Tip Refinement in Secondary Rhinoplasty

Abstract

The principles of tip rhinoplasty are largely the same for both primary and secondary rhinoplasty. However, in revision surgery, a shortage of inner or outer nasal lining frequently limits re-expansion of a foreshortened and/or underprojected tip framework. Although release of the external skin envelope with wide-field dissection may help to recruit additional external lining, a scarred and contractured internal lining is often the limiting factor in nasal re-expansion. In many cases, the nose was initially shortened by resecting portions of the internal nasal lining. Wide undermining alone seldom provides adequate soft-tissue lengthening, and relaxing incisions may be needed to obtain additional length. In stubborn cases, it is often useful to institute soft-tissue stretching exercises in order to pre-expand the nasal soft tissues. This is accomplished by having the patient repeatedly pull downward on the membranous septum, as well as on the outer nose, for 30–40 min daily over a period of at least 3 months. Sustained and repeated stretching will gradually increase soft-tissue compliance and length similar to tissue expansion.