Surgeons dedicated to nasal surgery are often faced with patients that have undergone previous nasal surgery (either rhinoplasty or septoplasty) or have had nasal trauma (accidents usually occurring in childhood) requiring surgical intervention.
Revision surgery is challenging, mainly because the previous technique is unknown and how much of the natural nose is present is also unknown. Scar tissue and changes to normal anatomy and vascular pathways also increase the degree of difficulty.
One of the key raw materials for rhinoplasty is cartilage from the nasal septum. However, in a first intervention this cartilage is discarded, making it hard in revision surgery to obtain the necessary material for aesthetic surgery. In revision surgeries alternative sources of cartilage derive from the ear or rib cage. The former is called auricular cartilage (leaving an imperceptible scar behind the ear without changes to the appearance of the ear). The latter is mainly used in extremely challenging revision surgeries where the cartilage needs to be stiffer, therefore using rib cartilage (leaving a small scar 2 to 3 cm).
Nasal deformities secondary to trauma are also one of the major challenges in rhinosseptoplasty. In addition to the external deformity, there is usually also a functional compromise relatively to large deviations of the nasal septum. These injuries may have occurred both in childhood and in adulthood. In these cases, too, the use of atrial cartilage or costal cartilage is frequent, since as a consequence of the trauma there may be almost total destruction of the septal cartilage, as well as large asymmetries of the nose that require the use of cartilage as support or as a disguise technique.