Plastic Surgery New Jersey

Revision surgery is perhaps the greatest challenge for the surgeon performing rhinoplasty. Dissatisfaction with the lower third of the nose is the most common source of postrhinoplasty complaints, and the nasal tip is the most complex portion to correct. The philosophic approach in revision surgery is the same as in primary procedures. This consists of identifying the aesthetic deformity, under-standing the structure that causes the deformity, and surgically correcting it. Although simple in conception, successfully implementing these steps to produce a good result and a happy patient can be extremely difficult. In our experience, two critical elements in achieving success are the external approach and the liberal use of grafts for reconstructing the tip. The external rhinoplasty approach allows ac-curate identification of the problem and precise application of surgical techniques. The exposure afforded by the external approach aids the surgeon in determining whether the residual tip structures can be manipulated and refined or must be camouflaged by tip grafts. In our experience with revision rhinoplasty, many of the unsatisfactory nasal tips result from inadequate tip support, overresection of tip structures, and distorted residual structure, all of which require nasal tip grafting to correct.

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