Revision rhinoplasty is an operation to correct unsuccessful results after plastic surgeries previously performed to correct the nose. Revision rhinoplasty is the only way out for patients who, after rhinoplasty, present significant visible deformities of the external nose or its functional impairment. So, sometimes after rhinoplasty, patients notice an unnatural divergence of the wings of the nose or their noticeable asymmetry. Sometimes a bump-shaped nose turns into a "saddle" nose - with a nose that is too low, because the surgeon has removed too much bone or cartilage tissue.
It also happens that the reason for the patient's dissatisfaction can be associated not with the technique of the operation, but with 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 predisposition to the unpredictable growth of scar tissue or as a result of an incorrectly performed operation. Revision rhinoplasty allows you to solve such problems and restore the correct natural shape of the nose, restore the functions of nasal breathing, and restore the patient's self-confidence and attractiveness.
Secondary rhinoplasty - approaches and methods
Typically, patients who have requested secondary rhinoplasty are disappointed and suspicious people who have little confidence in the success of a second operation. During the consultation, we try to collect a thorough medical history, study photographs before rhinoplasty, in order to understand what manipulations were performed and on what structures of the nose. We recommend that these patients undergo an MRI before undergoing revision rhinoplasty - analyzing this data allows us to create an objective picture of the internal structures of the nose, sketch an operation plan and agree with the patientthe possibility of a 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 bulges or depressions. Sometimes nose reshaping may be recommended to correct minor flaws. But, unfortunately, major defects can only be corrected during a second operation.
Sometimes the situation makes it possible to do without a second operation, to use the possibilities of drug therapy, 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 containing botulinum toxin to rotate the tip of the nose. But most often, surgical correction is still necessary, for example, transplantation of one's own cartilage tissue to fill the saddle-shaped depression or rotation of the nasal tip and restoration of the shape of the nasal wings with correction of theposition of the nasal septum. and alar cartilages of the nose.
It is possible to talk about the possibility of a new rhinoplasty only 6-8 months after the first rhinoplasty. This is due, on the one hand, to the fact that the final restoration of tissues takes a long time, a few months after the operation the shape of the nose changes, and the "defects" that the patient observes immediately after plastic surgery may disappearcompletely in time. In addition, an operation, even minimally invasive, always more or less injures tissues and nerve endings - therefore, before performing a second operation, one should wait for complete recovery.
The latest rhinoplasty techniques using micro-instruments make it possible to eliminate the consequences of any unsuccessful operation. The main thing is to seek help from a qualified specialist.
Causes of complications: surgeon's error or patient's fault?
It would be a mistake to put all the blame on the shoulders of the patient, 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 a specialist, and the patient's inattentive attitude 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 no one can be blamed in such a situation.
And yet, the errors of plastic surgeons can actually cause a deformed nose after rhinoplasty. Therefore, the choice of a specialist and a clinic should be of particular importance. You cannot choose a doctor with "low prices", health and beauty can only be entrusted to a master who is experienced in his profession. Otherwise, you are likely to have to pay twice.
Here are some of the possible mistakes made by plastic surgeons and the cosmetic complications of rhinoplasty they can cause:
Poor placement of grafts. Transplantation of autologous material (cartilaginous tissue from the patient) or placement of synthetic implants is quite often used in nose reshaping. If the implants are located asymmetrically, after tissue healing, the patient will see a "crooked nose" and pronounced asymmetry.
asymmetrical correction. Many rhinosurgery operations involve intervention on the bony and cartilaginous elements of the nasal skeleton, including the resection of part of the hard tissues. If the resection of the right and left sides is carried out unevenly, after rhinoplasty there is a curvature of the nose and asymmetry.
As already mentioned, the development of a cosmetic complication after rhinoplasty is not always the result of a surgeon's error or the irresponsibility of the patient at the stage of rehabilitation. The following are the causes of complications that can be termed as a consequence of a set of adverse circumstances:
graft extrusion. Tissue or implant grafting 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 graft is living tissue that is exposed to the action of the body's enzymes. With an unfavorable course of regeneration 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 to "curvature". Cartilage is elastic and flexible. Under pressure from other anatomical formations of the nasal skeleton, as well as due to strong tissue edema, it can deform. This will result in a deviated nose.
Violation of the integration of bone and cartilage of the back. During the operation, the connection between the bony and cartilaginous elements that form the back of the nose is broken. If during the rehabilitation period there is no proper integration of these structures, a gradual deformation develops.
Excessive callus growth. The process of bone regeneration includes an intermediate stage of the formation of a bone callus, which will then be replaced by full-fledged bone tissue. If the regeneration processes are too active, excess tissue forms in this place, which is externally manifested as a bump, "hump" or asymmetry. There may be a deviated septum.
Hypertrophy of scar tissue in the tip area. As a result of the abnormal growth of scar tissue in the region of the tip of the nose, more precisely, directly above the tip, excess tissue is formed, which is externally manifested as a coracoid deformity.
It remains to list some errors of the rehabilitation period on the part of the patient, which can lead to curvature and deformation of the nose:
- wear glasses;
- displacement or self-removal of plaster fixer;
- self-removal of rhinological splints (stamps in the nasal passages);
- accidental mechanical damage to the nose;
- sneeze with the mouth closed;
- blowing;
- drinking alcohol, smoking during rehabilitation;
- early return to sport.
The consequences of such an operation
Rhinoplasty is an expensive, complicated and sometimes necessary operation. What do you need to know about consequences?
When deciding on such an operation, one should be aware that the procedure is fraught with complications. It is not that there are inevitable natural difficulties in the field of any operation, they pass after a while. These include: hematomas, bruises 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 behavior during the recovery period,
- Individual characteristics of a person.
The final result is only known after a year, sometimes a little later. No doctor can predict with certainty.
Complications after rhinoplasty
Complications after rhinoplasty can be classified as follows:
- aesthetic,
- functional,
- Psychological.
The last point is a bit different, it stems from the two previous ones. However, sometimes it is especially distinguished, because it can proceed in a complex form, which depends on the level of the main complication and the psyche of each person. Similarly, functional complications can mark point 1 (aesthetics), because 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:
- Directly during the operation, most often it is severe blood loss,
- Immediately after the operation
- During the recovery period
- At the end of the rehabilitation period.
In addition to bleeding, complications include rough scarring, 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 take a closer look at some of the complications.
Kinds
Edema
Swelling after rhinoplasty is a natural phenomenon. It would be wrong to speak of a real complication. Edema appears in the operated area and under the eyes. Immediately after the operation, it is clearly visible. Falls in about two weeks. Puffiness can be present longer - up to six months. The reasons for the duration and quality of edema are strictly individual.
callus
If during the operation a violation of bone structures is required, the formation of a bone callus cannot be avoided. His presence is the norm. A complication is the overgrowth of bone tissue. Such a complication leads to a deformation of the nose, a violation of harmony.
The formation of calluses after rhinoplasty is a natural process of protecting the body against external influences. This is the process of bone regeneration. First, new connective tissues appear, then fine bone fibers are formed, and finally, bone tissue completely replaces soft tissue. The task of the surgeon is to prevent the intensity of this process.
The nose twists 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 may return, since the nasal tissues have no "memory". In this case, a correction is necessary.
But swelling can also be the cause of curvature. In this case, it is a natural complication that will collapse at some point. Again, individual characteristics play a role. For someone, the period will be 2 weeks, for another - a month, two, three.
In any case, such a curvature will be the norm. You can talk at the earliest one year, if the problem persists.
Nose that does not breathe
Violation of nasal breathing 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 only necessary if treatment fails.
With delayed complications (which occur after a long time), there may be a narrowing of the nasal passages, which also leads to difficulty in breathing through the nose. This causes a feeling of discomfort. In this case, the intervention of reconstructive surgery is necessary, since the cause of the complication is an increase in the amount of tissue inside the nostril. It must be cut.
drooping nose
This complication is called "hollow". The reason for this is the deformation due to the fracture of the cranial bone at the time of the osteotomy, when it is not possible to center the fragments. The reason may be an excessive seal in the nose. Corrected only by repeated osteotomies.
Bad smell
An unpleasant smell in the nose after rhinoplasty is a natural phenomenon. It is not a complication and is acceptable for the entire first year after the operation.
Temperature
After rhinoplasty, the body temperature increases, which is normal. It does not last more than 3 days. In other cases (higher temperature, prolonged duration), you should consult your doctor.
Other Complications
After the operation, the sense of smell is disturbed, which is quite natural. Gradually it will return to normal. have a reddish or pink tint. Not only that, they tend to grow taller.
To eliminate them, all the requirements of the surgeon, necessary during the recovery period, must be fulfilled:
- Treatment of sutures with drugs prescribed by the doctor,
- Keloid scars require corticosteroids
- In some cases, reconstructive surgery may be prescribed.
Rhinoplasty is a serious operation, although quite common. What matters is not only the experience of the specialist, but also your attitude to the procedure. Negligence is unacceptable. You must fully trust the surgeon, fulfill all the necessary conditions. Of course, the qualification of a specialist should not be in doubt.
It's no secret that facial imperfections create a detrimental public perception that is important to people's self-esteem. Often the loss of attractiveness causes a state of depression. In other words, it makes sense that facial deformities that reduce symmetry reduce patients' quality of life and self-esteem.
Curvature causes
Crooked nose is a general term used to define deformities related to the deviation of the nasal pyramid from the facial mid-sagittal axis passing through the center and dividing the face into equal parts.
The patient's history includes traumatic injuries and congenital nasal deformities. Of all the facial bones, the nasal bones are the most fractured, and these fractures often lead to cosmetic 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 make it possible to align it.
A deviated nose can also result from an asymmetrical growth of the nasal structures or from rhinoplasty. A nose with recessed features may appear crooked, although the structure does not actually deviate from the midline. Sometimes deformities 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 aesthetic 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.
Crooked nose, this result of complex deformations of structural elements, which includes:
- septum;
- upper and lower lateral cartilages;
- nasal pyramid bone.
This leads to functional and cosmetic disorders. The main cause of curvature is considered to be excessive deviation of the nasal septum.
Septal curvature
Deformations fall into two main categories. They include:
- cartilaginous deviations (2/3 lower);
- bony 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 purpose of an osteotomy is to create movable bone segments that can be returned to a favorable anatomical orientation and position. The risk of displacement of the bones in the original curved position is low.
The deviations of the nasal cartilages are most often among the most complex and difficult to correct deformities. Many deviations below 1/3 involve displacements of the main nasal septum. To correct it, its base is leveled, including the correction of the nasal bones and the nasal septum. With a significant curvature of the cartilaginous part, additional transplantation of cartilaginous material may be required.
Rhinoplasty correction
One of the most difficult tasks of rhinoplasty is to correct 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. Typically, revision rhinoplasty to correct deformities after surgery may be needed in about 3-6% of cases, but in cases of nasal deformity this figure can 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. A natural tension exists in the soft tissues and cartilaginous structures, continuing 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 drift back to their original position.
- Another factor that can cause the nose to return to its original curved shape is incomplete correction of the deviated septum. Also, with a congenital deviated nose, the deviation of the septum can pass in conditions of facial asymmetry. This means that it can be difficult to find the true midsagittal plane in order to try to place a new nose position there.
Why is the nose crooked after rhinoplasty?
It should be remembered that getting a completely straight nose is quite a challenge. After significant improvement, there may be slight residual asymmetry or deviation. A slight curvature is considered acceptable. The most difficult task is to make the frontal view symmetrical, since the incident lighting casts shadows and the nose can appear asymmetrical.
There are many reasons why the nasal septum may be twisted after rhinoplasty. This may be the result of a drift of asymmetric edema and/or soft tissue nasal bones. 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 fluctuate in different parts of the nasal structure. Many swellings after rhinoplasty disappear within a month. It will take much longer to resolve the last 25 swellings, over a year or more after rhinoplasty. The final effect of the operation may take 20-36 months.
Puffiness after rhinoplasty depends a lot 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 more prominent than in closed rhinoplasty. People with thick skin will have more swelling.
Swelling occurs under the influence of gravity, which means that the upper back already becomes the first. In general, the nose has some degree of swelling throughout the year.
When the septum is aligned and well held, the nose initially appears straighter, then, more often than not, deviates after a while. At first, the swelling will mask the deviations, which may increase over time.
Revision rhinoplasty aims to correct defects that were not taken into account during the first operation, for example, a deviated septum which makes the appearance distorted, or resulting from incorrect rhinoplasty or poor healing.
Rhinoplasty necessarily includes two different procedures, on the left side and on the right side of the nasal septum. Asymmetry can occur due to uneven correction of the sides, different intensity of scarring during healing. Curvature may appear as a result of excessive cartilage removal on one side. A deviated septum can be corrected. Revision rhinoplasty may involve cartilage grafting.
The full result of rhinoplasty can be seen after one year of observation. If the curvature of the nose persists after the operation, it is necessary to wait 5 to 10 months before carrying out a revision rhinoplasty. Very early surgery can lead to new problems.