Another Challenging Revision Rhinoplasty

Wow…this is the summer of the tough Revision Rhinoplasties. I’ve done tons of these very difficult cases but sometimes even I say an extra prayer to God….this was just such a Revision Rhinoplasty. I open the nose up and there staring back at me was a mess of scar tissue and nothing…I mean nothing that even remotely resembled the normal structure of the nasal tip.

Can you imagine the pressure that I felt at that very moment. I am in charge. It’s up to me and no one else to move this surgery forward and I need to keep moving…the patient is under general anesthesia and the nose will start to bleed like crazy after about 2 hours, so the clock is ticking…and ticking…and ticking! What to do? Where to start? There is so much wrong here that needs corrected…I have to act and act right now!

These are the types of cases that separate the men from the boys! The experienced form those less so! I’ve been here before, in similar cases hundreds if not thousands of times. I took a deep breath and started taking stock of the situation. Rule # 1…do a thorough assessment of the situation, but do it quickly. After that was done, I addressed the most pressing issue….Rule # 2…start with the most important aesthetic issue or area and start to make improvements there….

Once that was done things were looking much better. Mutiple sutures here to sew bits of tissue and cartilage fragments together…like some distorted zig saw puzzle…but it was taking shape. Next, I fashiond the ear cartilage into the proper sized tip graft and glued it into position using tissue glue. Now things really looked 1000 times better..more symmetric and normal in appearance. Then I went to my rule # 3: know when it’s good enough…or another way to state this is “the enemy of good is better.”

Experience has taught me when things look great and the case is over…..trying to get it to look better may actually undo what I spent all this time creating….and I definetly don’t want that. So I place the skin back over the newly created nasal tip and sew things back together….tape the outside of the skin. At this point, I can take a deep breath…a sigh of relief and a quick thankful prayer to God for the wisdom, guidance and courage to complete the case. Just another day here at the office….doing what I am trained to do…living with the stress, the joy and the wonder of it all!

I have often said that a gifted Plastic and Cosmetic Surgeon must posess:

“The eyes of an artist”

“The hands of an angel”

and….”The heart of a lion”….to do what must be done. True words for this Revsion Rhinoplasty!

Read more on Rhinoplasty here:

Dr. Francis R Palmer, III