Revision rhinoplasty is an operation aimed at correcting unsuccessful results after already performed plastic surgeries to correct the nose. Revision rhinoplasty is the only way out for patients who, after rhinoplasty, have 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 hump nose turns into a "saddle" nose - with a too low back of the nose, as the surgeon removed too much bone or cartilage tissue.
It also happens that the reason for the patient's dissatisfaction may 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 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 natural correct shape of the nose, restore the functions of nasal breathing, and restore the patient's self-confidence and attractiveness.
Secondary rhinoplasty - approaches and methods
As a rule, patients who applied for secondary rhinoplasty are disappointed, wary people who have little confidence in the successful outcome of the 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 such patients to undergo an MRI before undergoing revision rhinoplasty – the analysis of these data allows us to create an objective picture of the internal structures of the nose, outline 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 crooked, the tip of the nose is not elegant enough, the back of the nose has bulges or hollows. Sometimes nose contouring may be recommended to correct minor defects. But, unfortunately, major flaws 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 botulinum toxin-containing drugs to rotate the tip of the nose. But more often, surgical correction is still required, 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 alae with correction of the position of the nasal septum and alar cartilages of the nose.
It is possible to speak about the possibility of re-rhinoplasty only after 6-8 months after the first rhinoplasty. This is due, firstly, to the fact that the final restoration of 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 over time. In addition, an operation, even a minimally invasive one, always injures tissues and nerve endings to a greater or lesser extent - therefore, before performing a second operation, one should wait for complete healing.
The latest techniques for rhinoplasty using micro-instruments are such that the consequences of any unsuccessful operation can be eliminated. The main thing is to seek help from a qualified specialist.
Causes of complications: surgeon's mistake or patient's fault?
It would be wrong to shift 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 one cannot blame anyone in such a situation.
And yet, the mistakes of plastic surgeons can really cause nose deformity after rhinoplasty. Therefore, the choice of a specialist and a clinic should be given special importance. You can not choose a doctor at "low prices", health and beauty can be entrusted only to an experienced master of his craft. Otherwise, it is likely that you will have to pay twice.
Listed below are some of the possible mistakes plastic surgeons make and the aesthetic complications of rhinoplasty they can lead to:
Improper placement of grafts. Transplantation of autologous material (cartilage tissue of the patient) or the installation of synthetic implants is used quite often in nose remodeling. If the implants are located asymmetrically, after tissue healing, the patient will see a "crooked nose" and a pronounced asymmetry.
asymmetrical correction. Many operations of rhinosurgery involve intervention on the bone and cartilage elements of the nasal skeleton, including resection of a part of the hard tissue. If the resection on the right and left sides 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 surgeon's mistake or the patient's irresponsibility at the rehabilitation stage. The following are the causes of complications that can be called a consequence of an unfavorable set of circumstances:
transplant extrusion. Tissue or implant grafting is used in many rhinosurgical operations. 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 a living tissue that is exposed to the action of body enzymes. With an unfavorable course of regenerative processes, a 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 strong tissue edema, it can become deformed. 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 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, stepwise deformation develops.
Excessive growth of callus. The process of bone regeneration includes an intermediate stage of the formation of a bone callus, which will later be replaced by a full-fledged bone tissue. If the regenerative processes are too active, an excess of tissues is formed in this place, which is externally manifested by a hump, a "bump" or asymmetry. There may be a deviated septum.
Hypertrophy of scar tissue in the area of the tip. 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, an excess of tissue is formed, which externally manifests itself as a coracoid deformity.
It remains to list some mistakes of the rehabilitation period on the part of the patient, which can lead to a curvature and deformation of the nose:
- wearing glasses;
- displacement or self-removal of the plaster fixative;
- self-removal of rhinological splints (tampons in the nasal passages);
- accidental mechanical damage to the nose;
- sneezing with a closed mouth;
- blowing off;
- drinking alcohol, 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 fraught with complications. It's not that there are natural difficulties that are inevitable in the field of any operation, they pass after a certain time. 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 becomes 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,
- Psychological.
The last point stands somewhat apart, it follows from the two previous ones. However, sometimes it is singled out especially, 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 can leave their mark on point 1 (aesthetic), since all functional disorders also have external manifestations.
Consequences of rhinoplasty
Frequency of occurrence
Complications arise throughout the operating and. They can be divided into 4 time periods:
- Directly during the operation, more 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 scars, adhesions, bone damage, airway obstruction, bruising, and.
Complications expected and inevitable pass in 2 weeks. The danger is "unexpected" complications:
- infection,
- Tissue necrosis (skin, cartilage, bones),
- Divergence of seams (easily eliminated).
Let's look at some of the complications in more detail.
Kinds
Edema
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. Immediately after the operation, it is clearly visible. Falls off in about two weeks. Puffiness may be present for 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, then the formation of a bone callus cannot be avoided. Her presence is the norm. A complication is hypergrowth of bone tissue. Such a complication entails a deformation of the nose, a violation of harmony.
The formation of callus 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 form, and finally, bone tissue completely replaces soft tissues. The task of the surgeon is to prevent the intensity of this process.
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 can please, the curvature disappears. However, by the end of the rehabilitation period, it may return, since the nasal tissues do not have a "memory". In this case, a correction is required.
But swelling can also be the cause of curvature. In this case, it is a natural complication that will come to naught at a certain time. Here again individual characteristics play a role. For someone, the period will be 2 weeks, for another - a month, two, three.
In any case, such curvature will be the norm. You can talk about not earlier than a year, if the problem remains.
Nose not breathing
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 nasal breathing. This causes a feeling of discomfort. 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 needs to be cut off.
Sagging nose
This complication is called "hollow". The reason is the deformity due to 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 osteotomy.
Bad smell
An unpleasant smell in the nose after rhinoplasty is a natural phenomenon. It is not a complication and is acceptable during the entire first year after the operation.
Temperature
After rhinoplasty, body temperature rises, which is normal. It 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. Gradually it will return to normal. have a reddish or pink tint. Not only that, they tend to grow.
To eliminate them, all the requirements of the surgeon, which 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, although quite common, operation. It is not only the experience of the specialist that matters, but also your attitude to the procedure. Negligence is unacceptable. You must fully trust the surgeon, fulfill all the necessary requirements. Of course, the qualifications of a specialist should not be in doubt.
It's no secret that facial imperfections create a prejudiced public perception that 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 that reduce symmetry reduce the quality of life and self-esteem of patients.
Causes of curvature
Crooked nose is a generalized term used to define deformities associated with the deviation of the nasal pyramid relative to 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 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 make it possible to align it.
A deviated nose can also result from asymmetric growth of nasal structures or rhinoplasty. A nose with recessed features may appear crooked, although the structure does not actually deviate from the median axis. Sometimes deformities of the nasal septum occur during childbirth.
How is 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, alas, the level of revision rhinoplasty is quite high.
Crooked nose, this result of complex deformations of structural elements, which includes:
- nasal septum;
- upper and lower lateral cartilages;
- bones of the nasal pyramid.
Which 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:
- cartilage deviations (lower 2/3);
- bone deviations (upper 1/3 of the nose).
Deviations of the bone in the upper 1/3 are usually corrected with a controlled fracture of the nasal bones or osteotomy and displacement to the midline. The goal of an 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 original curved position is low.
Deviations of the nasal cartilages are most 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 the correction of the nasal bones and the nasal septum. With a significant curvature of the cartilage part, additional transplantation of cartilage material may be necessary.
Rhinoplasty correction
One of the most difficult tasks of rhinoplasty is correcting a crooked nose. 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 deformities after surgery may be required in approximately 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. Natural tension exists in soft tissues and cartilage 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 towards 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 deviated septum. In addition, 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 mid-sagittal plane in order to try to place a new nose position in it.
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, as the incident lighting casts shadows and the nose can look asymmetrical.
There are many reasons why the nasal septum may be crooked after rhinoplasty. This is possibly 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 couple of weeks after the operation, the swelling of the structures may be asymmetrical. This will possibly create the illusion that the septum is curved.
The intensity of swelling after surgery may also fluctuate in different parts of the nasal structure. Many swelling after rhinoplasty disappears within a month. Much longer will be needed to resolve the last 25% swelling, over a year or longer after rhinoplasty. The final effect of the operation may take 20-36 months.
Puffiness after rhinoplasty depends greatly on the nature of the operated structures of the nose, 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 greater than in closed rhinoplasty. People with thick skin will get more swelling.
Swelling occurs under the influence of gravity, which means that the upper part of the back becomes already the first. In general, the nose has a certain degree of swelling throughout the year.
When the septum is aligned and well held, the nose initially looks straighter, and then, most often, deviates after a certain time. At first, swelling will hide deviations, which may become more pronounced over time.
Revision rhinoplasty is aimed at correcting defects that were not considered at the first operation, for example, a deviated septum that makes the appearance distorted, or resulting from incorrect rhinoplasty or poor healing.
Rhinoplasty necessarily includes 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 scarring during healing. Curvature may appear as a result of excessive removal of cartilage on one side. A deviated septum can be corrected. Revision rhinoplasty may involve cartilage transplantation.
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 revision rhinoplasty. Very early surgery can lead to new problems.