Revision rhinoplasty is an operation that aims to correct unsuccessful results after already performed plastic surgeries for nose correction. Revision rhinoplasty is the only way out for patients who have significant visible deformities of the external nose or its functional damage after rhinoplasty. Thus, sometimes after rhinoplasty, patients notice unnatural divergence of the wings of the nose or their noticeable asymmetry. Sometimes a bumpy nose turns into a "saddle-shaped" nose - with too low a back part of the nose, because the surgeon removed too much bone or cartilage tissue.
It also happens that the reason for the patient's dissatisfaction may be related not to the technique of surgery, but to the individual characteristics of the organism. For example, after healing, the scar on the columella becomes large and noticeable. The nasal septum looks more convex and visually lengthens the nose due to a tendency to unpredictable growth of scar tissue or as a result of incorrectly performed surgery. Revision rhinoplasty allows to solve such problems and restore the natural correct shape of the nose, restore the functions of nasal breathing, restore the patient's self-confidence and attractiveness.
Secondary rhinoplasty - approaches and methods
Patients who have applied for secondary rhinoplasty are generally disappointed, cautious people who have little faith in the successful outcome of the second operation. During the consultations, we try to collect a detailed anamnesis, study photographs before rhinoplasty, in order to understand which manipulations were performed and on which structures of the nose. We recommend such patients to undergo magnetic resonance imaging before revision rhinoplasty - the analysis of this data allows us to create an objective picture of the internal structures of the nose, make an operation plan and agree with the patient on the possibility of revision rhinoplasty.
Curved nose after rhinoplasty
One of the main complaints of patients is that after rhinoplasty the nose is distorted, the tip of the nose is not elegant enough, the back of the nose has protrusions or depressions. Sometimes nasal contouring may be recommended to correct minor imperfections. But, unfortunately, major shortcomings can be corrected only during the second operation.
Sometimes the situation allows, without another operation, the use of drug therapy options, as, for example, in the case of excessively convex scars. To correct minor asymmetries, we recommend non-surgical rhinoplasty - the use of fillers, or the use of drugs that contain botulinum toxin to rotate the tip of the nose. But more often, surgical correction is needed, for example, transplantation of one's own cartilage tissue in order to fill the saddle depression or rotation of the tip of the nose and return the shape of the nasal ales with correction of the position of the nasal septum. and alarm cartilage of the nose.
It is possible to talk about the possibility of re-rhinoplasty only after 6-8 months after the first rhinoplasty. This is primarily due to the fact that the final tissue regeneration takes a long time, within a few months after surgery, the shape of the nose changes, and the "defects" that the patient notices immediately after plastic surgery may disappear. completely over time. In addition, surgery, even minimally invasive, always damages tissues and nerve endings to a greater or lesser extent - so complete healing should be awaited before performing another surgery.
The latest techniques of rhinoplasty of microinstruments are such that the consequences of any unsuccessful operation can be eliminated. The main thing is to seek help from a qualified professional.
Causes of complication: surgeon's error or patient's error?
It would be wrong to shift all the blame onto the patient's shoulders, but it would also be a big mistake to blame the plastic surgeon for everything. The reason for the malfunction can be the low qualification of the experts and the careless attitude of the patient towards the received recommendations. In a certain percentage of cases, "crooked nose" and other complications of rhinoplasty are associated with an unfavorable course of regenerative processes, and no one can blame anyone in such a situation.
However, the mistakes of plastic surgeons can really cause a deformity of the nose after rhinoplasty. Therefore, the choice of specialist and clinic should be given special importance. You can't choose a doctor at "low prices", you can only entrust your health and beauty to an experienced master of your craft. Otherwise, you will probably have to pay twice.
The following are some of the possible mistakes that plastic surgeons make and the aesthetic complications that rhinoplasty can lead to:
Improper placement of grafts. Autologous material transplantation (patient cartilage) or the installation of synthetic implants is often used in nose remodeling. If the implants are located asymmetrically, after the healing of the tissue, the patient will notice a "crooked nose" and a pronounced asymmetry.
asymmetric correction. Many rhinosurgery operations involve interventions on the bony and cartilaginous elements of the nasal skeleton, including resection of part of the hard tissue. If the resection on the right and left side is performed unevenly, after rhinoplasty there is a curvature of the nose and asymmetry.
As already mentioned, the development of an aesthetic complication after rhinoplasty is not always the result of a surgical error or irresponsibility of the patient in the rehabilitation phase. The following are the causes of complications that can be called the result of an unfavorable set of circumstances:
graft extrusion. Tissue or implant transplantation is used in many rhinosurgery operations. Unfortunately, the implant can move during the recovery period. The result will be a curvature of the nose or its asymmetry.
Cartilage graft resorption. A cartilage transplant is a living tissue that is exposed to the action of body enzymes. With an unfavorable course of regenerative processes, part of the transplant can be destroyed by enzymes. The result will be a "crooked nose" or a violation of the symmetry of the right and left halves.
Cartilage graft distortion. Distortion is a Latin word that translates as "curvature". Cartilage is elastic and flexible. Under the pressure of other anatomical formations of the nasal skeleton, as well as due to strong tissue edema, deformation can occur. This will result in a deviation of the nose.
Injury of bone and cartilage integration of the back. During the operation, the connection between the elements of bone and cartilage that make up the back of the nose is broken. If the proper integration of these structures does not occur during the rehabilitation period, a gradual deformation occurs.
Excessive callus growth. The process of bone regeneration includes the intermediate phase of bone callus formation, which will later be replaced by full-fledged bone tissue. If the regenerative processes are too active, excess tissue is created at this site, which is manifested externally by hump, "bulge" or asymmetry. There may be a deviation of the septum.
Hypertrophy of scar tissue in the apical region. As a result of abnormal growth of scar tissue in the area of the tip of the nose, more precisely just above the tip, there is an excess of tissue that manifests itself on the outside as a coracoid deformity.
It remains to list some mistakes during the rehabilitation period by the patient, which can lead to curvature and deformation of the nose:
- wearing glasses;
- moving or self-removing plaster casts;
- self-removal of rhinological splints (tampons in the nasal passages);
- accidental mechanical damage to the nose;
- sneezing with closed mouth;
- blowing;
- alcohol consumption, smoking during rehabilitation;
- early resumption of sports.
The consequences of such an operation
Rhinoplasty is an expensive, complicated and sometimes necessary operation. What do you need to know about the consequences?
When deciding on such an operation, one should be aware that the procedure is full of complications. It is not that there are natural difficulties that are inevitable in the field of any operation, they pass after a certain time. These include: hematomas, bruising under the eyes, difficulty breathing, impaired sense of smell, temporary asymmetry, numbness.
What could be the reason for that?
- Violation of the rules of preparation and conduct during the recovery period,
- Individual characteristics of a person.
The final result becomes known only after a year, sometimes a little later. No doctor can predict that with certainty.
Complications after rhinoplasty
Complications after rhinoplasty can be classified into:
- aesthetic,
- functional,
- Psychologically.
The last point is somewhat separate, deriving from the previous two. However, sometimes it stands out, because it can take place in a complex form, which depends on the degree of the main complication and the psyche of each individual person. Also, functional complications can leave a mark on point 1 (aesthetic), since all functional disorders also have external manifestations.
Consequences of rhinoplasty
Frequency of occurrence
Complications occur during surgery and. They can be divided into 4 time periods:
- Immediately during the operation, there is more often a great loss of blood,
- Immediately after surgery
- During the recovery period
- At the end of the rehabilitation period.
In addition to bleeding, complications include rough scars, adhesions, bone damage, airway obstruction, and bruising.
Expected and unavoidable complications pass in 2 weeks. The danger is "unexpected" complications:
- infection,
- Tissue necrosis (skin, cartilage, bone),
- Divergence of seams (easily eliminated).
Let's look at some of the complications in more detail.
Types
Edem
Swelling after rhinoplasty is a natural phenomenon. It would be wrong to call it a real complication. Edema appears in the operated area and under the eyes. It is clearly visible immediately after the operation. It falls off in about two weeks. Swelling can be present for longer - up to six months. The reasons for the duration and quality of edema are strictly individual.
callus
If bone fractures are required during surgery, then bone callus formation cannot be avoided. Her presence is the norm. The complication is bone hypergrowth. Such a complication implies deformation of the nose, violation of harmony.
Callus formation after rhinoplasty is a natural process of protecting the body from external influences. This is the process of bone regeneration. First, new connective tissues appear, then thin bone fibers are formed, and finally the bone tissue completely replaces the soft tissues. The task of the surgeon is to prevent the intensity of this process.
The nose turns to the side
What was the purpose of the operation? If the reason was the removal of the curvature of the nose, then the immediate result after the operation can be satisfied, the curvature disappears. However, he can return by the end of the rehabilitation period, because the nasal tissues do not have "memory". In that case, a correction is needed.
But swelling can also be a cause of curvature. In this case, it is a natural complication that will disappear at some point. Here, too, individual characteristics play a role. For some the period will be 2 weeks, for others - a month, two, three.
In any case, such curvature will be the norm. You can talk about it not earlier than a year, if the problem remains.
The nose does not breathe
Nasal breathing disorder after rhinoplasty can be caused by blockage of the nasal passages. This usually happens during the rehabilitation period. The cause of the complication is allergic or reciprocal rhinitis. This requires medical treatment. Surgery is necessary only if the treatment fails.
Delayed complications (which occur after a long time) can lead to narrowing of the nasal passages, which also leads to difficulty in nasal breathing. This causes a feeling of discomfort. In this case, the intervention of reconstructive surgery is needed, because the cause of the complication is an increase in the amount of tissue on the inner side of the nostril. He needs to be cut off.
Relaxed nose
This complication is called "hollow". The reason is the deformity due to fracture of the cranial bone at the time of osteotomy, when it is not possible to center the fragments. The reason may be excessive sealing in the nose. It is corrected only by repeated osteotomy.
The stench
Bad breath after rhinoplasty is a natural phenomenon. It is not a complication and is acceptable throughout the first year after the operation.
Temperature
After rhinoplasty, the body temperature rises, which is normal. It does not last longer than 3 days. In other cases (fever, prolonged time) you should consult your doctor.
Other complications
After the operation, the sense of smell is disturbed, which is quite natural. It will gradually return to normal. they have a reddish or pinkish tinge. And not only that, they tend to grow.
In order to eliminate them, all the requirements of the surgeon that are necessary during the recovery period must be met:
- Treatment of sutures with medication prescribed by a doctor,
- Keloid scars require corticosteroids
- In some cases, corrective surgery may be prescribed.
Rhinoplasty is a serious, although quite common operation. What is important is not only the experience of the specialist, but also your attitude towards the procedure. Negligence is unacceptable. You must fully trust the surgeon, meet all the necessary requirements. Of course, the qualification of a specialist should not be questionable.
It is no secret that facial imperfections create public prejudice that is important for people's self-esteem. Loss of attraction often causes a state of depression. That is, it is logical that facial deformities that reduce symmetry reduce the quality of life and self-esteem of patients.
Causes of curvature
A crooked nose is a generalized term used to define deformities associated with the deviation of the nasal pyramid relative to the medial sagittal axis of the face that passes through the center and divides the face into equal parts.
The patient's anamnesis includes traumatic injuries and congenital nasal deformities. Of all the facial bones, the nasal bones are the most broken, and these fractures often result in aesthetic changes and nasal deviations. As a rule, the curvature of the nasal septum occurs due to its deviation, different variants of the curvature of the septum allow its alignment.
A curved nose can also be the result of asymmetric growth of nasal structures or rhinoplasty. A nose with indented lines may look crooked, although the structure does not actually deviate from the middle axis. Deformities of the nasal septum sometimes occur during childbirth.
How is the settlement made?
Today, rhinoplasty is one of the main cosmetic surgeries performed by plastic surgeons. The main indications for rhinoplasty are functional and cosmetic disorders. Rhinoplasty is a delicate and complex operation from a functional and aesthetic point of view. Therefore, unfortunately, the level of revision rhinoplasty is quite high.
A crooked nose is the result of complex deformations of structural elements, which includes:
- nasal septum;
- upper and lower lateral cartilage;
- nasal pyramid bones.
Which leads to functional and cosmetic disorders. Excessive deviation of the nasal septum is considered to be the main cause of curvature.
Septal curvature
Deformations fall into two main categories. These include:
- cartilage deviations (lower 2/3);
- bone deviations (upper 1/3 of the nose).
Bone deviations in the upper 1/3 are usually corrected by controlled fracture of the nasal bones or osteotomy and displacement to the midline. The goal of osteotomy is to create mobile bone segments that can return to a favorable anatomical position and position. The risk of bone displacement in the original curved position is low.
Deviations of the nasal cartilage are most often among the most complex deformities that are difficult to correct. Many minor deviations of 1/3 include displacements of the main nasal septum. To correct it, its base is leveled, including the correction of the nasal bones and nasal septum. With significant cartilage curvature, additional transplantation of cartilage material may be required.
Rhinoplasty correction
One of the most difficult tasks of rhinoplasty is correcting a crooked nose. The curvature may remain after the first rhinoplasty, and even after the second operation.
The process after rhinoplasty can be quite unpredictable. As a rule, revision rhinoplasty to correct deformities after surgery may be required in approximately 3-6% of cases, but in cases of nasal deformities this figure may be much higher.
A number of nuances complicate the correction of the curvature of the nasal structures:
- The main factor is that the curvature of bone and cartilage tissue has a certain level of memory. Cartilage constantly tends to return to its original position. Natural tension exists in the soft tissues and cartilage structures, continuing to act on the nose after rhinoplasty, which makes it difficult to achieve a good result after surgery. Thus, the structures of the nose tend to retreat to their original position.
- Another factor that can lead to the return of the nose to its original curved shape is incomplete correction of septal deviation. In addition, with congenital nasal deviation, septal deviation may occur under conditions of facial asymmetry. This means that it can be difficult to find the right middle sagittal plane in order to try to place a new position of the nose in it.
Why is the nose distorted after rhinoplasty?
We must not forget that a perfectly correct nose is quite a challenge. After significant improvement, it may have a slight asymmetry or residual deviation. A small curvature is considered acceptable. The most difficult task is to make the frontal view symmetrical, because the intrusive lighting casts shadows and the nose can look asymmetrical.
There are many reasons why the nasal septum can be distorted after rhinoplasty. This is probably the result of applying asymmetric edema and / or nasal soft tissue bones. Healing after rhinoplasty is a dynamic process.
For the first few weeks after surgery, the swelling of the structure may be asymmetric. This may create the illusion that the septum is curved.
The intensity of swelling after surgery can also vary in different parts of the structure of the nose. Many swellings after rhinoplasty disappear within a month. It will take much longer to remove the last 25% of the swelling, more than a year or longer after the rhinoplasty. The final effect of the operation can take 20-36 months.
Swelling after rhinoplasty largely depends on the nature of the operated nose structures, the surgical approach, postoperative care and skin thickness. After open rhinoplasty, if an external incision is made near the base of the nose, the swelling will be longer and larger than with closed rhinoplasty. People with thick skin will get more swelling.
The swelling occurs under the influence of gravity, which means that the upper back becomes the first. In principle, the nose has a certain degree of swelling throughout the year.
When the septum is flattened and well held, the nose initially looks more correct, and then, most often, it recedes after a certain time. Initially, the island will hide deviations, which over time may become more pronounced.
Revision rhinoplasty aims to correct defects that were not considered in the first operation, for example, septal deviation due to which the appearance is distorted, or is the result of improper rhinoplasty or poor healing.
Rhinoplasty necessarily involves two different procedures, on the left and right side of the nasal septum. Asymmetry can occur due to uneven correction of the sides, different intensity of scars during healing. Curvature can occur as a result of excessive cartilage removal on one side. Septal deviation can be corrected. Revision rhinoplasty may involve cartilage transplantation.
The complete result of rhinoplasty can be observed after one year of observation. If the curvature of the nose continues after surgery, it is necessary to wait 5-10 months before revision rhinoplasty is started. Very early surgery can lead to new problems.