Revision Rhinoplasty: When to have it ( How to successfully heal )
It’s always a difficult question to answer for how long one should wait for revision following a rhinoplasty and it’s always a disappointing conversation to have with patients, because obviously one would ideally have the ideal result with the primary surgery. However, there are situations where secondary rhinoplasty is necessary. Usually we quote figures around between five and ten percent for revision operations following rhinoplasty and that’s a figure that is probably accepted around the world. I think there are certain factors that determine whether or not one should or how quickly one should consider revision surgery. We tend to follow patients up regularly.
Certainly in the Nose Clinic we would see patients initially the week after primary surgery and then three months and then usually at about a year and it is during that follow-up period that we will get a feel for whether or not the surgery has been successful or whether there may be necessary additional surgery required and I think it depends a little bit, first of all, on patients expectations and also there are certain physical factors like skin type, skin thickness, and the nature of the surgery that they had originally as to how long one should wait. But it is generally regarded as being appropriate to wait for about a year following initial surgery and that allows all the swelling, the scarring to have matured before considering second intervention.
This is another very common question that we get asked us to whether revision surgery will be covered by insurance and the most direct answer is unfortunately no. It’s not. It would be most uncommon for insurance companies to cover revision rhinoplasty.
There may be some situations where there are functional issues that have been created through trauma that may be covered, but it would be, I think, an exceptional circumstance that the insurance companies would consider revision rhinoplasty and I think there is acceptance that for cosmetic procedures, the insurance companies probably shouldn’t be contributing to the costs of that sort of intervention. As I say, there are occasional functional issues that may be addressed, but again, one would feel that, broadly speaking, I don’t think patients should consider– generally speaking, that their surgery would be covered by insurance.
Here at the Harley Street Nose Clinic, unfortunately we see a great number of patients who have had unfavourable results from primary rhinoplasty and therefore we do see a great number of patients requesting revision and secondary rhinoplasty. I think if you look at the published results, there are probably around 4,000 rhinoplasties carried out in the UK in a year and it is regarded that between five and ten percent of those operations may require revision. It’s an unfortunate number, but it is the consequence of the nature of the surgery. It is not necessarily a reflection of the surgical competencies.
Because it’s as an operation, there are unpredictable factors like scarring and healing that may cause the result to be suboptimal. So in the practise that I have, I see most might– well, 85% of my rhinoplasty practise is revision surgeries. So, I see an enormous number of revision cases and certainly that would be reflected in the other colleagues working within the Harley Street Nose Clinic. So regrettably, it is quite a common occurrence. So following a rhinoplasty, after the operation, patients wake up with a plaster of paris splint on their nose and often they’ll have some little stitches at the base of the nose and you will be bruised.
It would be most uncommon for you not to be bruised and that bruising will worsen for three or four days and they often get quite puffy around the eyes and in our practise here, we would keep the plaster on for about a week and the stitches also for about a week, and then return to the clinic and they will have the plaster and the stitches removed at that stage. When the plaster comes off, the nose is not how it’s going to be long term and it will take several weeks for the initial swelling to settle, but we would say that by two weeks, patients can return to work and hopefully the general public at that stage will not be looking at them and thinking that they have had surgery. Certainly, the majority of the bruising will have settled by that stage and the most obvious swelling.
There are situations where the bruising can last a little bit longer, but generally speaking by two weeks most of that has settled. However, the nose following this sort of surgery will take many months to settle down. I think the majority of patients are beginning to feel comfortable with the shape of their nose at around six to eight weeks; where the majority of the swelling has settled, but it will take up to a year for the swelling and the scarring and the sensation within the nose to return to normal and following the secondary rhinoplasty that actually may take longer than that. So it is a complex and a real process for patients to go through, because the final result does take a while to achieve.
I think the post-operative management following primary and secondary rhinoplasty is very much the same in my opinion. In that, for the first week with the cast and the stitches within the nose, patients should have a very quiet week, avoiding strenuous exercise because the risk of bleeding is greater at that stage. Once the cast is off and the stitches out, we would suggest that normal cardiovascular type exercise can be resumed at about two weeks. However, I think Pilates, yoga, swimming particularly pool should be delayed for between four and six weeks after the operation because it tends to promote more swelling and the sort of hotter the more active you are, certainly in the first six to eight weeks, the nose will become puffier after that sort of activity.
We also recognise that the nose is generally more variable over those first few months. So when you wake up in the morning, the nose may be puffier and so that reactivity that general response takes two or three months to calm down. Following the surgery, contact sports such as tennis, rugby should be delayed for six to eight weeks after the operation, but the surgery doesn’t weaken the nose and often adds additional strength to the nose if in revision cases, and so normal activities can certainly be resumed at between six to eight weeks.