What does revision surgery mean?

 

It is the second, third ... operations that are necessary for correction as a result of not achieving the targeted results in a nose surgery or getting away from it. In short, they are compensation, correction or completion surgeries. The targeted results in nose surgeries are determined by the physician and the patient before the surgery. Because the starting point is the patient's first nose. Therefore, the result that each nose can achieve is different from each other. The criterion of success in nose surgeries is to achieve a significant change and development functionally and aesthetically. The end point that this change and progress will reach is different in every nose. Because we physicians form the new nose of the patient from the previous nose, and this means a different starting point for each patient. When the starting point is different, the point reached will be different for each patient. Patients whose nose will not be perfect due to their structure should know this situation before the operation and physicians should tell this fact to their patients so that there is no inconsistency between the patient's expectation and the result of the surgery. There are rare patients who will not benefit from the surgery and will not improve. These patients are not suitable for surgery. If there is no consensus on the expected results between the physician and the patient before the surgery, disappointments and unhappiness can be expected after the surgery. As a result, every patient should know the possible level their nose can reach before surgery. We physicians always want to give the best to our patients. However, this may not be possible for every nose. Physicians are responsible for doing their best during the surgery and managing the recovery process after the surgery.

The nose is an organ that is located in the center of the face and seriously affects our facial appearance. Therefore, everyone wants a flawless look that is compatible with their face. Another important point is that breathing, which is the first principle of life, is the first and most important organ. We have two goals in nose surgeries, a better appearance and a more comfortable breath. Insufficient improvement in breathing after surgery is an absolute reason for revision. The issue of appearance is a little more complicated. As I said at the beginning of the article, the level that each nose can reach is different. For example, a thin, pointed and sharp nose cannot be obtained in a patient with very thick skin. Or a completely smooth nose cannot be obtained in a patient with severe facial asymmetry. Therefore, every patient undergo surgery should know the problems and limitations of his nose and should be informed about what his expectation should be from the surgery. In our practice, we see the patients twice before the operation. In the first meeting, we reveal the features of the patient's nose and face and talk about what we can do. In the second and close to the operation day, we ask the patient for sample pictures and try to understand the patient's tastes and learn the level of their expectations. In the last interview, if the patient has unrealizable expectations or the examples he shows are incompatible with each other and the patient gives the impression that he does not know what he wants, is confused, very worried about the operation, we state that these patients are not ready for the operation yet and that we can reevaluate the operation at a later date and postpone the operation. Because plastic surgeries are not emergency surgeries and should be performed at the most appropriate time for the patient.

 

what is revision rate?

 

Although the revision rate in nose surgeries is related to the structure of the patient's nose, the patient's recovery performance, and the surgeon's experience, it generally varies between 5-10%. Although this rate is lower in very experienced hands, it is definitely not zero percent. No matter how few problems the operated nose has, the revision rate will not be zero. It is very important for patients to know this before surgery. The duty of our patients is to comply with the treatment and follow-up rules at the maximum level after the operation and to wait patiently for the recovery period. Consulting other doctors while the healing process continues or taking an interest in alternative approaches from the internet will lead to unnecessary confusion. Therefore, we recommend that patients stay in close contact with the doctor they have operated on. The recovery period is at least one year for normal and thin skin, and at least two years for patients with thick skin.

 

what are the reasons for revision?

 

1. Nasal breathing is not relieved after sufficient time has passed after the operation. This is the absolute justification for revision.

2. Failure to achieve all the targeted results that aimed before surgery in one session.

3. The development of an unexpected complication (bleeding, infection..) after the operation 4. The result is not in line with the patient's expectation, for example, it is too upturned for the patient who wants a natural result, or it is too natural for the patient who wants an upturned result.

5. The patient has high expectations that cannot be obtained from his own nose and this issue is not discussed sufficiently before the surgery. For example, a patient with a thick-skinned nose dreams of a tiny nose with sharp and sharp lines, or a patient with severe facial asymmetry wants to have a straight nose as if drawn with a ruler.

6. Various problems in the healing process due to limitations such as facial asymmetry, thick skin, or insufficient correction.

7. Due to some psychological diseases, the patient constantly feels as if there is a problem in his normally unproblematic nose. It would be more appropriate for these patients to be identified by the physician before the operation and to postpone the surgery until this psychological disorder is brought under control by the relevant physician. However, unfortunately, it may not always be possible to detect this problem in the pre-operative interview. Although the reasons for revision can be very diverse, they can be grouped under these main headings.

 

who should make the revision decision?

 

The patient and the doctor should decide together whether a revision is required in a nose surgery. For example, when some patients apply to us for revision surgery with their photographs, we may say to these patients that no further results can be obtained for your nose than this, and we may reject the revision surgery. In other words, the revision decision is not a situation that the patient can decide alone. Likewise, when a doctor says that there is a problem with your nose, let's plan a revision and fix it, the patient may be happy with the result and reject the revision surgery. Therefore, the revision decision is a process in which the patient and the physician should meet and decide together after the recovery is completed.

So, how long after the first surgery should the revision be done?

In our practice, the recovery period is at least one year in patients with normal and thin skin, and at least two years in patients with thick skin. Emergency complications were excluded. This is the case in general. We find it inconvenient to plan revision surgery before these recovery periods expire. Because some problems may disappear as the healing is completed, while others may arise. Therefore, it is the most rational approach to wait long enough to see all the results and then plan the surgery if necessary.

 

What is the difficulty level of revision surgeries?

 

Although the degree of difficulty is different for each nose that needs revision, I can say that revision surgeries are more difficult and special than the first surgeries. Because in a patient who will be operated for the first time, if there is no congenital anomaly, the structure and anatomy of the nose are clear and the problems awaiting the surgeon are more predictable. In revision surgeries, this situation is different. During the surgery, the shape and anatomy of some structures may have changed and the cartilage structure may have decreased. In this case, it may be necessary to take cartilage from other parts of the body, most often from the ear and ribs.