The writing of this chapter was delayed for two years by a single question—can secondary rhinoplasty be taught? Three inescapable facts said no: 1) the highly variable normal anatomy is often destroyed by surgery and distorted by scar contracture, 2) operative plans must be changed radically when intraoperative findings are opposite to preoperative analysis, and 3) the diversity of cases precludes learning surgical cause and effect except by performing numerous complicated surgeries over many years. Ultimately, I came to the conclusion that teaching secondary rhinoplasty must be based on the fundamental principle learned in primary rhinoplasty. One simply can not provide the novice with the knowledge or expertise to deal with the complexities of secondary rhinoplasty. Just as there is a progression from medical school to residency to fellowship, most surgeons should progress from primary rhinoplasty to ones own revisions to secondary rhinoplasty over a 3- to 5-year period. One should not rush to treat the most difficult noses on the most difficult patients equipped with the least experience. For example, septal surgery both for functional reasons and harvesting of precious graft material is an integral part of secondaries. Yet in 75% of the secondaries I do, the septum has been previously resected. If one encounters a transected L-shape strut, it suddenly becomes your problem. Obviously, one should not be learning septal surgery in the midst of these difficult cases. Yet, the rewards of secondary rhinoplasty can be great for both patient and surgeon provided the latter is willing to make a total commitment to excellence. I have written this chapter from the perspective of how secondary rhinoplasty differs from primary cases rather than as a separate distinct entity. Also, 1 have reviewed 100 consecutive secondary rhinoplasties to determine the actual operative procedures used rather than relying on impressions. One must be a competent surgeon in primary cases before embarking on the ultimate challenge of secondary rhinoplasty. Note: A secondary rhinoplasty is defined as a case where the primary rhinoplasty was performed by another surgeon; a revision is when you reoperate on your own primary case.
KeywordsSecondary Case Alar Cartilage Spreader Graft Skin Envelope Conchal Cartilage
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