2.1 Morphologic and Functional Analysis of the Problem

A precise morphologic evaluation is essential. In making this analysis, the surgeon should have access to all previous findings including images before the primary operation, surgery reports, and imaging CDs if available. External inspection, external and internal palpation, and nasal endoscopy will reveal the scope of the problem. Often it is necessary to resect additional tissue from some structures and to augment others. As part of the analysis, then, it should be determined whether there is enough septal cartilage available for grafts or whether conchal or rib cartilage will be needed. Diagnostic maneuvers to assess function are helpful before any type of nasal revision surgery is performed. Standard tests include computed rhinomanometry and a standard olfactory test such as Sniffin’ Sticks to determine perception and identification thresholds.

2.2 Functionality and Aesthetics

Every nasal operation has a dual nature. This particularly applies to revision rhinoplasties in cases where functional aspects were poorly assessed and managed initially or the previous surgery itself gave rise to functional problems. ¹ The most common problems encountered in rhinoplasty revisions are:

• 
  

  Stenosis of the external or internal nasal valve

  
  
• 
  

  Inspiratory alar collapse due to overresection of alar cartilage

  
  
• 
  

  Very low lateral osteotomies that constrict the middle vault

  
  
• 
  

  Ballooning effect due to saddling in the supratip area

  
  
• 
  

  Neglected hyperplasia of the inferior turbinate

  
  
• 
  

  Septal deviation

Today it is no longer necessary to sacrifice function to improve nasal aesthetics. Consequently, top priority can be given to the correction of functional problems without compromising aesthetic goals.