Revision rhinoplasty is an operation aimed at correcting unsuccessful results after plastic surgery that has already been performed 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 obvious asymmetry. Sometimes a hunchbacked nose turns into a "saddle" nose - with a too low back of the nose, as the surgeon has removed too much bone or cartilage.
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 appears more convex and visually elongates 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 have applied for secondary rhinoplasty are disappointed, distrustful people who have little confidence in the success of a second operation. During the consultation, an attempt is made to collect a thorough medical history, to study photographs before rhinoplasty, to understand which manipulations were performed and on which structures of the nose. We advise these 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 operating plan and agree with the patient on the 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. Nose contouring may sometimes be recommended to correct minor defects. But, unfortunately, the main flaws can only be corrected during a second operation.
Sometimes the situation makes it possible to do without a second intervention, to use the possibilities of drug therapy, such as, for example, in the case of excessively convex 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 a 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 the position of the nasal septum and alar cartilages of the nose .
It is possible to talk about the possibility of rhinoplasty only after 6-8 months from the first rhinoplasty. This is due, in the first place, to the fact that the definitive restoration of the tissues takes a long time, within a few months from the operation the shape of the nose changes and the "defects" that the patient observes immediately after the plastic surgery can completely disappear. in time. Furthermore, an operation, even minimally invasive, always damages the tissues and nerve endings to a greater or lesser extent, therefore, before performing a second operation, it is necessary to wait for complete healing.
The latest rhinoplasty techniques with the use of micro-tools are such that they can eliminate the consequences of any unsuccessful operation. The main thing is to seek the help of a qualified specialist.
Causes of complications: surgeon's mistake or 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 whole plastic surgeon. The reason for the formation of a defect can be both the poor qualification of a specialist and the careless 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 no one can be blamed in such a situation.
Still, plastic surgeons' mistakes can really cause nose deformity after rhinoplasty. Therefore, particular importance should be given to the choice of a specialist and a clinic. You cannot choose a doctor at "low prices", health and beauty can only be entrusted to an expert master of his craft. Otherwise, chances are you will have to pay twice.
Listed below are some of the possible mistakes made by plastic surgeons and the aesthetic complications of rhinoplasty that can lead to:
Improper positioning of the couplings. Transplanting autologous material (patient's cartilage tissue) or installing synthetic implants is used quite often in nose reshaping. If the implants are located asymmetrically, after tissue healing, the patient will see a "crooked nose" and pronounced asymmetry.
asymmetric correction. Many kidney surgery operations involve surgery on the bone and cartilage elements of the nasal skeleton, including the resection of a portion of the hard tissue. If the resection on the right and left sides is performed unevenly, then 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 an error by the surgeon or the irresponsibility of the patient undergoing rehabilitation. 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 kidney surgery 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 living tissue exposed to the action of the body's enzymes. With an unfavorable course of 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 the pressure of 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 the bone and cartilage of the back. During the operation, the connection between the bone and the cartilaginous elements that form the back of the nose is interrupted. If during the rehabilitation period there is no proper integration of these structures, a gradual deformation develops.
Overgrowth of the callus. The process of bone regeneration includes an intermediate stage in the formation of a callus, which will subsequently be replaced by a full-fledged bone tissue. If the regenerative processes are too active, an excess of tissue forms in this place, which externally manifests itself as a hump, a "bump" or an asymmetry. There may be a deviated septum.
Hypertrophy of scar tissue in the toe 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, an excess of tissue is formed, which externally manifests itself as a coracoid deformity.
It remains to list some errors of the rehabilitation period by 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 rhinlogic splints (tampons in the nasal passages);
- accidental mechanical damage to the nose;
- sneezing with your mouth closed;
- blow away;
- drinking alcohol, smoking during rehabilitation;
- early resumption of sports activities.
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 is not that there are natural difficulties that are inevitable on the field of any operation, they pass after a certain time. These include: bruising, bruising under the eyes, difficulty breathing, altered 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 known only after a year, sometimes shortly after. No doctor can predict for sure.
Complications after rhinoplasty
Complications after rhinoplasty can be classified as:
- aesthetic,
- functional,
- Psychological.
The last point is somewhat detached, it follows from the previous two. However, it is sometimes particularly spotted, as 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 during the operation and. They can be divided into 4 time periods:
- Directly during the operation, more often it comes to 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, and bruising.
Expected and inevitable complications pass in 2 weeks. The danger is "unexpected" complications:
- infection,
- Tissue necrosis (skin, cartilage, bones),
- Divergence of the seams (easily eliminated).
Let's take a look at some of the complications in more detail.
types
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. It falls off in about two weeks. The swelling 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 there is a need for a violation of bone structures, it is not possible to avoid the formation of a callus. Its presence is the norm. One complication is the overgrowth of bone tissue. Such a complication entails a deformation 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 bone regeneration process. First, new connective tissues appear, 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 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, by the end of the rehabilitation period, it may return, as the nasal tissues have no "memory". In this case a correction is required.
But swelling can also be the cause of the curvature. In this case, it is a natural complication that at a certain moment will fail. Here too, 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 speak no earlier than a 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 attention. Surgery is only needed if treatment fails.
With delayed complications (occurring 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, reconstructive surgery is required, since the cause of the complication is an increase in the amount of tissue inside the nostril. It needs to be cut.
Saggy nose
This complication is called "cava". The reason is the deformity 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 osteotomy.
Stink
An unpleasant smell in the nose 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 lasts no more than 3 days. In other cases (higher temperature, prolonged time), it is necessary to consult the doctor.
Other complications
After the operation, the sense of smell is disturbed, which is quite natural. Slowly it will 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 must be met, which are necessary during the recovery period:
- Treatment of sutures with medications prescribed by the doctor,
- Keloid scars require corticosteroids
- In some cases, corrective surgery may be prescribed.
Rhinoplasty is a serious operation, albeit quite common. What matters is not only the experience of the specialist, but also your attitude to the procedure. Neglect is unacceptable. You need to completely trust the surgeon, meet all the necessary requirements. Of course, the qualification of a specialist should not be in doubt.
It's no secret that facial blemishes create a biased public perception that is important to people's self-esteem. Often the loss of attractiveness leads to a state of depression. That is, it makes sense 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 the deformities associated with the deviation of the nasal pyramid with respect to the facial mid-sagittal axis which passes through the center and divides 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 cosmetic changes and nasal deviations. As a rule, the curvature of the nasal septum occurs due to its deviation, several variants of the curvature of the septum allow it to be aligned.
A deviated nose can also result from asymmetrical growth of the nasal structures or from rhinoplasty. A nose with sunken features may appear crooked, although the structure does not actually deviate from the median axis. Sometimes nasal septal deformities occur during childbirth.
How does alignment happen?
Today, rhinoplasty is one of the main cosmetic surgery procedures 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, unfortunately, the level of revision rhinoplasty is quite high.
Crooked nose, this result of complex deformations of the structural elements, which includes:
- Nasal septum;
- upper and lower lateral cartilages;
- bones of the nasal pyramid.
Which leads to functional and aesthetic disorders. The main cause of curvature is considered to be excessive deviation of the nasal septum.
Curvature of the septum
Deformations are divided into two main categories. They include:
- deviations of the cartilage (lower 2/3);
- bony deviations (upper 1/3 of the nose).
Bone deviations in the upper third are usually corrected with a controlled fracture of the nasal bones or with an osteotomy and midline shift. The goal of an osteotomy is to create movable bone segments that can be returned to a favorable anatomical orientation and position. The risk of moving the bones to their original curved position is low.
Deviations of the nasal cartilages are most often among the most complex and difficult to correct deformities. Many deviations less than 1/3 involve displacements of the main nasal septum. To correct it, its base is leveled, including correction of the nasal bones and the nasal septum. With significant curvature of the cartilage, further transplantation of cartilage material may be required.
Correction of rhinoplasty
One of the most difficult tasks of rhinoplasty is to correct a crooked nose. The curvature can 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 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 the bone and cartilage tissue has a certain level of memory. Cartilage constantly tends to return to its original position. There is a natural tension in the soft tissues and cartilage structures, which continues to affect the nose after rhinoplasty, which makes it difficult to achieve a good result after surgery. Therefore, the structures of the nose tend to move towards their original position.
- Another factor that can lead to the nose returning to its original curved shape is the incomplete correction of the deviated septum. Also, with a congenital deviated nose, the deviation of the septum can pass into conditions of facial asymmetry. This means that it can be difficult to find the true mid-sagittal plane to try and place a new position of 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, it may exhibit slight asymmetry or residual deviation. A slight curvature is considered acceptable. The most difficult task is to make the front view symmetrical, as incident lighting casts shadows and the nose can appear asymmetrical.
There are many reasons why the nasal septum can be crooked after rhinoplasty. This is likely the result of a drift of asymmetrical 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 can be asymmetrical. This will likely 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% swelling, in a year or more after rhinoplasty. The final effect of the operation can take 20-36 months.
Swelling 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 greater than with 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 and then very often deviates after some time. At first, the swelling will hide the deviations, which may become more pronounced over time.
Revision rhinoplasty aims to correct defects that were not considered at the first surgery, for example a deviated septum that makes it look 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 scars during healing. Curvature can appear as a result of excessive cartilage removal on one side. A deviated septum 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 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.