unnoticed and unremarked by others. If you think about it, this is a good result.

Are you a candidate for revision rhinoplasty?

Revision rhinoplasty is performed on adult men and women who have already undergone at least one previous nose surgery procedure. Candidates should proceed with surgery with realistic goals and expectations for improving the function or appearance of the nose.

It is essential that you have healthy facial tissue and muscles and no life-threatening conditions at the time of surgery.

For your own safety, inform doctor at the initial consultation if you have any medical conditions, including disorders of the thyroid, circulatory disorders such as heart disease or high blood pressure, and diabetes.

If a surgeon other than doctor performed your previous rhinoplasty, it would be ideal to provide details and records of the previous operation, including medical records, image tests and before and after photos. The more comprehensive the information you can bring to the initial consultation the better. Because your nose is a delicate organ, what exactly has been done to it previously is essential knowledge.

When it comes to permanent birth control options for men, a no-scalpel vasectomy is a highly effective and minimally invasive procedure. This article aims to provide you with comprehensive information about the procedure, its benefits, what to expect before and after the surgery, and key considerations for individuals considering this form of contraception.

What is a No-Scalpel Vasectomy?

A no-scalpel vasectomy is a surgical procedure that involves blocking or cutting the vas deferens, the tubes that carry sperm from the testicles to the urethra. Unlike traditional vasectomies, no-scalpel vasectomies are performed without the use of a scalpel, resulting in smaller incisions, less discomfort, and a faster recovery time.

Benefits of a No-Scalpel Vasectomy:

Highly effective: No-scalpel vasectomies have a success rate of over 99% in preventing pregnancy, making it one of the most reliable forms of contraception.
Minimally invasive: The procedure requires only a small puncture in the scrotum, reducing the risk of complications, bleeding, and infection.
Quick and convenient: No-scalpel vasectomies are typically performed as outpatient procedures, meaning you can return home the same day. The procedure itself usually takes about 15-30 minutes.
Permanent birth control: Once the vasectomy is complete, it offers a long-term or permanent solution for birth control, eliminating the need for other forms of contraception.
Cost-effective: Compared to other contraceptive methods, a vasectomy is a cost-effective option in the long run, as it eliminates the ongoing expenses associated with other forms of birth control.

What to Expect Before the Procedure:

Before undergoing a no-scalpel vasectomy, you will have a consultation with a healthcare provider to discuss the procedure, address any concerns, and ensure that it is the right choice for you. During this appointment, you may be advised to:

  • Share your medical history: Inform your healthcare provider about any existing medical conditions, medications you are taking, and allergies you may have.
  • Arrange transportation: Since you will not be able to drive immediately after the procedure, it is important to have someone accompany you or arrange transportation.
  • Discuss fertility considerations: If you are considering future fertility, discuss options such as sperm banking with your healthcare provider.

What to Expect During and After the Procedure:

During the no-scalpel vasectomy procedure:

  • Anesthesia: Local anesthesia is administered to numb the scrotum, ensuring a comfortable experience during the procedure.
  • Puncture and sealing: Instead of making incisions, the healthcare provider will create a small hole in the scrotum to access the vas deferens. The tubes are then sealed, blocked, or cut to prevent sperm from entering the semen.
  • Closure: No sutures are required, as the small puncture heals on its own.

After the procedure:

  • Recovery: You may experience some discomfort, swelling, or bruising, but these symptoms usually subside within a few days.
  • Resuming normal activities: Most individuals can resume their regular activities within a couple of days, but it is advisable to avoid strenuous exercise and sexual activity for a week or as advised by your healthcare provider.
  • Follow-up appointments: You will be scheduled for a follow-up visit to ensure proper healing and to confirm the success of the procedure.

Considerations and Risks:

While no-scalpel vasectomies are generally safe, it is important to consider the following:

  1. Permanent contraception: A no-scalpel vasectomy is considered a permanent method of contraception. It is essential to be certain about your decision to undergo the procedure, as reversal surgeries can be complex, expensive, and may not always be successful.
  2. Effectiveness: While a no-scalpel vasectomy is highly effective, it is not immediately effective. It takes time and a specific number of ejaculations after the procedure to clear any remaining sperm from the vas deferens. It is crucial to use alternative contraception methods until your healthcare provider confirms that you are sperm-free.
  3. Infection: As with any surgical procedure, there is a risk of infection. Following post-operative care instructions, keeping the incision site clean, and reporting any signs of infection, such as redness, swelling, or fever, to your healthcare provider is essential to minimize the risk of infection.
  4. Bleeding or hematoma: Although rare, bleeding or hematoma (a collection of blood) can occur following the procedure. Applying ice packs and wearing supportive underwear can help reduce the risk of excessive bleeding or hematoma formation.
  5. Pain and discomfort: It is common to experience some pain, discomfort, or swelling in the scrotal area following a no-scalpel vasectomy. However, these symptoms are usually temporary and can be managed with over-the-counter pain medications, rest, and ice packs.
  6. Post-vasectomy pain syndrome: In rare cases, some individuals may experience long-term or chronic testicular pain after a vasectomy. The exact cause of this condition is unclear, and it may require further evaluation and management by a healthcare provider.
  7. Sperm granuloma: Occasionally, a small lump called a sperm granuloma may form at the site of the vasectomy. This is typically harmless and often resolves on its own. However, if it causes discomfort or persists, medical attention may be required.
  8. Failure or recanalization: Although rare, there is a small possibility of vasectomy failure or recanalization, where the vas deferens reconnects and allows the passage of sperm. To minimize this risk, it is crucial to follow up with your healthcare provider for semen analysis to ensure the success of the procedure.
  9. Psychological and emotional considerations: It is essential to discuss the psychological and emotional aspects of undergoing a no-scalpel vasectomy with your partner and yourself. Ensure that you are fully prepared for the decision and have considered its impact on your future family planning desires.