5 functional problems to check during a revision rhinoplasty consultation

Hello. I am Dr. Peter C. Kang, medical director of NOSELAB.

Today, I will explain the functional issues that must be checked during a revision rhinoplasty consultation. Patients considering revision surgery often first bring up cosmetic concerns such as the shape of the nasal bridge, tip height, or asymmetry; however, when planning the actual surgery, we must also evaluate breathing function.

The first thing to determine during a revision consultation is whether nasal obstruction was present before the first surgery, developed newly after surgery, or gradually worsened over time. Depending on whether only one side is blocked or both sides alternate, we consider different possibilities involving the septum, inferior turbinates, nasal valves, or mucosal rhinitis.

If revision surgery is planned without thoroughly checking these aspects, the patient may end up with an improved external appearance while persistent congestion remains. Above all, during a revision consultation, it is necessary to document the points of discomfort by dividing them into aesthetic and functional aspects.

In revision surgery, we must check whether the septum is deviated and how much septal cartilage was used in previous surgeries. Because the septum is involved in both the internal nasal airway and tip support, we cannot simply look at the amount of remaining cartilage; we must also assess how stably the current nasal tip is being supported.

Surgical plans may vary depending on whether silicone implants, septal cartilage, ear cartilage, or autologous rib cartilage were used in previous surgeries. At our clinic, rather than using an excessive amount of material, we believe it is essential to determine whether the current support structure is sufficient and, if deficient, which areas need reinforcement.

During a revision consultation, it is beneficial to assess the following functional checklist alongside aesthetic concerns.

• Septum: We check for deviation, septal defects, and tip support. Overlooking this may result in residual unilateral nasal obstruction.

• Inferior turbinates: We evaluate hypertrophy, mucosal swelling, and concurrent rhinitis. This can be the cause of bilateral congestion.

• Internal nasal valve: We examine whether the middle airway inside the nose is narrowed. This can be related to a sensation of tightness when inhaling.

• External nasal valve: We look at the support of the alae and nostril rims, checking whether there is a feeling of nostril collapse upon inhalation.

Because the nasal valve is a narrow airway passage, it must be evaluated during revision surgery. Patients who have had procedures to narrow the nasal bridge or whose tip support has weakened may experience nasal stuffiness when breathing in. In such cases, we must plan how to reconstruct the support structures alongside cosmetic correction.

During a revision consultation, we must also assess the degree of skin stiffness, any contracted upward pulling of the tip, mucosal dryness, and history of inflammation. If scar contracture is present, it is difficult to achieve the desired shape immediately, and if the mucosal condition is poor, stuffiness may persist longer during post-surgery recovery.

Evaluating functional issues does not mean that every patient requires septoplasty or turbinate surgery. Rather, what is more important in revision surgery is not missing necessary corrections while minimizing unnecessary manipulations.

A revision consultation is an opportunity to improve nasal aesthetics, and at the same time, a process of identifying why discomfort occurred. Only by thoroughly verifying the onset of nasal obstruction, the status of the septum and nasal valves, turbinate and mucosal issues, and past material use can we work toward both a natural shape and stable function.

This has been Dr. Peter C. Kang, medical director of NOSELAB.

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