Secondary Rhinoplasty

Secondary rhinoplasty implies a reoperation or redo procedure on the nose (nose job). Obviously, these procedures are often associated with an undesirable outcome from the primary rhinoplasty and deserve special consideration since the underlying supporting cartilage is often weakened, deformed, or malpositioned. Scarring within the nose is also common and may pose limitations on the desired correction.

One of the challenges in secondary rhinoplasty is in finding adequate replacement for the structures that have been weakened or removed. Septal cartilage works great and is always a first choice but is frequently missing in secondary noses owing to its total or partial removal at the initial operation. In these cases I will frequently use ear cartilage or rib cartilage as a substitute. When structural support is needed, my strong preference is for rib. When "fill" or camouflage is needed, I'll use ear cartilage.

Due to the presence of scar and contraction of lining, it is often impossible to restore the nose to its pre-existing shape. Patients are often frustrated and psychologically affected by the deformity. Agreeing on

"It may seem shallow that a nose can sink a heart, but it can."

a reasonable surgical alternative is an essential part of a secondary rhinoplasty and I find the process to be one of the most challenging and satisfying of the surgical procedures I perform.

This patient developed dorsal and caudal septal deviation and tip and nostril asymmetry following rhinoplasty. I used her native septal cartilage to reconstruct both the tip and the bridge of the nose.

Dear Dr Byrd,
It is rare to find someone who touches your life and changes it for the better through a gentle touch and a caring heart. I searched the country and found you. Each day I am grateful for the patience you extended to me. You allowed me to express my concerns, never once brushing them aside or leaving them unanswered.
Before meeting you, Dr. Byrd, I struggled with a deformity which was thrust on me by far less experienced hands. I felt ugly and less than what I am. You changed that. You helped me find the hidden sparkle in my eyes, and the ability to forget myself, thus shedding a tremendous burden.
It may seem shallow that a nose can sink a heart, but it can. You touched me greatly by restoring me. Thank you for showing the miracle of a change that starts in the flesh, but radiates throughout a life. Thank you for being true to the trust I placed in you. Thank you from the bottom of my heart.
Sincerely,
JH

Byrd HS: Secondary Rhinoplasty (Expert Exchange). In: Saleh M. Shenaq (ed), Perspectives in plastic Surgery. New York, Thieme, 2000 Vol 14(1)pp 87-100.