Revision rhinoplasty for monographs in facial plastic surgery contemporary rhinoplasty

Revision rhinoplasty represents the amalgamation of years of knowledge, judgment, technique, communication, self-critique, and patient selection. The surgeon's ego, economics, or personality should not persuade or dissuade him or her from undertaking revision rhinoplasty. This decision should be made after critical evaluation of his/her skills at technical execution, and communicating with the patient, as well as the patient's perception and expectations. If any concern exists, delay. Re-evaluation and referral become prudent. These patients may already be angry. They are obviously dissatisfied with their results and have frequently had attempts at revision by the previous surgeon. All these factors complicate the psychological aspects of an already difficult task. One other realization is the fact that this now becomes your result if it is the revision of a colleague's surgery. When comfortable with all of these factors, revision rhinoplasty can then be undertaken. The need for revision may be subtle or grotesque and can result from a multitude of factors: unrecognized deformities at the primary surgery; misunderstood consequences of technique; poor technique; unfavorable healing; postsurgical injury; the inevitable need for revision surgery in a difficult nose; and poor aesthetic judgment. Revision of one's own results is emotionally more difficult, but functionally and technically easier. A complete understanding of the primary surgery, access to the initial photographs, and a rapport with a patient who is willing to return are all helpful in achieving a satisfactory result. In approaching the correction of postoperative deformities, it is important to have an understanding of the anatomic abnormality as well as the aesthetic deformity. Recognizing the anatomic cause of the postsurgical deformity is more relevant to their avoidance and to the maturation of the surgeon than to their correction and the desired aesthetic result except when functional abnormalities exist and need correction. Ultimately it is the deformity that needs to be corrected, and this may or may not require the restoration of anatomic normalcy.