About 50% of our rhinoplasty cases are secondary / revision rhinoplasties previously performed at an outside institution. Revision rhinoplasties are usually the result of either previous performed surgeries or trauma. In both cases often not only the shape but also the breathing abilities are affected. Some patients have already undergone 2 or more surgical procedures. Revision rhinoplasty is usually a complex procedure – commonly a more time consuming and demanding procedure than primary rhinoplasty. This is because cartilage in the nose is often depleted from preceding surgeries, leaving the patient with scars and tightening of the skin. Choosing an experienced rhinoplasty surgeon to perform a revision rhinoplasty by using modern and advanced techniques is important.
Revision rhinoplasty and secondary rhinoplasty procedures are somewhat more involved, in that the recognition and reshaping of tissue is more complex, due to the presence of scar tissue and removed missing cartilage. It may seem to the patient that only some small corrections need to be done, however this is usually much more difficult than some patients imagine. Most operated noses are missing structural support, resulting in stigmatic deformities of the “operated“ nose.
This may result for example in a collapsed middle vault, resulting in a sunken-in appearance of the middle part of your nose. Quiet commonly these patients also complain about breathing difficulties. Another common example is collapsed nostrils, alar notching, and a pinched or asymmetric appearing nasal tip. Other commonly encountered problems are visible nasal tip grafts, irregularities, of the nasal dorsum, a too low created nasal bridge, an unnaturally shaped, sloped dorsum, or the so-called “parrot beak“ deformity, often encountered after closed rhinoplasties. Just to name a few, there are actually many more.
There are 2 general approaches to rhinoplasty surgery: open and closed, as you probably already know. In the previously operated nose, an open rhinoplasty approach is preferred. With an open approach your surgeon has the best visibility to identify your anatomy and to control and reshape your nose. Depending on what type of surgery has been performed already, Dr Knoll might be able to work with the nasal cartilage that is still present, or additional tissue, usually cartilage from either the ear or the rib may be needed to correct the structural, functional and aesthetic defects of the previously operated nose. Based on your personal desires and anatomic needs, Dr. Knoll will choose the right rhinoplasty and surgical appropriate surgical approach with you.
The success of a rhinoplasty procedure is clearly dependent on the meticulous planning and skilled surgical performance of your nasal surgery. Most of Dr Knoll’s rhinoplasty procedures can be performed safely in an ambulatory setting. The rhinoplasty procedure will be performed under general anesthesia, and may take between 3.5 to 6 hours, depending on what needs to be done. Based on your general health, length and type of the procedure and your personal comfort an overnight stay in the hospital might be necessary. If rib cartilage is needed to rebuild your nose, 1 overnight stay is mandatory.
Unfortunately, it is quiet difficult to provide any estimated costs of a secondary or revision rhinoplasty without having examined and talked to the patient. Having read the information above, it is easy to understand that the costs of the surgery will vary depending on the complexity, length of the procedure, hospital stay, and the details involved. Usually there are 3 different costs: the surgeon’s fee, hospital fee, and anaesthesia fee.
Dr Bianca Knoll’s office in Frankfurt, will provide you with a detailed cost proposal including all these 3 different costs after your consultation. The best thing to do is to come in to see Dr Knoll for a consultation. You will be thoroughly examined and provided with all the information you will need, and how much it will cost. We totally understand that it can be impractical for some of our out of town / or international patients, to come into Frankfurt, to get a first impression. For these reason Dr Knoll’s office offers the possibility of an online consultation. However, a virtual consultation has it’s limitations, and does not replace an in person consultation.
We understand, that considering another rhinoplasty can be psychologically very challenging to patients. The initial trust and confidence of the patient in the surgeon and the nasal surgery has been damaged, esp after several surgical rhinoplasty procedures. The ideal secondary or revision rhinoplasty candidates are medically and mentally healthy patients having realistic expectations of what can be achieved aesthetically and functionally. Perfectionist patients who are absorbed by small, barely noticeable asymmetries or minor shadows, spending most of the day thinking about their nose, are not good candidates for a rhinoplasty. The majority of these patients never will be happy and satisfied with their appearance.During your consultation Dr Knoll will carefully listen to your concerns, examine you and thoroughly analyse your facial features. She will then discuss this with you, and explain your available options. You can be confident, that Dr Knoll will talk to you very honestly about realistic expectations, obtainable results, potential risks and benefits associated with an additional rhinoplasty procedure. In some cases a preoperative CT-scan or additional functional studies of your nose might be required. If you have already some of these testings performed, please bring a copy with you to your consultation. Old operative reports are also very helpful. Some patients opt also to send those medical documents to us, prior to their consultation appointment. The more information Dr Knoll has about your previous rhinoplasty procedures, the more conclusive your consultation will be. Medical photographs will be performed during your consultation. The computer imaging is a service part of Dr Bianca Knoll, for our rhinoplasty patients, when they visit her for a consultation in her Frankfurt office. After your consultation appointment, you will receive several computer simulations, based on Dr Knoll’s analysis and your goals that had been discussed. The imaged simulations will serve as an educational tool only, to help you to understand your options and facial proportions, and to discuss your preferences. You will also receive further information about any type of preoperative testing required and additional information about the procedure.
If you wish to have additional information or would like to schedule a consultation please contact the office Dr Bianca Knoll, we will be happy to assist you.