In cases where one or more nose surgeries have been performed before and the desired result cannot be achieved, rhinoplasty We call this surgery a revision rhinoplasty. There are different designations: secondary rhinoplasty, sekonder rhinoplasty gibi..
It is generally accepted that these operations are more difficult than the first operation. Because there is a nasal skeleton whose structure has been changed and has not been successful, there is a skin that has adapted to it, and when you start the operation, you will encounter surprises.
But if to rhinoplasty entered with adequate preparation, these surgeries are no different from the first surgeries. By adequate preparation I mean:
- Problems should be presented clearly and concretely.
- Expectations must be realistic
- There should be enough tissue, especially cartilage tissue.
This is the issue that patients find most difficult to understand. Actually, the matter is very simple. We nose job We are trying to create the closest anatomy to nature. For this, we need some tissues, especially cartilage tissue. In the first surgeries, this cartilage reserve is present in the middle roof of the nose called the "septum". However, in revision surgeries, the cartilage tissue here is sometimes not enough. In this case, either some costly but reliable materials obtained from a cadaver called ready-made cartilage and undergoing various processes can be used, or it can be obtained from cartilage tissues elsewhere in our body. Behind the ear is an alternative for this. But I don't use ear cartilage much. Because it is not enough and it is not useful due to its curved structure. Another option is to take approximately 3 cm of cartilage from the rib at the level of the breast line. This is the most reliable and useful way in my opinion.
If adequate preparation is made and these surgeries are performed, the difficulties of the surgery are minimized.
3 Basic Elements in Revision Rhinoplasty Surgery
1. Why a second nose job would it need?
Aesthetic nose surgeries Some undesirable results may occur in 7-10% of them. After these operations, a second revision rhinoplasty surgery may become inevitable. Revision rhinoplasty In addition to deformity, aesthetic and functional problems in the nose can also be corrected in surgeries. However revision rhinoplasty For the surgery, at least 9 months, if possible, 1 year should pass from the first surgery.
2. Before nose job What kind of process is followed by the passers-by?
- Preoperative evaluation
- Aesthetic evaluation
- Functional assessment
- Photographing and computer analysis
In revision rhinoplasty It can be done with an open or closed approach as in primary rhinoplasty. Here it is necessary to know from the beginning; The open or closed approach is not the surgical technique, but the way used to reach the cartilage and bone structures of the nose.
Revision surgery differs from primary surgery. Tissue planes are often narrowed, cartilage and bone tissues that are very valuable to us have been excessively or asymmetrically removed, and forces during healing have bent weak or weakened cartilages. This situation requires more careful and gentle work during the surgery. Skin and soft tissue are very important in revision rhinoplasty.
Revision rhinoplasty its success; It depends on well-developed reasoning, ability, knowledge and, above all, experience. In this process, the surgeon must have a very good knowledge of anatomy and have a good knowledge of surgical approaches. In addition, the surgeon must know what to do in the face of undesirable difficulties and consequences. Patients should be followed for a long time after surgery.
3. Revision nose surgery How is the nose shaped?
In revision rhinoplasty primer rhinoplasty There is a more intense inflammatory tissue response than In patients with thin skin, all protruding structures should be filed, the grafts should be thinned properly, and used by wrapping with fascia if necessary. In thick skin, strong cartilage is needed to keep the tip of the nose stable and to carry the weight of the skin. In people with thick skin, swelling resolves later (lymphatic drainage resolves later), sometimes it may take 2 years. The duration of the operation varies between 30 minutes and 4 hours, depending on the shape of the nose and the approach. Minor retouches can be done in 30 minutes, while major revisions can take 3-4 hours on average. Revision rhinoplasty often requires grafts. Nasal septum cartilage is often used or insufficient because of previous surgery. In this case, it may be necessary to take cartilage from the ear or, if necessary, from the rib. In such cases, the duration of the operation will be longer. However, it should not be forgotten that the important thing is not the duration of the surgery, but the result!
Why Revision Nose Surgery Is it necessary?
I can easily say this: The need for revision rhinoplasty has decreased with new techniques.
There was excessive extraction in previous surgeries. These are surgeries in which the back of the nose is too hollow and the tip of the nose is excessively raised. Nose tip problems with asymmetries, where the tip of the nose is pinched, are also not few.
These problems are less in recent surgeries. But now there are problems due to putting too much graft, that is tissue, or over tightening the tip of the nose with stitches.
Among the most common problems I see are; There are surgeries in which the bone arch is removed and the cartilage is not removed, the nose looks like a parrot's beak when viewed from the side, the ridge of the nose remains pointed, and the tip of the nose is asymmetrical. Often they can be together.
Cartilage Removal from the Rib for Revision Nose Surgery
In rhinoplasty We respect the natural anatomy and surgical tissues and reshape them. In the first operation, the cartilage tissue in the middle roof called the septum may be sufficient for us. however, this reserve is mostly lost in revision surgeries.
We need to get cartilage from another part of our body. This cartilage can be taken from behind the ear. Patients show a half-jokingly half-serious reaction saying "Let's not be out of our ears". If this procedure is done with appropriate incisions, this does not cause a deformity in the ear. I do not find ear cartilage useful. I don't prefer it because of its curved and irregular structure.
Taking cartilage from the rib is very useful for creating the desired skeletal structure. We make an incision of approximately 2-3 cm from the level of approximately 5 cm below the right nipple. This then creates no trace problems. We take a cartilage tissue with a diameter of about 3 cm from here and use it to form the nasal skeleton.
The scar remains below the bikini line in women. When it is properly closed, a vague trace remains after weeks or months. When the appropriate technique is used, there is no pain.