Tertiary and Salvage Rhinoplasties Using the Open Rhinoplasty Approach

Abstract

This paper reviews the results of 26 tertiary and salvage rhinoplasties, all managed by the open technique. Typically, the endonasal approach has been recommended for these difficult cases because of concerns with skin viability, and the belief that scarred nasal skin will not redrape satisfactorily. Minimal undermining has also been promoted to reduce the risk of graft shifting. Each deformity presented in this review was managed with an open exposure. There were no problems with skin viability or redraping. Cartilage grafts were required less often, and when needed, were sewn precisely into place. Tissue swelling could take 12 to 18 months to settle. This paper reinforces the need for careful preoperative planning. Potential surgical pitfalls are examined.