People with a bad experience of rhinoplasty, who want to undergo it again, usually have great expectations regarding the nose repair. In some cases, no defect may be present in the operated nose, while the person does not think so. Most of these people cannot describe their desired shape for their nose, and are not an appropriate candidate for secondary rhinoplasty.
The other important point is the amount of recovery and whether the patient is satisfied of the result or not.
To assess this issue, it should be noted that whether the description of patient regarding the conditions is realistic and reasonable or not. If the criticism is valid and the patient has reasonable expectations, and with regard to all conditions, he can be a candidate for secondary rhinoplasty.
Patients preoperative photos including family photos which clearly show the patient’s face are also helpful for further evaluation.
The primary surgeon who has operated the patient is not our concern, but if asked sometimes, we prefer to refer the patient to him, provided that he can perform the secondary surgery. It may be asked that which surgeons are eligible for reconstructive surgery; in general, it is said that surgeons learn the procedure in the first 5 years of practice (mastering the techniques of surgery), learn what cases to select in the second 5 years of practice (careful selection of patients), and learn what cases not to select in the third 5 years of practice, the latter shows the surgeon’s professional maturity, after which he can perform reconstructive surgery.
The most difficult secondary patients are those who have too thick or too thin skin in addition to the existing deformity. Deviation in the nose or face makes the task more difficult. The worst case is the presence of multiple incisions on skin, in particular, incisions in alas and nostrils, or damaged and small skin, which sometimes requires repair and provision of skin from forehead or other areas in some of these patients, such as patients who need nasal reconstruction; the necessary explanations are given to patients and their relatives.
Many secondary patients whose noses are too small, have too small and tighten skin as well. These patients often need to massage the skin; acceptably softens the skin after which the secondary rhinoplasty, the necessary cartilage transplantation, and nose fitness can be performed.
Mental and emotional stability of patients in nose cosmetic surgery either primary or secondary is a basic and decisive condition. When you have a patient who correctly identifies the personal problems and knows what he wants, and the physical conditions of the skin, nose, and cartilage are acceptable, the task is clear. But when one person does not know what is wrong and what he wants, the job will be challenging for surgeons.