Revision rhinoplasty is an operation aimed at correcting unsuccessful results after plastic operations to correct the nose that have already been performed. Revision rhinoplasty is the only way out for patients who have clearly visible deformities of the outer nose or functional limitations after rhinoplasty. After rhinoplasty, patients sometimes notice an unnatural divergence of the nostrils or their noticeable asymmetry. Sometimes a hump nose becomes a "saddle" nose - with the bridge of the nose being too low because the surgeon has removed too much bone or cartilage tissue.
It also happens that the reason for the patient's dissatisfaction is not related to the surgical technique, but to the individual characteristics of the organism. For example, after healing, the scar on the columella becomes large and conspicuous. The nasal septum looks more convex and visually lengthens the nose due to a predisposition to unpredictable growth of scar tissue or as a result of improperly performed 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 patient's confidence and attractiveness.
Secondary rhinoplasty - approaches and methods
Patients who have requested secondary rhinoplasty are typically disappointed, suspicious people who have little faith in the success of a second surgery. During the consultation we try to collect a thorough anamnesis, study photos before rhinoplasty to understand what manipulations were performed and on what structures of the nose. We recommend such patients to undergo MRI before revision rhinoplasty - the analysis of these data allows us to create an objective picture of the internal structures of the nose, create a surgical plan and agree with the patient on the possibility of revision rhinoplasty.
Crooked nose after rhinoplasty
One of the main complaints of patients is that the nose after rhinoplasty is crooked, the tip of the nose is not elegant enough, the bridge of the nose has bulges or indentations. Sometimes nose contouring may be recommended to correct minor defects. Unfortunately, larger defects can only be corrected in a second operation.
Sometimes the situation makes it possible to do without a second operation in order to take advantage of the possibilities of drug therapy, such as in the case of scars that are too convex. To correct minor 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. More often, however, surgical correction is required, such as transplantation of the patient's own cartilage tissue to fill the saddle-shaped depression or rotation of the tip of the nose and restoration of the shape of the nostrils with correction of the position of the nasal septum and alar cartilage of the nose.
The possibility of another rhinoplasty can only be discussed 6-8 months after the first rhinoplasty. First of all, this is due to the fact that the final tissue restoration 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 the plastic surgery can disappear completely over time. In addition, an operation, even a minimally invasive one, always injures tissue and nerve endings to a greater or lesser extent - so you should wait for complete healing before a second operation.
The latest rhinoplasty techniques using micro-instruments are designed in such a way that the consequences of a failed operation can be eliminated. The main thing is to seek help from a qualified specialist.
Causes of Complications: Surgeon Error or Patient Fault?
It would be wrong to put all the blame on the patient's shoulders, but it would also be a huge mistake to blame everything on the plastic surgeon. The reason for the emergence of a defect can be both the low qualification of a specialist, and the inattentive attitude of the patient to the recommendations received. In a certain percentage of cases, a "crooked nose" and other complications of rhinoplasty are associated with an unfavorable course of regenerative processes, and in such a situation one cannot blame anyone.
And yet the mistakes made by plastic surgeons after rhinoplasty can really cause a nose deformity. Therefore, the choice of a specialist and a clinic should be given special importance. You cannot choose a doctor at "cheap prices", health and beauty can only be entrusted to an experienced master of his craft. Otherwise, you will probably have to pay twice.
Below are some of the possible mistakes plastic surgeons make and the aesthetic complications of rhinoplasty they can lead to:
Improper placement of grafts. The transplantation of endogenous material (the patient's cartilage tissue) or the installation of plastic implants is quite often used in nose reconstruction. If the implants are asymmetrical, the patient will see a "crooked nose" and a pronounced asymmetry after the tissue has healed.
asymmetric correction. Many rhinosurgical procedures involve manipulation of the bony and cartilaginous elements of the nasal skeleton, including the resection of some hard tissue. If the resection is performed unevenly on the right and left sides, there will be curvature of the nose and asymmetry after rhinoplasty.
As already mentioned, the development of an aesthetic complication after rhinoplasty is not always the result of the surgeon's error or the patient's irresponsibility in the rehabilitation period. Below are the causes of complications, which can be called the result of unfavorable circumstances:
graft extrusion. Tissue or implant grafting is used in many rhinosurgical surgeries. Unfortunately, the implant can move during the recovery period. The result will be a curvature of the nose or its asymmetry.
Resorption of the cartilage graft. A cartilage graft is living tissue exposed to the action of body enzymes. In the event of an unfavorable course of regenerative processes, part of the transplant can be destroyed by enzymes. The result is a "crooked nose, " or violation of the symmetry of the right and left halves.
Distortion of the cartilage graft. Distortion is a Latin word that translates to "curvature". Cartilage is elastic and flexible. Under pressure from other anatomical formations of the nasal skeleton, as well as from severe tissue edema, it can deform. This results in a deviated nose.
Violation of the integration of bones and cartilage of the back. During the operation, the connection between the bone and cartilage elements that form the bridge of the nose is broken. If proper integration of these structures does not occur during the rehabilitation period, gradual deformation will develop.
Excessive callus growth. The process of bone regeneration includes an intermediate stage of formation of bone callus, which is later replaced by full bone tissue. If the regenerative processes are too active, an excess of tissue forms at this point, which is manifested externally by a hump, a "bump" or asymmetry. There may be a deviated septum.
Hypertrophy of the scar tissue in the area of the apex. Due to the abnormal growth of scar tissue in the area of the tip of the nose, more precisely directly above the tip of the nose, excess tissue forms, which manifests itself externally as a coracoid deformity.
It remains to list some mistakes of the patient's rehabilitation period, which can lead to curvature and deformation of the nose:
- Wear glasses;
- displacement or self-removal of the patch fixative;
- Self-removal of rhinological splints (tampons in the nasal passages);
- accidental mechanical damage to the nose;
- sneezing with closed mouth;
- blow off
- alcohol consumption, smoking during rehabilitation;
- early resumption of sport.
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 fraught with complications. It's not that there are natural difficulties that are inevitable with any surgery, they pass after a period of time. These include: hematoma, bruising under the eyes, difficulty breathing, impaired sense of smell, temporary asymmetry, numbness.
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 final result is known only after a year, sometimes a little later. No doctor can predict it with certainty.
Complications after rhinoplasty
Complications after rhinoplasty can be classified as follows:
- esthetic,
- functional,
- mentally.
The last point is a bit apart, it follows from the two previous ones. However, sometimes it is given special attention, since it can proceed in a complex form, which depends on the level of the main complication and the psyche of each individual person. Likewise, functional complications in point 1 (aesthetics) can leave their mark, since all functional disorders also have external manifestations.
Consequences of rhinoplasty
frequency of occurrence
Complications arise throughout the operation and. They can be divided into 4 periods:
- Severe blood loss occurs more frequently directly during the operation,
- Immediately after the operation
- During the recovery period
- At the end of the rehabilitation period.
In addition to bleeding, complications include gross scars, adhesions, bone damage, airway obstruction, bruising and.
The expected and inevitable complications pass in 2 weeks. The danger is "unexpected" complications:
- Infection,
- tissue necrosis (skin, cartilage, bones),
- Seam divergence (easily eliminated).
Let's take a closer look at some of the complications.
species
edema
Swelling after rhinoplasty is a natural phenomenon. It would be wrong to speak of a real complication. Edema occurs in the operated area and under the eyes. Immediately after the operation, it is clearly visible. Will fall off in about two weeks. Swelling can last longer - up to six months. The reasons for the duration and quality of edema are strictly individual.
callus
If an injury to bone structures is required during the operation, the formation of a bone callus cannot be avoided. Your presence is the norm. One complication is the hypergrowth of bone tissue. Such a complication leads to a deformation of the nose, a violation of harmony.
Callus formation after rhinoplasty is a natural process to protect 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 bone tissue completely replaces soft tissues. The task of the surgeon is to prevent the intensity of this process.
Nose turns to the side
What was the purpose of the operation? If the reason was the elimination of the curvature of the nose, then the immediate result after the operation may please, the curvature disappears. However, at the end of the rehabilitation period, it can return because nasal tissue has no "memory". In this case, correction is required.
But swelling can also be the cause of a curvature. In this case, it is a natural complication that will be nullified at some point. Individual characteristics also play a role here. For someone, the deadline is 2 weeks, for another - a month, two, three.
In any case, such a curvature will be the norm. You can talk about it no earlier than a year if the problem persists.
nose not breathing
Violation of 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 only necessary if treatment fails.
With delayed complications (which occur after a long time), narrowing of the nasal passages can occur, which also causes difficulty in nasal breathing. This causes an uncomfortable feeling. In this case, the intervention of reconstructive surgery is required, since the cause of the complication is an increase in the amount of tissue on the inside of the nostril. It must be cut off.
hanging nose
This complication is called "hollow". The reason is the deformity due to fracture of the skull at the time of osteotomy, when it is not possible to center the fragments. The reason may be excessive sealing in the nose. Corrected only by repeated osteotomy.
Bad smell
An unpleasant odor in the nose after rhinoplasty is a natural phenomenon. It is not a complication and is acceptable throughout the first year after surgery.
temperature
After rhinoplasty, body temperature rises, which is normal. It takes no more than 3 days. In other cases (higher temperature, longer time) you should consult your doctor.
Other Complications
After the operation, the sense of smell is disturbed, which is quite natural. It's gradually getting back to normal. have a reddish or pink hue. Not only that, they tend to grow.
To eliminate them, all the requirements of the surgeon that are necessary during the recovery period should be met:
- treatment of sutures with the drugs prescribed by the doctor,
- Keloid scars require corticosteroids
- In some cases, corrective surgery may be prescribed.
Rhinoplasty is a serious, albeit fairly common, operation. Not only the experience of the specialist is decisive, but also your attitude towards the procedure. Negligence is not acceptable. You must have full trust in the surgeon and meet all the necessary requirements. Of course, the qualification of a specialist should not be questioned.
It's no secret that facial imperfections create a biased public perception that's important to people's self-esteem. Loss of attractiveness often leads to 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
Crooked nose is a general term used to define deformities associated with the deviation of the nasal pyramid relative to the mid-sagittal axis of the face, which runs through the center and divides the face into equal parts.
The patient's history includes traumatic injuries and congenital nasal deformities. Of all facial bones, the nasal bones are the most fractured, and these fractures often lead to aesthetic changes and nasal deviations. The curvature of the nasal septum is usually caused by its deviation, different variants of the curvature of the nasal septum allow for alignment.
A deviated nose can also result from asymmetrical growth of nasal structures or rhinoplasty. A nose with recessed features can appear crooked, although the structure doesn't actually deviate from the central axis. Sometimes malformations of the nasal septum occur during childbirth.
How is the alignment done?
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.
Crooked nose, this is the result of complex deformations of structural elements, including:
- nasal septum;
- upper and lower lateral cartilages;
- bones of the nasal pyramid.
Which leads to functional and cosmetic disorders. Excessive deviation of the nasal septum is considered to be the main cause of the curvature.
septal curvature
Deformations fall into two main categories. They include:
- cartilage abnormalities (lower 2/3);
- Bone abnormalities (top 1/3 of the nose).
Bone deviations in the upper 1/3 are usually corrected by a controlled nasal bone fracture or osteotomy and midline displacement. The goal of an osteotomy is to create mobile bone segments that can be restored to a favorable anatomical alignment and position. The risk of bone displacement to the original curved position is small.
Deviations of the nasal cartilages are often among the most complex deformities that are difficult to correct. Many lower 1/3 deviations involve displacements of the main nasal septum. To correct it, its base is leveled, including correction of the nasal bones and nasal septum. If the cartilage portion is severely deformed, additional transplantation of cartilage material may be necessary.
Correction of rhinoplasty
One of the most difficult rhinoplasty tasks is correcting a crooked nose. The curvature may remain after the first rhinoplasty or even after the second surgery.
The process after a rhinoplasty can be quite unpredictable. As a general rule, revision rhinoplasty to correct post-operative deformities may be required in approximately 3-6% of cases, but in cases of nasal deformities, this number can be much higher.
A number of nuances complicate the correction of the curvature of the structures of the nose:
- The main factor is that the curvature of bone and cartilage tissue has a certain amount of memory. Cartilage constantly tends to return to its original position. There are natural tensions in the soft tissues and cartilage structures that affect the nose even after rhinoplasty, making it difficult to achieve a good result after the operation. Thus, the structures of the nose tend to drift to their original position.
- Another factor that can cause the nose to return to its original curved shape is incomplete correction of the septum deviation. In addition, with a congenital deviated nose, the deviation of the septum can occur with facial asymmetry. This means that it can be difficult to find the true midsagittal plane to try to place a new nose position in.
Why is the nose crooked after rhinoplasty?
We must not forget that getting a completely straight nose is quite a challenge. After a significant improvement, it may have a slight asymmetry or residual deviation. A slight curvature is considered acceptable. The most difficult task is to make the front view symmetrical, because incident light casts shadows and the nose can appear asymmetrical.
There are many reasons why the nasal septum may be crooked after rhinoplasty. This may be the result of asymmetrical edema and/or soft tissue nasal bone. Healing after rhinoplasty is a dynamic process.
For the first time a few weeks after the operation, the swelling of the structures can be asymmetrical. This may create the illusion that the septum is curved.
The intensity of swelling after surgery can also vary in different parts of the nasal structure. Many swellings after rhinoplasty go away within a month. It will take much longer to eliminate the last 25% of the swelling, over a year or more after the rhinoplasty. The final effect of the operation can take 20-36 months.
Swelling after rhinoplasty is highly dependent on the type of nasal structures operated on, surgical approach, postoperative care and skin thickness. If an external incision is made near the base of the nose after an open rhinoplasty, the swelling will be longer and larger than with a closed rhinoplasty. People with thicker skin get more swelling.
Swelling occurs under the influence of gravity, which means that the upper part of the back will already become the first. In general, the nose shows some swelling all year round.
When the septum is aligned and held well, the nose will appear straight at first, and then tend to deviate over time. Swelling initially hides deviations, which can increase over time.
Revision rhinoplasty aims to correct defects that were not addressed in the initial surgery, such as: B. A septum deviation that distorts the appearance, or that results from improper rhinoplasty or poor healing.
Rhinoplasty inevitably includes two different interventions, on the left and right side of the nasal septum. Asymmetry can occur due to uneven correction of the sides, different intensity of scar formation during healing. Curvature can occur as a result of excessive cartilage removal on one side. A deviated septum can be corrected. A revision rhinoplasty may involve a cartilage transplant.
The full result of rhinoplasty can be observed after a year of observation. If the curvature of the nose persists after the operation, it is necessary to wait 5-10 months before proceeding with the revision rhinoplasty. Very early surgery can lead to new problems.