Controversies in Revision Rhinoplasty

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Key points

  • Revision rhinoplasty must improve nasal esthetic appearance and airway patency for complete patient satisfaction.

  • Key grafts for improving the nasal airway include spreader graft, lateral crural strut graft, and alar batten graft.

  • Infection prevention in rhinoplasty should include topical, systemic, or combination therapy, with or without drain management during revision surgery.

  • Pros and cons exist regarding potential pitfalls of diced cartilage versus solid cartilage grafting.

  • Alloplastic versus

Alloplastic Material versus Autologous Grafts in Dorsal Augmentation

Revision rhinoplasty frequently involves correction of iatrogenic nasal deformities, often the result of overresection of the existing nasal cartilaginous skeleton. Surgical correction requires augmentation with material similar to the natural nasal cartilage. The ideal graft material should be sufficient in quantity, strength, resiliency, and ability to be carved. It should be easily removed and unlikely to warp, migrate, become immunogenic, cause infection, or resorb. The source of this ideal

Summary

Revision rhinoplasty has undergone considerable changes over the past 40 years. Techniques continue to evolve, but a common trend among experienced rhinoplasty surgeons has shifted from a reductive approach to structural grafting and combination techniques, which simultaneously improve cosmetic and functional outcomes.46 Continued long-term follow-up is required of the previously discussed techniques and methods currently comprising controversial topics in revision rhinoplasty.

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  • Cited by (16)

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      Indeed, injectables are no longer only indicated when surgical revision is refused but are primarily proposed as an effective therapeutic option and their indications are expanding [11–13,38]. Moreover, some surgeons do not yet use this technique which suggests that more cases of injections will be performed once they will be convinced by injectables benefits [62]. Finally, given that respiratory functional disorders after primary rhinoplasty are a major cause of surgical revision [7], the using of injectables to correct inspiratory collapse of the nasal valve, especially by using endonasal injection at its apex (“spreader graft”) [2,61,63–65] is promising.

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    • A systematic review and meta-analysis of comparison between autologous costal cartilage and alloplastic materials in rhinoplasty

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      Moreover, there is a long learning curve for surgeons to apply ACC grafting successfully.71 The common use of ACC in revision rhinoplasty reflects surgeons' concerns that alloplastic material might cause more frequent or severe complications.70–73 Autologous tissue is more durable in a damaged recipient site than alloplastic implants.74

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    Disclosure Statement: The authors have nothing to disclose.

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