Revision rhinoplasty is an operation that aims to correct unsuccessful results after plastic surgeries already performed to correct the nose. Revision rhinoplasty is the only option for patients who, after rhinoplasty, have significant visible deformities of the external nose or its functional impairment. Thus, sometimes after rhinoplasty, patients notice an unnatural divergence of the wings of the nose or their noticeable asymmetry. Sometimes a hunchbacked nose turns into a "saddle" nose - with a very low back, as the surgeon has removed too much bone or cartilaginous 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 appears more convex and visually lengthens the nose due to a predisposition to unpredictable scar tissue growth or as a result of an incorrectly performed operation. Revision rhinoplasty allows you to solve these 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
As a rule, patients who have applied for secondary rhinoplasty are disappointed, cautious people who have little faith in the successful outcome of a second operation. During the consultation, we tried to collect a detailed medical history, study photographs before rhinoplasty, in order to understand which manipulations were performed and which structures of the nose. We recommend that these patients have an MRI before revision rhinoplasty – the analysis of this data allows us to create an objective image 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 depressions. Sometimes nose contouring may be recommended to correct minor defects. But, unfortunately, major flaws can only be fixed during a second operation.
Sometimes, the situation makes it possible to dispense with 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 medications containing botulinum toxin to rotate the tip of the nose. But more often, surgical correction is still required, for example, transplantation of the cartilaginous tissue itself to fill in the saddle-shaped depression or rotation of the nasal tip and restoration of the shape of the nasal ala with correction of the position of the nasal septum and alar cartilages. of the nose.
It is possible to talk about the possibility of re-rhinoplasty only after 6-8 months after the first rhinoplasty. This is due, in the first place, to the fact that the definitive restoration of the tissues takes a long time, in a few months after the operation, the shape of the nose changes and the "defects" that the patient observes immediately after plastic surgery can disappear completely. over time. In addition, an operation, even a minimally invasive one, always damages tissues and nerve endings to a greater or lesser degree - therefore, before performing a second operation, one must wait for complete healing.
The latest microinstrument rhinoplasty techniques 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 error or patient fault?
It would be wrong to place 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 either the low qualification of a specialist or 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, plastic surgeons' mistakes can actually cause nose deformity after rhinoplasty. Therefore, the choice of a specialist and a clinic must be of special importance. You cannot choose a doctor at "low prices", health and beauty can only be entrusted to an experienced master of his craft. Otherwise, you are likely to have to pay twice.
Listed below are some of the possible mistakes that plastic surgeons make and the aesthetic complications of rhinoplasty they can lead to:
Improper placement of grafts. The transplantation of autologous material (cartilaginous tissue of the patient) or the installation of synthetic implants is widely used in nose remodeling. If the implants are located asymmetrically, after the tissue has healed, the patient will see a "crooked nose" and pronounced asymmetry.
asymmetric correction. Many rhinosurgical operations involve interventions in the bony and cartilaginous elements of the nasal skeleton, including the resection of part of the hard tissue. If the resection on the right and left sides is performed unevenly, after rhinoplasty there is 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 error or the patient's irresponsibility in the rehabilitation phase. The following are the causes of complications that can be called a consequence of an unfavorable set of circumstances:
transplant extrusion. Tissue grafting or implantation 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.
Cartilage graft resorption. A cartilage graft is living tissue that is exposed to the action of enzymes in the body. 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 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 adequate integration of these structures, a gradual deformation develops.
Excessive callus growth. The bone regeneration process includes an intermediate stage of bone callus formation, which will later be replaced by complete bone tissue. If the regenerative processes are very active, an excess of tissue is formed at this location, which is manifested externally by a bulge, a "bump" or asymmetry. There may be a deviated septum.
Scar tissue hypertrophy 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 forms, which manifests itself externally as a coracoid deformity.
It remains to list some errors 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 fixator;
- self-removal of rhinological splints (nose plugs);
- accidental mechanical damage to the nose;
- sneezing with your mouth closed;
- 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 is not that there are natural difficulties that are inevitable in the field of any operation, they pass after a certain time. These include: bruising, 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 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 this with certainty.
Complications after rhinoplasty
Complications after rhinoplasty can be classified as:
The last point is a little apart, it follows from the previous two. However, it is sometimes especially highlighted as it can occur in a complex way, which depends on the level of the main complication and the psyche of each person. Likewise, 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 arise during the operation e. They can be divided into 4 time periods:
- Directly during the operation, most often 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, bruising, and bruising.
Expected and unavoidable complications pass in 2 weeks. The danger is "unexpected" complications:
- Tissue necrosis (skin, cartilage, bones),
- Divergence of seams (easily eliminated).
Let's look at some of the complications in more detail.
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 drops 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.
If during the operation a violation of bone structures is necessary, the formation of a bone callus cannot be avoided. Your presence is the norm. One complication is overgrowth of bone tissue. Such a complication entails a deformation of the nose, a violation of harmony.
The formation of calluses 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 fine bone fibers are formed, and finally, bone tissue completely replaces the soft tissues. The surgeon's task 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, the immediate result after the operation may please, the curvature disappears. However, at the end of the rehabilitation period, it can return, as the nasal tissues do not have "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 will come to nothing at a given time. Here again, individual characteristics play a role. For one, the period will be 2 weeks, for another - one month, two, three.
In any case, such curvature will be the norm. You can speak no sooner than a year if the problem persists.
Nose doesn't 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 late 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, reconstructive surgery is required, as the cause of the complication is an increase in the amount of tissue inside the nostril. It needs to be cut.
This complication is called "hollow". The reason is the fracture deformity of the cranial bone at the time of osteotomy, when it is not possible to centralize the fragments. The reason could be an excessive seal in the nose. Corrected only by repeated osteotomy.
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.
After rhinoplasty, body temperature rises, which is normal. It doesn't last more than 3 days. In other cases (higher temperature, prolonged time), you should consult your doctor.
After the operation, the sense of smell is disturbed, which is quite natural. Gradually 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, necessary during the recovery period, must be met:
- 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, although quite common. What matters is not just the specialist's experience, but also his attitude towards the procedure. Negligence is unacceptable. You must fully trust the surgeon, fulfill all necessary requirements. Naturally, the qualification of an expert should not be questioned.
It's no secret that facial imperfections create a biased public perception that is important to 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 patients' quality of life and self-esteem.
Causes of curvature
Crooked nose is a general term used to define deformities associated with deviation of the nasal pyramid in relation to the mid-sagittal facial 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 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 allow you to align it.
A deviated nose can also result from asymmetrical growth of nasal structures or rhinoplasty. A nose with recessed features may appear crooked even though the structure does not deviate from the midline. Sometimes nasal septum deformities 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, unfortunately, 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;
- nasal pyramid bones.
Which leads to functional and aesthetic disorders. The main cause of curvature is considered to be excessive deviation of the nasal septum.
Deformations fall into two main categories. They include:
- cartilage deviations (lower 2/3);
- bone deviations (upper 1/3 of the nose).
Deviations of bone in the upper 1/3 are usually corrected with 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 return to a favorable anatomical position and orientation. The risk of bone displacement in the original curved position is low.
Deviations of the nasal cartilages are most often among the most complex and difficult to correct deformities. Many inferior 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. With a significant curvature of the cartilage part, an additional transplant of cartilage material may be necessary.
One of the most difficult tasks of rhinoplasty is correcting 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 deformities after surgery may be necessary in approximately 3-6% of cases, but in cases of nasal deformity, this number can be much higher.
Several nuances complicate the correction of the curvature of 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 cartilaginous structures, continuing to affect the nose after rhinoplasty, which makes a good result after the surgery difficult. Thus, the structures of the nose tend to deviate to their original position.
- Another factor that can lead to the nose returning to its original curved shape is incomplete correction of deviated septum. Also, with a congenitally deviated nose, the deviated septum may pass under conditions of facial asymmetry. This means that it can be difficult to find the true midsagittal plane to try and place a new nose position on it.
Why is the nose crooked after rhinoplasty?
We must not forget that achieving a completely straight nose is a great challenge. After significant improvement, there may be slight asymmetry or residual deviation. A slight bend 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 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 few 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 can also vary in different parts of the nasal structure. Many bumps after rhinoplasty go away within a month. Much more time will be needed to resolve the last 25% of swelling, more than a year or so after rhinoplasty. The final effect of the operation can take 20 to 36 months.
Swelling after rhinoplasty is highly dependent on the nature of the operated nose structures, the surgical approach, post-operative 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 have more swelling.
Swelling occurs under the influence of gravity, which means that the upper back already becomes the first. In general, the nose shows a certain degree of swelling throughout the year.
When the septum is aligned and tight, the nose initially appears straighter and, most of the time, deviates after a while. At first, the swelling will hide the deviations, which can become more pronounced over time.
Revision rhinoplasty aims to correct defects that were not considered in 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 healing intensity during healing. The 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 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 5-10 months before proceeding with revision rhinoplasty. Surgery too early can lead to new problems.