Summary

The dedicated revision surgeon continues to acquire throughout his or her career an increasingly detailed understanding of the anatomy and of the problems that occur and a growing tool chest of techniques to achieve improvement or correction. The revision surgeon must attend to the patient’s surgical need and to their emotional and psychological needs. In this chapter, I have outlined my approach and discussed some selected technical problems and my solutions to them. Focusing on the two essential goals – making patients happy and making this their last nasal surgery-I find revision rhinoplasty to be a uniquely rewarding experience for both patient and surgeon.

References
1. Tardy ME. Rhinoplasty: The Art and the Science. Philadelphia, Pa: W.B. Saunders; 1997
2. Kamer FM, Pieper PG. Revision rhinoplasty. In: Bailey B, ed. Head and Neck Surgery Otolaryngology. Philadelphia, Pa: Lippincott; 1998: 2291-2302
3. Rees TD, ed. Aesthetic Plastic Surgery. Philadelphia, Pa: W.B. Saunders; 1980
4. McKinney P, Cook JQ. A critical evaluation of 200 rhinoplasties. Ann Plast Surg 1981;7:357-361
5. Thomas JR, Tardy ME. Complications of rhinoplasty. Ear Nose Throat J 1986;65:19-34
6. Tardy ME, Cheng EY, Jernstrom V. Misadventures in nasal tip surgery. Otolaryngol Clin North Am 1987;20:797-823
7. Simons RL, Gallo JF. Rhinoplasty complications. Facial Plast Surg Clin North Am 1994;2:521-529
8. Becker DG. Complications in rhinoplasty. Papel I, ed. Facial Plastic and Reconstructive Surgery. 2nd ed. New York, NY: Thieme; 2002;452-460
9. Goin JM, Goin MK. Changing the Body-Psychological Effects of Plastic Surgery. Baltimore, Md: Williams & Wilkins; 1981
10. Toriumi DM, Becker DG. Rhinoplasty Dissection Manual. Philadelphia, Pa: Lippincott, Williams, & Wilkins; 1999
11. Toriumi DM, Josen J, Weinberger MS, Tardy ME. Use of alar batten grafts for correction of nasal valve collapse. Arch Otolaryngol Head Neck Surg 1997;123:802-808
12. Constantian MB, Clardy RB. The relative importance of septal and nasal valvular surgery in correcting airway obstruction in primary and secondary rhinoplasty. Plast Reconstr Surg 1996;98:38-54
13. Goode RL. Surgery of the incompetent nasal valve. Laryngoscope 1985;95:546-555
14. Sheen JH. Spreader graft: A method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Reconstr Surg 1984;73:230-237
15. Constantian MB. The incompetent external nasal valve:Pathophysiology and treatment in primary and secondary rhinoplasty. Plast Reconstr Surg 1994;93:919-933
16. Becker DG, Becker SS. Alar batten grafts for treatment of nasal valve collapse. J Long Term Eff Med Implants 2003;13:259-269
17. Pownell PH, Minoli JJ, Rohrich RJ. Diagnostic nasal endoscopy. Plast Reconstr Surg 1997;99:1451-1458
18. Levine HL. The office diagnosis of nasal and sinus disorders using rigid nasal endoscopy. Otolaryngol Head Neck Surg 1990;102: 370-373
19. Becker DG. Septoplasty and turbinate surgery. Aeasthetic Surg J 2003;23:393-403
20. Lanfranchi PV, Steiger J, Sparano A, et al. Diagnostic and surgical endoscopy in functional septorhinoplasty. Facial Palst Surgery 2004;20:207-215
21. Becker DG, Weinberger MS, Greene BA, Tardy ME Jr. Clinical study of alar anatomy and surgery of the alar base. Arch Otolaryngol Head Neck Surg 1997;123:789-795
22. Tardy ME, Toriumi DM. Alar retraction: Composite graft correction. Facial Plast Surg 1989;6:101-107
23. Tardy ME, Genack SH, Murrell GL. Aesthetic correction of alar- columellar disproportion. Facial Plast Surg Clin North Am 1995;3: 395-406
24. Becker DG, Weinberger MS, Greene BA, Tardy ME Jr. Clinical study of alar anatomy and surgery of the alar base. Arch Otolaryngol Head Neck Surg 1997;123:789-795
25. Gunter JP, Rohrich RJ, Friedman RM. Classification and correction of alar-columellar discrepancies in rhinoplasty. Plast Reconstr Surg 1996;97:643-648
26. Becker DG, Park SS, Toriumi DM. Powered instrumentation for rhinoplasty and septoplasty. Otolaryngol Clin North Am 1999;32: 683-693
27. Becker DG, Toriumi DM, Gross CW, Tardy ME. Powered instrumentation for dorsal nasal reduction. Facial Plast Surg 1997;13: 291-297
28. Becker DG. The powered rasp: advanced instrumentation for rhinoplasty. Arch Facial Plast Surg 2002;4: 267-268
29. Tardy ME, Kron TK, Younger RY, Key M. The cartilaginous pollybeak: Etiology, prevention, and treatment. Facial Plast Surg 1989;6: 113-120
30. Tardy ME, Schwartz M, Parras G. Saddle nose deformity: Autogenous graft repair. Facial Plast Surg 1989;6:121-134
31. Gunter JP, Rohrich RJ. Augmentation rhinoplasty: Dorsal onlay grafting using shaped autogenous septal cartilage. Plast Reconstr Surg 1990;86:39-45
32. Daniel RK. Rhinoplasty and rib grafts: Evolving a flexible operative technique. Plast Reconstr Surg 1994;94:597-611
33. Murakami CS, Cook TA, Guida RA. Nasal reconstruction with articulated irradiated rib cartilage. Arch Otolaryngol Head Neck Surgery 1991;117:327-330
34. Toriumi DM. Management of the middle nasal vault. Operative Techniques in Plastic and Reconstructive Surgery 1995; 2:16-30
35. Larrabee WF Jr. Open rhinoplasty and the upper third of the nose. Facial Plast Surg Clin North Am 1993;1:23-38
36. Toriumi DM, Ries WR. Innovative surgical management of the crooked nose. Facial Plast Surg Clin North Am 1993;1:63-78
37. Rettinger G, Zenkel M. Skin and soft tissue complications. Facial Plastic Surgery 1997;13:51-59
38. Toriumi DM, Mueller RA, Grosch T, Bhattacharyya TK, Larrabee WF. Vascular anatomy of the nose and the external rhinoplasty approach. Arch Otolaryngol Head Neck Surg 1996; 122:24-34

Previous