Revision nose surgery is applied to patients who have had surgery before but the desired nose shape has not been achieved. In other words, it can be named as secondary aesthetic nose surgery. Revision nose surgeries are more difficult to operate than the first surgery. The soft tissue in the nose can be easily damaged, and at the same time, the nasal skeleton may become evident from the skin as a result of harsh surgical interventions on the nose or tissue thinning. The skin may adhere to the mucous membrane as a result of excessive removal of the cartilages and a loss of elasticity of the nostrils.
In patients with thick skin, certain imperfections may be masked by the non-thinning skin coating, and a moderate correction is the most to be expected in these examples. Limited dissection and placement of dorsal and tip grafts should enlarge rather than reduce the nose. Also, dead spaces must be eliminated.
Thin skin of the nasal type and the lateral angle of the radix, where the tissues begin to thin towards the eyelids, are manageable. But the challenges vary from case to case. When performing reconstruction, problems may be in the outer tissues, mucosa, and osteocartilaginous skeletal level.
THOSE WHO HAVE NOSE REVISION
The key fact here is the psychological profile of the patient undergoing multiple nose surgery operations. While primary rhinoplasty patients are not affected much by a negative outcome, second revision rhinoplasty patients know the risks of the surgery very well and begin to demand more for corrections. They may be reminded repeatedly of the negative consequences of the first procedure, and some may want to go back to their old ways.
If the patient’s expectations are very high in nose revision surgery, care should be taken. Especially if the defect is very obvious and the result is unpredictable. In severe cases of injury, minor surgery is recommended. Graft placement should be done with limited dissection on the nasal dorsum and should be done using a closed approach.
Although quite significant corrections have been made in primary rhinoplasty, some patients may still have minor imperfections; They may state that they are satisfied with the first surgeon but still want an advanced configuration. Plastic surgeon; One should be wary of patients who, despite their minor flaws, still complain and expect perfection, and should also be wary of patients with obvious flaws who disparage their first surgeon. Sometimes these patients consult many specialists and still have very high expectations.
NOSE REVISION BEFORE SURGERY
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It is very important to make a detailed story and analyze the photographs closely and read the reports and working papers of previous operations. Worksheets detailing the position, amount of resection, and grafts are very useful. This combination of information helps the plastic surgeon evaluate the original deformities and understand how they were treated, whether the septum or any other area has been tampered with, and whether any complications have occurred. In primary cases, nasal examination should be performed in the same way. Soft tissues should be examined and palpated to determine their condition and any injury.
Nasal revision examination should be from the root of the nose to the tip of the nose, the position and protrusion of the nasal root, the nasal ridge should be evaluated, and it should be determined whether there is any asymmetry in the bony and middle roof arch with examination and palpation. The nasal tip and nasal roof supports should be evaluated.
Intranasal examination may reveal external and internal valve problems, septal curvatures, perforations and adhesions. To evaluate whether the septum has been intervened; The plastic surgeon can precisely examine one side of the septum using a flat head instrument and at the same time observe the other side with the aid of a light. If the septum cartilage has been removed, a softness will be evident in this area.
long-term edema; Some unfortunate and invisible accidents, risk of infection and bleeding are to be expected. Finally, potential hostility between an unhappy patient and a self-defense surgeon should be avoided.
AFTER NOSE REVISION SURGERY
Many early problems, such as mild asymmetry, coarse nose tip, and descriptive errors, can be resolved within a few months following surgery. During the healing process, the surgeon should support the patient. A nose revision is usually done after 1 year, but if there is serious damage that can be corrected with a quick operation, this operation is traditionally done within a week. Examples; involves the removal of a displaced graft or the correction of overly shortened noses caused by displacement of the septum.
A minor defect such as visible dorsal prominence; It can be done within a few months, accompanied by local anesthesia, with a light rasping. Correction of secondary nasal tip problems and correction of thick and damaged soft tissues should be done at least one year after the primary procedure.
NOSE REVISION SURGERY TECHNIQUES
The surgical approach varies according to the preferences of the physician. No single approach or technique is sufficient to perform primary or secondary nasal revision surgery because it depends on the indications. The technique chosen also depends on the difficulties involved. These challenges include the unseen.
