Revision rhinoplasty is an operation aimed at correcting unsuccessful results after plastic surgery to correct the nose. Revision rhinoplasty is the only way out for patients who have significant visible deformities of the outer nose or its functional impairment after rhinoplasty. So, sometimes after rhinoplasty, patients notice an unnatural divergence of the wings of the nose or their noticeable asymmetry. Sometimes a humped nose becomes a "saddle" nose - with the back of the nose too low because the surgeon has removed too much bone or cartilage.
It also happens that the reason for the patient's dissatisfaction is not related to the technique of the operation, but to the individual characteristics of the organism. For example, after healing, the scar on the columella becomes large and noticeable. The nasal septum appears more prominent and visually lengthens the nose due to a predisposition to unpredictable scar growth or as a result of improper surgery. Revision rhinoplasty allows you to solve such problems and restore the natural correct shape of the nose, restore the functions of nasal breathing and restore the self-confidence and attractiveness of the patient.
Secondary rhinoplasty - approaches and methods
As a rule, patients who have applied for secondary rhinoplasty are frustrated, cautious people who do not believe in the successful outcome of a second operation. During the consultation we try to gather a thorough medical history, to study photos before rhinoplasty, to understand what manipulations were performed and on what structures of the nose. We recommend such patients to have an MRI before revision rhinoplasty - the analysis of these data allows us to create an objective picture of the internal structures of the nose, to outline a plan of operation and agree with the patient about the possibility of revision rhinoplasty.
Curved nose after rhinoplasty
One of the main complaints of patients is that after rhinoplasty the nose is crooked, the tip of the nose is not elegant enough, the back of the nose has bumps or dents. Sometimes nasal contouring may be recommended to correct minor defects. But, unfortunately, major shortcomings can be corrected only during the second operation.
Sometimes the situation allows to do without a second operation, to use the possibilities of drug therapy, as in the case of excessively prominent scars. To correct small asymmetries, we recommend non-surgical rhinoplasty - the use of fillers, or the use of drugs containing botulinum toxin to rotate the tip of the nose. But more often, surgical correction is still required, such as transplanting one's own cartilage tissue to fill a saddle depression or rotating the nasal tip and restoring the shape of the nostrils by correcting the position of the nasal septum and nasal cartilage.
The possibility of re-rhinoplasty can be discussed only 6-8 months after the first rhinoplasty. This is due, firstly, to the fact that the final recovery of the tissues takes a long time, within a few months after the operation the shape of the nose changes and the "defects" that the patient observes immediately after plastic surgery may disappear completely withinIn addition, an operation, even a minimally invasive one, always damages the tissues and nerve endings to a greater or lesser degree - therefore, before a second operation is performed, a complete cure must be awaited.
The latest techniques for rhinoplasty with the help of micro-instruments are such that the consequences of any failed operation can be eliminated. The main thing is to seek help from a qualified professional.
Causes of complications: the surgeon's mistake or the patient's fault?
It would be wrong to put all the blame on the patient's shoulders, but it would also be a big mistake to blame the plastic surgeon for everything. The reason for the formation of a defect can be both the low qualification of the specialist and the inattentive attitude of the patient to 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 be blamed for such a situation.
However, the mistakes of plastic surgeons can really cause deformity of the nose after rhinoplasty. Therefore, the choice of specialist and clinic should pay special attention. You can not choose a doctor at "low prices", health and beauty can be entrusted only to an experienced master of his craft. Otherwise, you may have to pay twice.
The following are some of the possible mistakes of plastic surgeons and the aesthetic complications of rhinoplasty that can lead to:
Improper placement of grafts. Autologous material transplantation (patient cartilage tissue) or the installation of synthetic implants is often used in nasal remodeling. If the implants are located asymmetrically, after the tissues have healed, the patient will see a "crooked nose" and pronounced asymmetry.
asymmetric correction. Many rhinosurgery operations involve intervention on the bone and cartilage 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 the surgeon's mistake or the patient's irresponsibility at the stage of rehabilitation. The following are the causes of complications, which can be called a consequence of adverse circumstances:
extrusion transplantation. Tissue or implant transplantation is used in many rhinosurgical operations. Unfortunately, the implant can move during the recovery period. The result will be a distortion of the nose or its asymmetry.
Cartilage graft resorption. A cartilage graft is a living tissue that is exposed to the action of bodily enzymes. In case of unfavorable regenerative processes, part of the graft can be destroyed by enzymes. The result will be a "crooked nose" or a violation of the symmetry of the right and left halves.
Distortion of the cartilage graft. Distortion is a Latin word that translates as "curvature". Cartilage is elastic and flexible. Under pressure from other anatomical formations of the nasal skeleton, as well as due to severe swelling of the tissues, it can be deformed. This will distort the nose.
Impaired integration of the bones and cartilage of the back. During the operation, the connection between the bone and cartilage elements that form the back of the nose is broken. If during the rehabilitation period there is no proper integration of these structures, a step-like deformation develops.
Excessive callus growth. The process of bone regeneration involves an intermediate stage in the formation of bone callus, which will later be replaced by complete bone tissue. If the regenerative processes are too active, an excess of tissue is formed in this place, which is externally manifested by a hump, "swelling" or asymmetry. There may be a deflected barrier.
Hypertrophy of scars in the apex. As a result of the unusual growth of scars in the area of the tip of the nose, more precisely just above the tip, an excess of tissue is formed, which externally manifests itself as coracoid deformity.
It remains to list some mistakes from the rehabilitation period on the part of the patient, which can lead to distortion and deformation of the nose:
- wearing glasses;
- displacement or self-removal of the gypsum fixator;
- self-removal of rhinological splints (tampons in the nasal passages);
- accidental mechanical damage to the nose;
- sneezing with closed mouth;
- blowing;
- drinking alcohol, smoking during rehabilitation;
- early resumption of sport.
The consequences of such an operation
Rhinoplasty is an expensive, complicated and sometimes necessary operation. What you need to know about the consequences?
When you decide on such an operation, you should know that the procedure is fraught with complications. Not that there are natural difficulties that are inevitable in the field of any operation, they pass after a certain time. These include: haematomas, bruising under the eyes, difficulty breathing, olfactory disturbances, temporary asymmetry, tingling.
What could be the reason for this?
- Violation of the rules of preparation and conduct during the recovery period,
- Individual characteristics of a person.
The end result became known only after a year, sometimes a little later. No doctor can predict it for sure.
Complications after rhinoplasty
Complications after rhinoplasty can be classified as:
- aesthetic,
- functional,
- Psychologically.
The last point is somewhat separate, it follows from the previous two. Sometimes, however, it stands out, as it can take a complex form, which depends on the level of the main complication and the psyche of each individual. In the same way, functional complications can leave their mark on point 1 (aesthetic), as all functional disorders also have external manifestations.
Consequences of rhinoplasty
Frequency of occurrence
Complications occur during her surgery. They can be divided into 4 time periods:
- Directly during surgery, more often it is severe blood loss,
- 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.
The expected and inevitable complications pass after 2 weeks. The dangers are "unexpected" complications:
- infection,
- Tissue necrosis (skin, cartilage, bone),
- Seam mismatch (easily eliminated).
Let's look at some of the complications in more detail.
Kinds
swelling
Swelling after rhinoplasty is a natural phenomenon. It would be wrong to call it a real complication. Swelling occurs in the operated area and under the eyes. Immediately after the operation it is clearly visible. It disappears in about two weeks. Puffiness can be present for up to six months. The reasons for the duration and quality of edema are strictly individual.
callus
If a violation of bone structures is necessary during the operation, then the formation of bone callus cannot be avoided. Her presence is the norm. A complication is overgrowth of bone tissue. Such a complication leads to deformity of the nose, a 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 tissue appears, then thin bone fibers are formed and finally the bone tissue completely replaces the soft tissues. The surgeon's task is to prevent the intensity of this process.
The nose curves to the side
What was the purpose of the operation? If the reason is the elimination of the curvature of the nose, then the immediate result after the operation can be pleasing, the curvature disappears. However, by the end of the rehabilitation period may return, as the nasal tissues have no "memory". In this case, an adjustment is needed.
But swelling can also be a cause of distortion. In this case, it is a natural complication that will disappear at some point. Here again, individual characteristics play a role. For some the period will be 2 weeks, for others - a month, two, three.
In any case, such a curvature will be the norm. You can talk about no earlier than a year if the problem persists.
The nose does not breathe
Impaired nasal breathing after rhinoplasty can be caused by obstruction 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 needed only if treatment is unsuccessful.
With delayed complications (which occur after a long time) there may be narrowing of the nasal passages, which also leads to difficulty breathing through the nose. This causes a feeling of discomfort. In this case, the intervention of reconstructive surgery is necessary, as the cause of the complication is an increase in the amount of tissue on the inside of the nostril. It must be cut.
Hanging nose
This complication is called "hollow". The reason is the deformation due to a fracture of the skull during osteotomy, when it is not possible to center the fragments. The cause may be excessive tightness in the nose. It is corrected only by repeated osteotomy.
Bad smell
Bad breath after rhinoplasty is a natural phenomenon. It is not a complication and is acceptable throughout the first year after surgery.
temperature
After rhinoplasty, the body temperature rises, which is normal. Does not last more than 3 days. In other cases (higher temperature, 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. have a reddish or pink tinge. Not only that, they tend to grow.
To eliminate them, all the requirements of the surgeon that are necessary during the recovery period must be met:
- Treatment of stitches with drugs prescribed by your doctor,
- Keloid scars require corticosteroids
- In some cases, corrective surgery may be prescribed.
Rhinoplasty is a serious, although quite common operation. It is important not only the experience of the specialist, but also your attitude to the procedure. Negligence is unacceptable. You must fully trust the surgeon, to fulfill all the necessary requirements. Of course, the qualification of a specialist should not be in doubt.
It is no secret that facial imperfections create a biased public perception, which is important for people's self-esteem. Often the loss of attractiveness causes a state of depression. That is, it is logical that facial deformities, which reduce symmetry, reduce the quality of life and self-esteem of patients.
Causes of distortion
Curved nose is a generalized term used to define the deformations associated with the deviation of the nasal pyramid from the median sagittal axis of the face, passing through the center and dividing the face into equal parts.
The patient's medical history includes traumatic injuries and congenital deformities of the nose. Of all the facial bones, the nasal bones are the most broken and these fractures often lead to aesthetic changes and deviations of the nose. 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.
Nasal curvature may also be the result of asymmetric growth of nasal structures or rhinoplasty. The nose with concave features may appear crooked, although the structure does not actually deviate from the middle axis. Deformities of the nasal septum sometimes occur during childbirth.
How is the alignment performed?
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, alas, the level of revision rhinoplasty is quite high.
Curved nose, this is the result of complex deformations of structural elements, which includes:
- nasal septum;
- upper and lower lateral cartilage;
- bones of the nasal pyramid.
Which leads to functional and cosmetic disorders. The main reason for the distortion is considered to be excessive deviation of the nasal septum.
Septal curvature
Deformations fall into two main categories. They include:
- cartilage abnormalities (lower 2/3);
- bone abnormalities (upper 1/3 of the nose).
Bone abnormalities in the upper 1/3 are usually corrected with controlled nasal fracture or osteotomy and displacement to the midline. The goal of osteotomy is to create mobile bone segments that can be returned to a favorable anatomical orientation and position. The risk of displacement of the bones in the initial curved position is low.
Deviations of the nasal cartilage are most often among the most complex deformities that are difficult to correct. Much lower 1/3 deviations include displacement of the main nasal septum. To correct it, its base is leveled, including the correction of the nasal bones and nasal septum. With a significant curvature of the cartilage, additional cartilage transplantation may be required.
Rhinoplasty correction
One of the most difficult tasks of rhinoplasty is the correction of a crooked nose. The curvature may remain after the first rhinoplasty or even after the second operation.
The process after rhinoplasty can be quite unpredictable. As a general rule, revision rhinoplasty to correct postoperative deformities may be necessary 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. The natural tension exists in the soft tissues and cartilage structures, and continues to affect the nose after rhinoplasty, which makes it difficult to achieve a good result after surgery. Thus, the structures of the nose tend to deviate to their original position.
- Another factor that can lead to the return of the nose to its original curved shape is the incomplete correction of the deflected septum. In addition, with a congenitally deviated nose, the deviation of the septum can pass into conditions of asymmetry of the face. This means that it can be difficult to find the true middle sagittal plane to try to put a new position on the nose in it.
Why is the nose crooked after rhinoplasty?
We must not forget that getting a completely straight nose is quite a challenge. After significant improvement, there may be a slight asymmetry or residual deviation. A slight curvature is considered acceptable. The most difficult task is to make the front view symmetrical, as falling light casts shadows and the nose may look asymmetrical.
There are many reasons why the nasal septum can be distorted after rhinoplasty. This is probably due to a deviation of the asymmetric swelling and / or nasal bones of the soft tissues. Healing after rhinoplasty is a dynamic process.
For the first time a few weeks after surgery, the swelling of the structures may be asymmetric. This will probably create the illusion that the barrier 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 resolve the last 25% of the swelling, more than a year after the rhinoplasty. The final effect of the operation can take 20-36 months.
Swelling after rhinoplasty depends largely on the nature of the operated structures of the nose, the surgical approach, postoperative care and the thickness of the skin. 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.
Swelling occurs under the influence of gravity, which means that the upper back is already the first. In general, the nose has a certain degree of swelling throughout the year.
When the septum is aligned and well retained, the nose initially looks straighter, and then most often deviates after a certain time. Initially, the swelling will hide the deviations, which over time may become more pronounced.
Revision rhinoplasty is aimed at correcting defects that were not taken into account in the first operation, such as a deflected barrier that makes the appearance distorted or as a 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. The distorted barrier can be corrected. Revision rhinoplasty may include a cartilage transplant.
The full result of rhinoplasty can be observed after one year of observation. If the curvature of the nose persists after surgery, it is necessary to wait 5-10 months before proceeding to revision rhinoplasty. Very early surgery can lead to new problems.