What is Rhinoplasty Surgery?

Second or more surgical interventions performed in cases such as anatomical problems such as bending and asymmetry in the nose, functional problems such as nasal congestion, or the visual result is not as desired after aesthetic nose surgeries are called “revision”.

The reason why rhinoplasty is among the most frequently revised surgical procedures is that the problems that occur on the nose in the middle of the face are visible and remarkable.

Although the rates given about the rate of occurrence of a problem requiring re-surgical application after aesthetic nose surgeries vary widely, it is accepted that this rate is around 10-15%.

There are different factors that cause undesired results or problems after the surgery, the most common of which are;

Inability to identify the problems before the operation

The patient’s expectations are not fully understood

Errors in surgical technique

· Structural features of the patient (very thin or thick skin, crooked nose, etc.)

· Problems experienced during the post-operative recovery period (trauma, infection, etc.) can be counted as.

Visual problems requiring revision can be divided into four different categories;

Although there is no obvious problem in terms of aesthetics, the patient’s desired result is not achieved.

Minor problems: minor irregularities on the nasal dorsum, slight asymmetries at the tip of the nose

Moderate problems: Asymmetry and irregularities that negatively affect nasal breathing

· Major problems: Loss or deterioration of cartilage or bone structures, as well as severe asymmetry and deformities that may adversely affect nasal breathing.

Although it is accepted that the completion of the healing process and the final shape of the nose after rhinoplasty take between 6 months and 1 year depending on the content of the surgical intervention, the results of the changes in the nasal skin may take even longer. For this reason, it is generally recommended to wait at least one or one and a half years before performing a second operation.

The most important factor that plays a decisive role in the timing of the revision surgery is the cause and content of the problem requiring revision.

In cases of mild irregularities, asymmetrical formations and the patient’s thick skin or regional accumulation of excessive healing tissue, it is generally appropriate to wait for the completion of the healing (at least 1 year) and to thin the thick and edematous tissues with cortisone injections when necessary. Depending on the graft technique used, 1.5-2 years should be waited before a second corrective intervention is performed for the cartilage graft used to shape the nasal dorsum in the first surgery.

It is preferred to perform the second operation without waiting for the recovery period in major problems that do not improve over time, but also negatively affect the patient’s nasal breathing, or in asymmetry and deformities that occur as a result of blows to the nose after the operation.

Although there is no obvious problem in terms of aesthetics, the most correct approach would be to wait for at least 1 year to complete the recovery in order to minimize the risk of third surgery in revisions to be made because the patient’s expectations could not be met.

Revision nose surgeries are interventions that involve significant surgical difficulties due to defects in tissue planes due to the previous surgery, adhesions between the skin and cartilage or bone roof, and damage and deformities in cartilage or bone tissues.

For this reason, in order to obtain a successful result in revision surgeries, it is necessary to evaluate the existing problems very well, to plan alternative approaches such as ear and rib cartilage that can be applied during the surgery, to make the necessary preparations, and to have the surgeon who will perform the surgery have sufficient knowledge and experience for such interventions.

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    Hanne Dilara KÜÇÜK
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