Revision nose surgery is performed on patients who have had surgery before but could not obtain the desired nose shape. In other words, it can be called secondary aesthetic nose surgery. Revision nose surgeries are more difficult to perform than the first surgery. The soft tissue in the nose can be easily damaged, and at the same time, as a result of harsh surgical interventions on the nose or thinning of the tissue, the nasal skeleton may become visible through the skin. The skin may adhere to the mucosa and a loss of elasticity of the nostrils may be the result of excessive removal of cartilage.
In patients with thick skin, definite defects may be masked by the skin covering which cannot be thinned, and the most that can be expected in these examples is a moderate correction. Limited dissection and placement of dorsal and tip grafts should enlarge the nose rather than reduce it. Additionally, dead spaces must be eliminated.
The 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. During reconstruction, problems may occur in external tissues, mucosa and osteocartilaginous skeleton level.
THOSE WHO HAD NOSE REVISION
The key fact here is the psychological profile of the patient who undergoes multiple nose surgery operations. While primary aesthetic nose surgery patients are not much affected by a negative outcome, second revision nose surgery patients know very well the risks of the surgery and begin to request more for corrections. They may remind themselves again and again of the negative results of the first procedure, and some may want to return to their old ways.
If the patient's expectations are very high during nose revision surgery, caution should be exercised. Especially if the defect is very obvious and the outcome is unpredictable. In cases of extensive injury, minor surgery is recommended. Graft placement should be performed with limited dissection on the dorsum of the nose and should be done using a closed approach.
Although quite significant corrections have been achieved in primary aesthetic nose surgery, minor defects may still be present in some patients; They may state that they are satisfied with the first surgeon but still want an advanced level of reconstruction. Plastic surgeon; have very minor flaws One must be wary of patients who, despite all their health, still complain and expect perfection, and one must also be wary of patients who have obvious flaws and who disparage their original surgeon. Sometimes these patients consult many specialists and their expectations are still very high.
NOSE REVISION BEFORE SURGERY
Examination
It is very important to draw a detailed story and closely analyze photographs and read reports and working papers from 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 manipulated, 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 understand their condition and whether there is 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 root of the nose, the dorsum of the nose should be evaluated, examination and It should be determined by manual examination whether there is any asymmetry in the bony and middle roof arch. 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 or not; The plastic surgeon can precisely examine one side of the septum using a flat-headed instrument and at the same time observe the other side with a light support. If the septum cartilage has been removed, a softness will be evident in this area.
Long-term edema; Some unfortunate and invisible accidents, problems such as infection and bleeding risk are expected. Finally, a potential feud between an unhappy patient and a self-defensive surgeon should be avoided.
AFTER NOSE REVISION SURGERY
Many early problems, such as slight asymmetry, rough nasal tip and distortions in definition, a It may resolve within a few months following the surgery. During the recovery process, the surgeon must support the patient. A nose revision is usually performed after 1 year, but if there is serious damage that can be corrected with a quick operation, this operation is traditionally performed within a week. Examples; It involves the removal of a displaced graft or the correction of overshortened noses caused by displacement of the septum.
A minor defect such as visible dorsal prominence; It can be done within a few months, under 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 physician's preferences. shows. No single approach or technique is sufficient to perform primary or secondary nasal revision surgery because it depends on the indications. The chosen technique also depends on the challenges present. These challenges include the unseen.
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