Health Zone Turkey: November 2019

Saturday, November 30, 2019

Details About Revision Rhinoplasty Operation

Revision Nose Aesthetic Surgery in Istanbul, Turkey

Revision Rhinoplasty Operation in Istanbul

Nose aesthetics is one of the most complex and challenging operations among all cosmetic surgery operations because the anatomy of the nose is more complex and small compared to other parts of the face and body. Compared to other aesthetic operations, the rate of revision in nose esthetics is quite high. Even in the hands of an expert surgeon, disorders of the external shape of the nose or difficulty in breathing may occur after the procedure.

The nose is a focal point that forms the middle symmetry of the face and therefore attracts attention. When people communicate, they focus most carefully and most often on the facial area. The nose, which is the focal point of the face, which is the basic area of communication, is remarkable both in our own image and in the communication relations established when we look in the mirror. In terms of moderate symmetry and focus, the nose can often cause aesthetic concerns, physical complaints and functional problems.

Causes of "revision" nose aesthetic operations

Even millimetric errors during surgery can cause aesthetic deformations and functional problems. If the surgeon removes more or less tissue than is required, a second surgical procedure may be necessary. Revision rhinoplasty operations may be more complex and difficult than the initial nasal surgery. In nose revision surgery, the surgeon's experience becomes even more important, requiring more experience, knowledge and skills.

In fact, revision nose surgery is a procedure that progresses in more difficult conditions both for the patient and the doctor and should be performed more meticulously. The surgeon needs to comfort the patient, perform meticulous evaluations and provide the necessary information in detail, and ensure that the problems are successfully resolved with revision surgery.

Which Patients Are Suitable For Revision Nose Aesthetics?

Revision nose aesthetics can benefit from people who had previous nose aesthetic surgery and are not satisfied with aesthetic appearance or health due to incorrect application. Patients often complain that the nose does not fit their faces, do not feel as if they are their own, or suffer from various health problems.

Revision Rhinoplasty Operation in Istanbul

Even if the operation is successful, there may be problems in the recovery process. The nasal structure consists largely of cartilage, so there is no blood flow to the area for feeding. In some cases, the nose cannot heal as expected, as this blood flow is absent. In such cases, patients may experience nasal trauma or infection following their initial rhinoplasty. Cartilage problems may cause an image that is incompatible with facial features.

Various problems may occur in patients due to newly formed nose shape or respiratory distress. In some cases, the patient may be dissatisfied with the newly formed nose shape and may require major changes to be made. At this point, the effect of nose aesthetics being a personalized aesthetic operation is in question. Aesthetic nose surgeries are personalized applications that can be achieved to the extent of patient satisfaction.

When Revision Nose Surgery Be Performed?

We can talk about the healing mechanism as a valid condition for all tissues in our body. A period of time has to pass before the healing of the body tissues that have undergone surgical intervention and return to their old healthy structures. This situation emerges as a necessity of the healing mechanism.

After aesthetic nose surgeries, certain amounts of damage inevitably occur in the related tissues and a certain period of time is required for the healing mechanism to be healed. During this transformation and recovery process, revision should not be applied.

Revision Rhinoplasty Operation in Istanbul

After aesthetic nasal surgery, it is necessary to pass at least 9 months and even 1 year after the first surgery in order for the tissues exposed to surgical intervention to return to their original softness and healthy structure. After the first surgical intervention, the tissue is transformed within a period of approximately one year. No revision intervention should be performed in this transformation process.

Before The Revision Nose Aesthetics

In revision nose aesthetics, one's expectations should be realistic and talk to his doctor about his worries. The nasal aesthetic surgeon may, but not always, request the patient's previous medical records.

What Does Revision Nose Aesthetic Process Include?

The purpose of revision rhinoplasty operations is to solve the problem by applying revision no matter how big the aesthetic or functional problem. It deals with nasal collapse and other problems and changes the basic skeleton of the nose once again. This may lead to more complications and longer recovery time.

In revision nose aesthetics, intranasal cartilages are often used and relocated to reshape the nose. Care is taken to preserve the respiratory function of the nose while reshaping the nasal bone and cartilage. The procedure is usually performed under general anesthesia.

"Cartilage Deficiency" in Revision Rhinoplasty Operation

The aim of the rhinoplasty is to reshape the nose frame to improve aesthetic and functional problems. However, in some cases, there is insufficient cartilage tissue to reshape. In these cases, the cartilage is usually removed from the rib and shaped for re-use in the nose. There is no room for error in the operation, so it is very important to have it done by experienced rhinoplasty specialists for the nose for a balanced fit to the facial contours.

The stem cell method is used to solve problems such as fat injection from the patient's own fat, nasal collapse or lack of adipose tissue. Enriched with stem cells, this oil is used as a filler and provides the patient with lifelong comfort.

Which Method is Preferred in Revision Nose Aesthetics?

The necessary changes in revision nasal esthetics can be done by “closed” or “open” methods. If there are major structural changes, open nose aesthetics will be preferred. Small corrections are usually done with closed technique. Closed rhinoplasty requires only incisions on the inner wall of the nose to reach the nasal skeleton, no scarring on the outer nasal skin. In open rhinoplasty, an incision is made between the nostrils and the skin of the nose is lifted up. It allows the surgeon to intervene directly in the nose skeleton. However, the healing time is longer than the closed technique because it requires incision. The decision to use a closed or open technique in revision rhinoplasties depends on the condition of the case and the preference of the surgeon and both techniques have their advantages and disadvantages.

How "The Revision Rhinoplasty" Be Performed?

The nasal problem may be over-taken or lost tissues, or asymmetry and respiratory distress.

After the first surgical intervention, problems caused by tissues lost or excessively taken from the nose can be treated by removing bone and cartilage from various parts of the body for repair. The skeleton of the nose has a structure consisting of cartilage and bone, so the main skeleton needs to be supported with a solid tissue. In simple cases, deficiencies can be removed by cartilage tissue from the ear region. In severe cases, rib cartilage, and in some cases rib cartilage and bone can be used for repair. The temporal muscle fascia from the scalp can also be added to this process.

Asymmetries formed after aesthetic nose surgeries, the nose skeleton can be opened again and necessary shaping can be done, low nose tips can be carried up to determine the ideal location.

In aesthetic nasal surgeries with respiratory problems, the respiratory distress that is already present is often overlooked and manifested after rhinoplasty. Revision nose surgeries can treat the respiratory problems in the nose.

Operation Technique

Depending on the condition of the previous nose operations and nose structure, I prefer to use open technique.

The cartilage, bone and soft tissue forming the nasal structure are reshaped. Low or excessive height at the tip of the nose, asymmetry, protruding area or missing area of the nose, curvature of the nose, nose tip, nostrils are corrected to provide an ideal appearance.

Pollybeak Deformity
Revision nose job Turkey

If cartilage is required during correction, the first choice is intranasal cartilage. If these cartilages are used or insufficient in the first surgery, cartilage grafts are required. In this case, the second choice is the ear, the third choice is the cartilage rib. (Note: Cartilage removal from the ear does not disrupt the shape and hearing function of the ear, there is no suture scar because it is removed from the back of the ear.)

Deviated septum deviation and turbinate hypertrophy affecting nasal breathing are intervened and corrected during the operation.

After giving a new aesthetic shape to the nose, special bands are applied to the outside of the nose and silicone splint is placed on it for 7-10 days.

Revision Rhinoplasty Operation With Temporal Muscle Fascia

After the first surgical intervention, problems caused by lost or over-removed tissues in the nose can be treated by removing bone and cartilage for repairs from various parts of the body. The nose skeleton has a structure consisting of cartilage and bone, so the main skeleton needs to be supported with a solid tissue. In simple cases, deficiencies can be removed with cartilage tissue taken from the ear region. In advanced cases, rib cartilage, and in some cases, rib cartilage and bone can be used for repair. Temporalis fascia from the scalp can also be added to this procedure. In the video above, during the revision rhinoplasty operation, the nose dorsum augmentation using the temporal muscle fascia shows the nose shape before and after the operation. The fascia used here is also used because of both the volume increase and the camouflage effect.

In revision nasal aesthetic surgeries, the membrane (fascia) of the temporal muscle in the temples with natural camouflage and filling material under the skin can be taken as grafts, especially in patients with irregularities in the back of the nose or loss of tissue and with very thin skin features. After this procedure, it may be necessary to apply a printed bandage on the patient for approximately 5 days.

After Revision Rhinoplasty Operation

The operation time of revision nasal esthetics is longer than the first operation. However, patients are usually discharged on the day of surgery unless there are any complications. It is possible to experience bruises and swelling around the eyes after revision rhinoplasty. However, these bruises disappear within 3-4 days, edema decreases day by day. Patients can return to work within approximately 10 days.

The final results of the revision surgery are observed within 6 months. Therefore, patients should be patient during this time and wait for a better final appearance.

Video description: We have performed a revision noses urgery to my patient from Spain. His first rhinoplasty operation was performed 3 year ago at Spain and nasal obstruction was started due to collapse in the nose wings. We performed revision rhinoplasty operation and nasal valve surgery with a limited amount of shape changes. We did the shortening of the distance between the tip of the nose and the face and the lifting of the nose tip at the same time.

Secondary, Tertiary, Fourth or Fifth Revision Rhinoplasty Operations

The term secondary rhinoplasty is used to describe all of the secondary surgical procedures for the previously operated nose. To put it more clearly, it is the name given to the operation to be performed for patients who are not satisfied with the operation performed by another physician. If a second operation is performed by the same surgeon whenever necessary, despite any care and effort, this is called a "revision" operation. These surgeries are not as comprehensive as the first operation, and a correction is made according to the problem that arises. Sometimes a problem can be encountered with a small filing. If the first surgery was performed by another surgeon, the correction surgery is called 'secondary', and if the patient has been operated twice before, it is called 'tertiary' surgery. Various problems can be encountered here. The scope of the surgery also changes in proportion to the size of the problem. It should be understood why the patient is dissatisfied and his expectations. Likewise, how the nose could be better and the risks should be revealed. Risks may increase as the number of operations increases. Profit-loss balance should be established very well.

Why is it Necessary to Name a Different Name for the Second and Third Nose Surgery?

Because secondary attempts to the nose require more experience and some difficulties are encountered.

• Adhesions related to the previous surgery occur in the operation area and it becomes difficult to reveal the structures to be corrected.

• As the nose skin was opened before, the skin became thinner. It may indicate millimetric errors in the bone or cartilage below.

• In the previous attempt, the nose may have been heavily removed from bone or cartilage.

• The mucous membrane (intra-nasal skin) and perforation due to cartilage damage may have occurred in the midline cartilage in the nose.

• Since the previous surgery was performed by another physician, the patients who performed the first surgery to the patient cannot be fully known.

• The operation time is longer.

In secondary rhinoplasty surgeries, it may be necessary to bring cartilage or fascia (muscular membrane) from another area of the body in order to provide the old support to the nose.

In my personal experience, I may need to take these types of grafts in almost 90% of secondary rhinoplasty surgeries. Usually in the previous surgery, cartilage or bone in the nose is removed, so there is a collapse in certain parts of the nose. These collapses can occur not only after uncontrolled plastic surgeries, but also in cases where this cartilage is removed in the curvatures of the cartilage in the midline of the nose.

In these surgeries, I first say that my patients will be able to get ear or rib cartilage according to the situation in the surgery.

Tertiary Revision Rhinoplasty Operation in Istanbul

In secondary rhinoplasty operations, plaster splint and then bandage application procedures can be applied. If there is a serious intervention in the nose, it may be necessary to place silicone tampons. Apart from this situation, it is not necessary to apply tampons frequently.