Revision Rhinoplasty

The end cosmetic result of a primary (first time) rhinoplasty is a balance of opposing forces. The strength of the supporting cartilage of the nose resisting the contractile forces of the skin envelope covering the nose as it heals. The need for a revision rhinoplasty is usually the result of excessive cartilage and bone being removed from the nose during a primary rhinoplasty. During the healing phase over the following year, the nasal skin shrinks around the remaining nasal supporting architecture. Because the structure is now weakened, the nose buckles and becomes distorted and misshapen with ski jump bridges, pinched nasal tips, retracted nostrils (alar retraction) with twisted noses and blocked nasal breathing.

Classic post rhinoplasty deformities such as the pinched tip, pollybeak deformity, alar collapse/retraction, bossae formation and 'V' shaped deformity can all be related to inappropriately aggressive cartilage resection during the initial rhinoplasty operation. It is now well accepted that many of the rhinoplasty techniques of 20 years ago were over aggressive and destructive in nature leaving many patients with more problems than they started out with. 

Revision rhinoplasty is one of the most difficult facial plastic operations to perform and the surgeon must have extensive ear, nose and throat surgical training as well as facial plastic surgical training to treat this specific type of nasal deformity.

When reconstructing the nose often the cartilage of the nasal septum has already been removed or used for the primary rhinoplasty, therefore limiting options for replacement support for the reconstructive surgery. Dr. Pincock may have to repeat the septal portion of the operation to harvest cartilage to rebuild the supporting cartilages of the nose, alternatively auricular (ear) cartilage, rib cartilage or even cranial bone can be taken to rebuild the support of the nose. Occasionally when those options are unavailable or undesirable, implant materials such as Gore-Tex or Medpor can be used.

Most revision rhinoplasty operations require an external approach rhinoplasty incision to appropriately reconstruct the nose, in some circumstances when a primary rhinoplasty has simply under corrected the problem an internal incision alone can be used.

After your revision rhinoplasty Dr. Pincock will see you in the office five to seven days after surgery to ensure that healing is progressing well and to clean out your air passages, so as to ease your breathing. Some swelling is expected after the surgery, and you may need to use medications or nasal spray to keep your nasal passages open. Keeping the head elevated and applying cold compresses helps to reduce the swelling. Pain is usually minimal, but you will be prescribed pain medications to take as needed. The splint and the sutures will be removed in about a week. The majority of the swelling resolves during the first month, but your nose will continue to adjust its shape over twelve to eighteen months.

Facial Nerve Injury

The facial nerve is arguably one of the most important nerves in the body, it can be damaged permanently by trauma, infection, tumour or Bell's palsy. Permanent facial nerve injury can be a devastating injury to a patients overall self esteem and has been shown to seriously affect a patients quality of life. In many cases an attempt to reestablish a connection to the facial nerve via microvascular nerve anastomosis is possible, however sometimes either due to extensive damage to the facial nerve or other cranial nerves this is not possible.

There is a variety of surgical techniques to improve both the function of a patients face with a facial nerve paralysis or to improve the cosmetic appearance of a patient with a permanent facial nerve paralysis.

From simple techniques such as gold weight insertion to help eye-closure to more advanced functional techniques such as temporalis tendon transfer or cosmetic procedures such as brow or facelifting procedures, Dr Pincock can discuss all these options with you and offer a tailored management plan suitable to an individual patient's facial nerve injury. Dr. Pincock also works very closely with other surgeons who are world class experts in facial nerve surgery and the treatment of all facial nerve disorders.

Scar Revision

Many factors determine the severity of scarring: the size of a wound, its depth, the blood supply to the area, and skin tone as well as surgical closure technique and the occurrence of any infection during the healing period. No surgeon can completely remove a scar, but in some cases, the appearance of the scar can be greatly improved.

Scar revision is a surgical procedure used to improve the appearance of scars that have not healed in an ideal fashion leaving a wide, raised or hyper-pigmented scar.

Several techniques are available, including scar excision, Z-plasty, geometric broken line closure, W-plasty,  dermabrasion, and laser treatment. A combination of these surgical technique's can be used to get maximum results.

 

Skin Cancer Reconstruction

Moh's Micrographic Surgery and other skin cancer removal techniques are intended to remove cancers while preserving as much healthy tissue as possible and leaving only a small wound. Unfortunately, even highly precise techniques can result in a large wound or a scar, which can be especially upsetting if the tumor was on a cosmetically critical area of the body such as the face. Patients who have had skin cancer surgery in the past can also have the scar revised or an adjunctive procedure such as facial contouring or lipostructure's to improve the cosmetic result.