Rhinoplasty pp 421-525 | Cite as

Secondary Rhinoplasty

  • Rollin K. Daniel
Chapter

Abstract

The writing of this chapter was delayed for two years by a single question—can secondary rhinoplasty be taught? Three inescapable facts said no: 1) the highly variable normal anatomy is often destroyed by surgery and distorted by scar contracture, 2) operative plans must be changed radically when intraoperative findings are opposite to preoperative analysis, and 3) the diversity of cases precludes learning surgical cause and effect except by performing numerous complicated surgeries over many years. Ultimately, I came to the conclusion that teaching secondary rhinoplasty must be based on the fundamental principle learned in primary rhinoplasty. One simply can not provide the novice with the knowledge or expertise to deal with the complexities of secondary rhinoplasty. Just as there is a progression from medical school to residency to fellowship, most surgeons should progress from primary rhinoplasty to ones own revisions to secondary rhinoplasty over a 3- to 5-year period. One should not rush to treat the most difficult noses on the most difficult patients equipped with the least experience. For example, septal surgery both for functional reasons and harvesting of precious graft material is an integral part of secondaries. Yet in 75% of the secondaries I do, the septum has been previously resected. If one encounters a transected L-shape strut, it suddenly becomes your problem. Obviously, one should not be learning septal surgery in the midst of these difficult cases. Yet, the rewards of secondary rhinoplasty can be great for both patient and surgeon provided the latter is willing to make a total commitment to excellence. I have written this chapter from the perspective of how secondary rhinoplasty differs from primary cases rather than as a separate distinct entity. Also, 1 have reviewed 100 consecutive secondary rhinoplasties to determine the actual operative procedures used rather than relying on impressions. One must be a competent surgeon in primary cases before embarking on the ultimate challenge of secondary rhinoplasty. Note: A secondary rhinoplasty is defined as a case where the primary rhinoplasty was performed by another surgeon; a revision is when you reoperate on your own primary case.

Keywords

Secondary Case Alar Cartilage Spreader Graft Skin Envelope Conchal Cartilage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Constantian M. Four common anatomic variants that predispose to unfavorable rhinoplasty results. Plast Reconstr Surg 2000; 105:316.PubMedCrossRefGoogle Scholar
  2. 2.
    Constantian MB. Distant effect of dorsal and tip grafting in rhinoplasty. Plast Reconstr Surg 1992;90(3):405–18.PubMedCrossRefGoogle Scholar
  3. 3.
    Constantian MB, and Clardy RB. The relative importance of septal and nasal valvular surgery in correcting airway obstruction in primary and secondary rhinoplasty. Plast Reconstr Surg 1996;98(1):38–58.PubMedCrossRefGoogle Scholar
  4. 4.
    Daniel RK. Rhinoplasty: Creating an aesthetic tip. Plast Reconstr Surg 1987;80:775. Follow-up:PubMedCrossRefGoogle Scholar
  5. 4a.
    Daniel RK. Rhinoplasty: A simplified, three-stitch, open tip suture technique. Part I: Primary rhinoplasty, Part II: Secondary rhinoplasty. Plast Reconstr Surg 1999;103:1491.PubMedGoogle Scholar
  6. 5.
    Daniel RK (ed). Aesthetic Plastic Surgery: Rhinoplasty. Boston: Little, Brown, 1993.Google Scholar
  7. 6.
    Daniel RK. Rhinoplasty and rib grafts: Evolving a flexible operative technique. Plast Reconstr Surg 1994;94:597.PubMedCrossRefGoogle Scholar
  8. 7.
    Daniel RK. Secondary rhinoplasty following open rhinoplasty. Plast Reconstr Surg 1995;96:1539.PubMedCrossRefGoogle Scholar
  9. 8.
    Gunter JP. Secondary rhinoplasty: The open approach. In: Daniel RK (ed) Aesthetics Plastic Surgery: Rhinoplasty. Boston: Little, Brown, 1993.Google Scholar
  10. 9.
    Gunter JP, Rohrich RJ, and Friedman RM. Classification and correction of alar-columellar discrepancies in rhinoplasty. Plast Reconstr Surg 1996;97(3):643–648.PubMedCrossRefGoogle Scholar
  11. 10.
    Gunter JP, Clark CP, and Friedman RM. Internal stabilization of autogenous rib cartilage grafts in rhinoplasty: A barrier to cartilage warping. Plast Reconstr Surg 1997;100(1):161–169.PubMedCrossRefGoogle Scholar
  12. 11.
    Johnson CM, and Toriumi DM. Open Structure Rhinoplasty. Philadelphia: Saunders, 1990.Google Scholar
  13. 12.
    Juri J. Salvage techniques for secondary rhinoplasty. In: Daniel RK (ed) Aesthetic Plastic Surgery: Rhinoplasty, Boston: Little, Brown, 1993.Google Scholar
  14. 13.
    Kridel RW, and Konior RJ. Controlled nasal tip rotation via the lateral crural overlay technique. Arch Otolaryngol 1991;117(4):441.CrossRefGoogle Scholar
  15. 14.
    Meyer R. Secondary and functional rhinoplasty—The difficult nose. Orlando: Grune and Stratton, 1988.Google Scholar
  16. 15.
    Ortiz-Monasterio F, and Ruas EJ. Cleft lip rhinoplasty: The role of bone and cartilage grafts (Review). Clin Plast Surg 1989;16(1):177.PubMedGoogle Scholar
  17. 16.
    Peck GC. Techniques in Aesthetic Rhinoplasty, (2nd ed.) Philadelphia: JB Lippincott, 1990.Google Scholar
  18. 17.
    Rohrich RJ, Sheen JH, and Burget G. Secondary Rhinoplasty, St. Louis: Quality Medical Publishing, 1995.Google Scholar
  19. 18.
    Sheen JH. Achieving more nasal tip projection by the use of a small autogenous vomer or septal cartilage graft. A preliminary report. Plast Reconstr Surg 1975;56:35.PubMedCrossRefGoogle Scholar
  20. 19.
    Sheen JH. A new look at supratip deformity. Ann Plast Surg 1979;3:498.PubMedCrossRefGoogle Scholar
  21. 20.
    Sheen JH. Tip graft: A 20-year retrospective. Plast Reconstr Surg 1993;91 (1):48—63.PubMedCrossRefGoogle Scholar
  22. 21.
    Sheen JH, and Sheen AP. Aesthetic Rhinoplasty (2nd ed.) St. Louis: Mosby, 1987.Google Scholar
  23. 22.
    Sheen JH. Balanced rhinoplasty. In: Daniel RK (ed) Aesthetic Plastic Surgery: Rhinoplasty, Boston: Little, Brown, 1993.Google Scholar
  24. 23.
    Tabbal N. The alar sliding graft for correcting alar collapse and expanding the nasal tip. Aesth Surg J 2000;20:244.CrossRefGoogle Scholar
  25. 24.
    Toriumi DM, and Johnson CM. Open structure rhinoplasty: featured technical points and long-term follow-up. Facial Plast Clin North Am 1993;1:1.Google Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • Rollin K. Daniel
    • 1
    • 2
  1. 1.Newport BeachUSA
  2. 2.Department of Plastic SurgeryUniversity of California, IrvineIrvineUSA

Personalised recommendations