Revision rhinoplasty is an operation intended to correct unsuccessful results after plastic surgeries already performed to correct the nose. Revision rhinoplasty is the only way out for patients who, after rhinoplasty, have significant visible deformities of the external part of the nose or its functional impairment. So, sometimes after rhinoplasty, patients note an unnatural divergence of the wings of the nose or their noticeable asymmetry. Sometimes a humped nose becomes a "saddle" nose, with the back of the nose being too low, because 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 correct natural shape of the nose, restore nasal breathing functions, and restore the patient's self-confidence and attractiveness.
Secondary rhinoplasty - approaches and methods
As a rule, patients who applied for a secondary rhinoplasty are disappointed, cautious people who have little faith in the successful outcome of a second operation. During the consultation, we try to collect a complete medical history, study photos before rhinoplasty, to understand what manipulations were performed and on what structures of the nose. We recommend these patients to undergo an MRI before undergoing revision rhinoplasty: the analysis of these data allows us to create an objective image of the internal structures of the nose, outline an operation plan and agree with the patient 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 bumps or depressions. Sometimes nose contouring 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 medications containing botulinum toxin to rotate the tip of the nose. But, more often, surgical correction is still required, for example, transplantation of own cartilaginous tissue to fill in the saddle-shaped depression or rotation of the nasal tip and restoration of the nasal ala shape with correction. of the position of the nasal septum. and alar cartilages of the nose.
It is possible to talk about the possibility of a new rhinoplasty only after 6-8 months after the first rhinoplasty. This is due, first of all, to the fact that the definitive restoration of the 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 they can disappear. completely over time. In addition, an operation, even minimally invasive, always damages the tissues and nerve endings to a greater or lesser extent; therefore, before performing a second operation, complete healing should be expected.
The latest micro-instrument rhinoplasty techniques make it possible to eliminate the consequences of any failed 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 patient's shoulders, but it would also be a big mistake to blame everything on the plastic surgeon. The reason for the formation of a defect can be both the low qualification of a specialist, and the patient's inattention to the received recommendations. 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 really cause nose deformity after rhinoplasty. Therefore, special importance should be attached to the choice of a specialist and a clinic. You can not choose a doctor at "low prices", health and beauty can only be entrusted to an experienced master of the craft from him. Otherwise, you may have to pay twice.
Listed below are some of the potential mistakes plastic surgeons make and the cosmetic rhinoplasty complications they can cause:
Incorrect placement of the grafts. The transplantation of autologous material (cartilage tissue of the patient) or the installation of synthetic implants is used quite frequently in the remodeling of the nose. If the implants are located asymmetrically, after tissue healing, the patient will see a "crooked nose" and pronounced asymmetry.
asymmetric correction. Many rhino-surgical operations involve intervention 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, then 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 error or the patient's irresponsibility at the rehabilitation stage. They are causes of complications that can be called a consequence of a set of unfavorable circumstances, the following:
transplant extrusion. The tissue graft or implant is used in many rhino 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 that is exposed to the action of body enzymes. With an unfavorable course of regenerative processes, enzymes can destroy a part of the graft. 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 the pressure of other anatomical formations of the nasal skeleton, as well as due to strong tissue edema, it can be 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 cartilaginous elements that form the back of the nose is broken. If during the rehabilitation period there is not an adequate integration of these structures, a stepped deformation develops.
Excessive growth of calluses. The bone regeneration process includes an intermediate stage of bone callus formation, which will then be replaced by complete bone tissue. If the regenerative processes are too active, an excess of tissues forms in this place, which is externally manifested by a hump, "bump" or 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 that manifests externally 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 fixator;
- self-removal of rhinological splints (plugs in the nostrils);
- accidental mechanical damage to the nose;
- sneeze with your mouth closed;
- blowing;
- drinking alcohol, smoking during rehabilitation;
- prompt 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 consequences?
Deciding on such an operation, it should be borne in mind that the procedure is fraught with complications. It is not that there are natural difficulties that are unavoidable in the field of any operation, they pass after a certain time. These include: bruising, bruising under the eyes, shortness of breath, impaired sense of smell, temporal 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 a little later. No doctor can predict it for sure.
Complications after rhinoplasty
Complications after rhinoplasty can be classified into:
- aesthetic,
- functional,
- Psychological.
The last point departs a little, it follows from the previous two. However, sometimes it stands out especially since it can proceed in a complex way, which depends on the level of the main complication and the psyche of each particular 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 operation and. They can be divided into 4 time 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.
The expected and unavoidable complications pass in 2 weeks. The danger is "unexpected" complications:
- infection,
- Tissue necrosis (skin, cartilage, bones),
- Seam divergence (easily removable).
Let's look at some of the complications in more detail.
Types
Edema
Swelling after rhinoplasty is a natural phenomenon. It would be a mistake to call it a royal 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 a violation of bone structures is required, the formation of a bone callus cannot be avoided. His presence is the norm. One complication is hypergrowth of bone tissue. Such a complication implies 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 process of bone regeneration. First, new connective tissues appear, 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.
The nose is twisted to one 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, at the end of the rehabilitation period, it can return, since the nasal tissues have no "memory". In this case, a correction is required.
But swelling can also be the cause of the curve. In this case, it is a natural complication that will fade at a certain point. 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 a curvature will be the norm. You can talk about not before a year, if the problem persists.
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 late 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.
droopy nose
This complication is called "hole". The reason is fracture deformity of the cranial bone at the time of osteotomy, when it is not possible to center the fragments. The reason may be an excessive seal in the nose. Corrected only by repeat osteotomy.
Bad smell
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, 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 pinkish tint. Not only that, they tend to grow.
To remove them, all the requirements of the surgeon must be met, which are necessary during the recovery period:
- Treatment of sutures with the 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 only the experience of the specialist, but also his attitude towards the procedure. Negligence is unacceptable. You must fully 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 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 with respect to the sagittal midfacial axis that 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, different variants of the curvature of the nasal septum make it possible to align it.
A crooked nose can also result from asymmetric growth of the nasal structures or from rhinoplasty. A nose with sunken features may appear lopsided, although the structure does not actually deviate from the midline. Nasal septum deformities sometimes 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;
- 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.
septal curvature
Warps fall into two main categories. They include:
- cartilage deviations (lower 2/3);
- bony deviations (upper 1/3 of the nose).
Bone deviations in the upper 1/3 are usually corrected with a controlled fracture of the nasal bones or osteotomy and midline shift. The goal of an osteotomy is to create mobile bone segments that can be returned to a favorable anatomic position and orientation. The risk of displacement of the bones in the original curved position is low.
Deviations of the nasal cartilages are most often found among the more complex deformities that are difficult to correct. Many deviations less than 1/3 imply 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, an additional transplant of cartilage material may be necessary.
rhinoplasty correction
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 required in approximately 3-6% of cases, but in cases of nasal deformity, this figure may 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. The cartilage constantly tends to return to its original position. There is natural tension in the soft tissues and cartilaginous structures, which continues to affect the nose after rhinoplasty, making it difficult to achieve a good result after surgery. Thus, the structures of the nose tend to move towards their original position.
- Another factor that can lead to the return of the nose to its original curved shape is incomplete correction of the deviated septum. Also, with a congenital deviated nose, the deviation of the septum can happen in conditions of facial asymmetry. This means that it can be difficult to find the true midsagittal plane to try to 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, you may have a slight residual asymmetry or 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 may be crooked after rhinoplasty. This is possibly the result of asymmetric edema drift 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 asymmetric. This will possibly 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% of the swelling, more than a year or more after rhinoplasty. The final effect of the operation can take between 20 and 36 months.
Swelling after rhinoplasty largely depends 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 larger and longer than in closed rhinoplasty. People with thick skin will swell more.
Swelling occurs under the influence of gravity, which means that the upper back already becomes the first. The nose usually has some degree of swelling throughout the year.
When the septum is aligned and well supported, the nose initially appears straighter and then more often deviates after some time. At first, the swelling will hide the deviations, which can become more pronounced over time.
Revision rhinoplasty is intended to correct defects that were not considered in the first operation, for example a deviated septum causing the appearance to be distorted, or as a result of 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. The curvature may appear as a result of excessive cartilage removal on one side. A deviated septum can be corrected. Revision rhinoplasty may involve a cartilage transplant.
The complete 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 proceeding with revision rhinoplasty. Surgery too early can lead to new problems.