Revision rhinoplasty planning is the process of assessing a previously operated nose and modeling a corrective surgical plan, accounting for scar tissue, prior grafts, and altered anatomy. It is more complex than primary rhinoplasty planning because the baseline anatomy has already been changed by a prior operation. This guide outlines a step-by-step planning framework using 3D simulation.
Step 1: What Should the Initial Assessment Cover?
Before simulating any outcome, document the patient's surgical history: what was done in the prior operation(s), what grafts (if any) were used, and what the patient's specific complaint is (functional, aesthetic, or both). A 3D scan at this stage establishes the current baseline anatomy, including asymmetries introduced by scar contracture.
Step 2: How Do You Account for Prior Cartilage Changes?
Because prior surgery may have removed, weakened, or repositioned cartilage, an accurate revision plan needs an estimate of current subcutaneous structure, not just the skin surface. Kratos 3D's Kratos Anatomy module estimates cartilage and bone structure beneath the current skin envelope, which helps identify where support is likely compromised.
Step 3: What Metrics Should Guide the Revision Plan?
The same angle-based metrics used in primary rhinoplasty apply, but the target values differ because the baseline is different: naso-frontal angle, naso-facial angle, tip projection and deviation, dorsal height, and the Ricketts E-Line relationship.
Step 4: How Do You Simulate the Corrective Outcome?
With the current 3D scan and estimated subcutaneous anatomy as a starting point, the surgeon models the planned correction (e.g., graft placement, osteotomy, tip refinement) and generates a morph animation between the current state and the projected post-operative result.
