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Secondary rhinoplasty: analysis of the deformity and guidelines for management.

Secondary rhinoplasty aims at modifying the functional and cosmetic defects caused by an improperly performed a primary procedure. Correction follows a logical sequence from which there is no reason to deviate if one wishes to achieve sure results. The sequence includes analysis of the deformity, accurate photographic documentation, functional and diagnostic examination, consultation with the patient, and precise planning of the different steps of surgery. Deformities are grouped in four different sectors depending on the characteristics of the repair: upper, intermediate, lower, and inner. However, defects may involve more than one sector, making it difficult or impossible to establish a precise boundary between them. The surgical technique requires a wide exposure of the operating field so that the surgeon can clearly evaluate the anatomical deformities and carry out the necessary corrections. For this reason, the open approach is the solution of choice. Two types of grafts are commonly used in revision rhinoplasty, cartilage and bone. They become necessary to reestablish function and to restore volume and/or contour. We strongly believe that only autologous grafts can be used. Grafting materials, their sources, and applications in different clinical cases are described here.