Revision rhinoplasty is my favorite operation to perform. I enjoy the challenge of diagnosing the cause of a particular deformity or problem and then operating to analyze and correct it. All aspects of my training are involved with these cases and no two of them are exactly alike. Once in surgery the process is similar to solving a puzzle. A thorough understanding of normal nasal anatomy is essential in order to determine what abnormal structures and distortions have resulted from previous surgery. A good aesthetic eye is then critical in order to yield the desired aesthetic outcome. Revision rhinoplasty requires intense concentration, superior technique, appreciation for nasal function, aesthetic judgement, and the ability to communicate with the patient. The relief and gratefulness of these specific patients is unparalleled and the ultimate reward for me.
In dealing with the previously operated nose I attempt to first define the problem anatomically and establish what the patient hopes to achieve. Instead of focusing on minor points we discuss overall conceptual changes that are possible. I then formulate a plan that will allow me to address each of the elements in a priority fashion. My goal is to return the anatomy as closely back to normal as is feasible using the patient’s own tissues. Emphasis is placed on using techniques that will hold up over time and not become distorted with scar tissue. Recreating or preserving nasal function is always prioritized because if someone cannot breathe they really could care less about the way they look. I prefer a nose that doesn’t draw attention to itself. It should be in balance and harmonious with the other facial features and should look natural; like it has not ever been operated on. In general, I prefer a stronger nose than a smaller one.
-Andrew S. Frankel MD