Should I Get Revision Rhinoplasty? How S45 Clinic Plans a New Shape From Your Nasal Structure

You decided to have rhinoplasty, but the result was not what you hoped for, and in some cases complications turned a nose you liked into a ‘failed case’, causing worry. Common problems include:

• a thin nasal tip
• a silicone implant that moves or pushes through the skin (implant extrusion)
• a stiff nose shape that looks like a plastic doll’s

Nose Reshaping With Open Rhinoplasty to Help You Feel Confident About Your Nose Again

Why Can Problems Happen After a First Rhinoplasty?

• An unsuitable technique. Closed rhinoplasty with a silicone implant may not be able to correct a complex nasal structure, especially when the tip needs correcting.
• Unsuitable materials. A silicone implant that is too large or a poor-quality material can cause long-term problems, such as a thin nasal tip or a silicone implant that moves.
• Not considering the original nasal structure. Every nose is different. Rhinoplasty that does not take the original structure into account can give a shape that does not suit the face and makes it look stiff, harsh or older than your age.
• Problems from tissue or scar tissue. In nose reshaping cases, the existing tissue has stiff scar tissue, which makes it harder to achieve a good shape.

A thin nasal tip after rhinoplasty is common and worries many people. The main cause is that the nasal tissue has been ‘stretched’ or put under too much ‘tension’.

Causes of Thin Nasal Soft Tissue

• A silicone implant larger than the existing nasal tissue can hold. This puts constant pressure and tension on the skin and the tissue at the tip, so the tissue gradually thins until the silicone shows through or the tip looks red and shiny.
• An unsuitable technique. For example, closed rhinoplasty that places a silicone implant without structural support for the tip may push the silicone directly against the tip, especially in people with little nasal soft tissue, so the tip takes all the weight and pressure.
• A nose shape that does not suit the facial structure. Wanting a very high, projected nose without considering how much soft tissue you have means the surgeon has to use a large silicone implant, which increases the chance of thin tissue later.
• Repeated nose reshaping. Repeated surgery causes scar tissue and reduces the tissue inside the nose, so the nasal tissue becomes thinner and less flexible than before, which makes a thin tip and extrusion more likely.

What Is Open Rhinoplasty?

Open rhinoplasty, or the open technique, is surgery in which the surgeon makes an incision at the base of the nose to see the whole nasal structure clearly, from the tip cartilage and nasal bones to the nasal axis. It offers the following:

• Targeted structural correction. The surgeon can directly correct tip cartilage that droops or is crooked.
• Managing scar tissue and soft tissue. The surgeon can carefully release scar tissue from previous surgery, so the silicone implant or cartilage can be placed smoothly.
• Using your own cartilage. This lowers the chance of rejection. Ear cartilage or rib cartilage is usually used.
• A septal extension graft builds a strong yet flexible nasal axis.

Why the Open Technique Suits Nose Reshaping

Nose reshaping with the open technique can correct problems that closed rhinoplasty cannot, such as:

• A thin tip close to extrusion. Cartilage from your own body can be used to add thickness to the tip.
• A silicone implant that moves or is crooked. The old silicone can be removed and the internal structure rearranged precisely.
• A nose shape that does not suit the face. The shape can be refined in detail to suit the face and look well-proportioned. Results depend on each person.

Nose reshaping after a failed rhinoplasty can often correct the problem when a suitable technique and proper care are used. Open rhinoplasty is one option that can help restore your confidence, with the aim of lowering the chance of needing further reshaping. Results depend on each person.

Note: Repeat nose surgery, which many people know as ‘nose reshaping’, is surgery for people who have had nose surgery before and need a further assessment by a surgeon. The approach to care depends on the original concern, the nasal structure and the surgeon’s judgement in each case.