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Failed rhinoplasty surgery

 

Why Rhinoplasty surgery would fail?

 

We call the nose reparation surgeries performed after a failed rhinoplasty surgery the "nose-sculpturing reconstruction" surgery. In the early going, since the rhinoplasty technology was not yet mature enough to sculpture a perfect nasal shape, the results were often less than perfect. There are also some other factors that cause failed rhinoplasty surgeries, so the failed rhinoplasty reconstruction surgery accounts for a large proportion of nose surgeries. During the nose-sculpturing reconstruction surgeries, the tissue adhesions from the previous failed rhinoplasties will result in surgical difficulties, so a patient must carefully selected experienced plastic surgeons who are familiar with a variety of surgical materials and skills, so as to avoid repeatedly having failed rhinoplasty surgeries.

What are the reasons that cause rhinoplasty surgery failures? The reasons of failed rhinoplasty surgeries for oriental people are as follows:


1.Capsular contracture:

The capsule is a natural protective system of the human body. Our bodies will have inflammatory reactions against artificial foreign objects such as artificial nasal bones, artificial breast implants among others, creating “capsules” to completely cover the artificial foreign objects to avoid adverse reactions from our bodies. However, the thickness of the artificial nasal bone capsule will vary according to individual physical condition. If the capsule is thin, the nose will look natural. If the capsule is thick and tightly wraps around the artificial nasal bone, it will shorten and deform the nose. There are many reasons for capsular contracture, and many of them are attributed to the individual's physique. However, let’s not forget that the infection is also a very important factor of it. Therefore, intraoperative aseptic technique is very important, and the incidence of capsular contracture is about 3% to 5%.


2.Infection:

Any surgery will have the chance of infection, and it is especially true for implant surgeries. When infections occur during rhinoplasty surgeries, in most cases the plastic surgeon must remove the artificial implants, wait six months, and then re-perform the surgeries. Furthermore, in the event of chronic inflammation, there is also possible consequence of capsular contracture in the future. The incidence of infection in the rhinoplasty surgery is about 0.5% to 1%.


3.Evaluation errors before or during surgeries:

The nose is a very complex organ, which consists of skin, mucous membranes, cartilage and bones. If the original defects of the nose, such as bending of the nasal septum, asymmetry of the nasal or alar cartilage, nasal or cartilage defects after the previous injuries were not discovered prior to a surgery, the nose might become skewed or asymmetric after the surgery. If proper treatment is not made toward the preoperative undiscovered defects or the existing defects of the nose during the surgery, there bounds to be postoperative issues. The 3D CT scan in the CT room of our clinic is a valuable tool for preoperative diagnosis. A detailed preoperative assessment is a must for the success of the "nose-sculpturing reconstruction" surgery.




Using the 3D printing to print the patient's nasal bone, and then design the artificial nasal bone according to the patient’s needs.



4.Poor communication:

This is the main reason for most of the surgical failures or postoperative dissatisfaction. Whether a nose-sculpturing surgery is successful or not is related to both subjective and objective factors. Nose is an organ exposed on the face, and you cannot hide it whether it looks good or bad. In particular, when one looks into the mirror, he or she will see it immediately. Therefore if a patient is not happy with the surgical result or a rhinoplasty surgery fails, a second surgery is likely to happen. The problem is that whether a nose looks good or not is a matter of opinions, and each person may have a different take on it. Sometimes the surgeons are satisfied but the patients are not, and sometimes it is the opposite. Thus, the preoperative communication is very important. Things such as what nasal shape the patient wants to have and what the plastic surgeon is capable of doing should be communicated clearly. If the two sides cannot come to an agreement, the patient should consider bypassing the surgery. Therefore, every surgeon in our clinic prefers our patients to bring along the photos of their favorite nasal shape, spend enough time analyzing, and communicating to establish consensus so there will be no controversial after the surgery. The 2D on-site simulation software (Figure) in our clinic and the detailed communication with patients prior to the surgeries greatly enhance the patient satisfaction.



Our clinic uses 2D on-site simulation software and communicate with our patients in detail. Left: before to the simulation; Right: after the simulation.

 

Rhinoplasty failures and nose-sculpturing reconstruction surgery can be in many different forms and cannot be categorized, so we use case studies for further discussions.

The nose-sculpturing reconstruction surgery for prosthesis protrusion issue

  1. Preoperative analysis: The nasal bone of the patient in this case study had prosthesis protrusion issue due to infection. The removal of the artificial nasal bone caused capsular contracture and a concave scar on the nose, resulting in an upturned nose and unnatural curve on her dorso nasal.


  2. Surgical procedures:


    The surgery adopted two-section rhinoplasty with open incision. The surgeon firstly removed the scar tissue of the nasal contracture (that was the most time-consuming and tricky step. If the tissues were not removed completely, it would result in the failure of the reconstruction surgery). Next, the surgeon removed the cartilage from the previous surgery and kept the parts that could be reused, as well as removing appropriate amount of cartilage from the right ear for subsequent uses. The surgeon also removed appropriate amount of nasal septum cartilage for the subsequent extension of nasal septum. The surgeon used the nasal tip cartilage transposition surgery and stacked the ear cartilages to re-shape the nasal tip, so as to change upturned angle of the nose. Lastly, he pad the sculptured I-shaped nasal bone under the nasal dorso nasal bone subperiosteum to increase the dorso nasal height. After six months of postoperative reparation, coupling with the laser treatment to discolor the scar, the patient finally had a perfect nasal shape and curve.


The nose-sculpturing reconstruction surgery after two L-shaped rhinoplasty surgeries that caused capsular contracture

  1. Preoperative analysis: The patient in this case study originally had a saddle nose. After undergoing two L-shaped rhinoplasty surgeries, they caused contracture to the nasal tip and resulted in exposed nostrils, skewed nasal columella and very obvious nasal alar groove.

  2. Surgical procedures:


    Our surgeon adopted two-section nose-sculpturing with open incision for this surgery. Similarly, the surgeon first carefully removed the scar tissue of the nasal tip contracture and took out some nasal septum cartilage to extend the nasal septum later on, and then used the nasal tip cartilage transposition to reshape the nasal tip. He used the autologous ear cartilage transplantation to fill the depressed alar groove of nostril, as well as mincing the autologous ear cartilage to reshape the nasal tip. Lastly, our surgeon placed the I-shaped nasal bone under the dorso nasal bone subperiosteum to increase the dorso nasal height and improve the previously thin and weird nasal shape.


The exposed nostrils and overly-long nasal columella after multiple rhinoplasty surgeries

  1. Preoperative analysis: The patient in this case study underwent multiple rhinoplasty surgeries, resulting in overly-high dorso nasal, excessive cartilage implanted inside the columella causing overly-long nasal columella and exposed nostrils, as well as skewed nasal columella.


  2. Surgical procedures:


    The surgeon adopted nasal tip reconstruction surgery with closed incision for this surgery. He cleaned up the nasal tip and removed the excessive cartilages previously implanted, took out appropriate amount of ear cartilages and fascia tissue from both ears, and then used the cartilages to reshape the nasal tip. Then, our surgeon sutured the composite tissue of the ear cartilage with skin onto the inner edge of the nostrils. After the surgery, the overly-long nasal columella and exposed nostrils will both be improved.


Contracture and upturned nasal tip after rhinoplasty surgery

  1. Preoperative analysis: This is another typical case of capsular contracture after rhinoplasty surgery. The surgeon of the previous surgery used the L-shaped nasal bone to perform the rhinoplasty, while suturing her ear cartilages onto the tip of the L-shaped nasal bone. Capsular contracture occurred after the surgery and caused a entangled nasal tip as well as a retracted nasal columella.


  2. Surgical procedures:


    Our surgeon adopted the two-section nose-sculpturing surgery with open incision. He first removed the scar tissues in the entangled nasal tip and the L-shaped nasal bone. Then he placed the sculptured I-shaped nasal bone at proper height under the dorso nasal bone subperiosteum as well as removing the scar tissues entangled inside the nasal tip. Afterward, our surgeon used the nasal septum cartilage to extend the nasal septum, as well as using the nasal tip cartilage transposition surgery to reshape the nasal tip, and then he took out appropriate amount of ear cartilage from the patient’s right ear to reshape the nasal tip and nasal columella. The postoperative nasal shape was natural and in line with what the patient wanted.


Upturned nose after multiple rhinoplasty surgeries

  1. Preoperative analysis: The patient in this case study underwent a dozen of nasal plastic surgeries, which resulted in overly-high nasal curve caused by dorso nasal contracture, nasal tip tissue contracture, ala nasi collapse caused by excessive trimming, and severe deformation of nostrils.


  2. Surgical procedures:


    Our surgeon adopted the two-section nose-sculpturing surgery to remove the L-shaped nasal bone and the contracture scar tissues inside the entangled nasal tip tissues. He removed the appropriate amount of ear cartilages from the right ear of the patient and used the allogeneic costal cartilage to extend the nasal tip as much as possible, changing the angle of the nasal tip so that the nose is no longer facing up. Afterward, our surgeon placed the sculptured Gortex at proper height under the subperiosteum. As for his ala nasi, since the previous surgery removed too much ala nasi tissues already, so this time our surgeon only incised the original wound to perform shrink and lift re-positioning. The patient was very satisfied with the postoperative changes to his nose.


Reconstruction surgery on hook nose after two rhinoplasty surgeries

  1. Preoperative analysis: The nasal tip of the patient in this case study had contracture and depression due to the infection to his artificial nasal bone. In the subsequent rhinoplasty surgeries, the surgeon did not completely removed the contracture scar tissues, while using the L-shaped nasal bone and suturing his ear cartilage under the L-shaped nasal bone in order to extend the nasal tip. After the surgery, the patient had nasal tip contracture, depression and defect nasal infra-tip. His nasal tip was pushed to the wrong position by the L-shaped nasal bone cartilage, and there was another bone thereunder, making the bumps even more obvious, as if a piece of his nose was cut off.


  2. Surgical procedures:


    Our surgeon adopted the two-section nose-sculpturing surgery with open incision. He firstly carefully removed the scar tissues of the nasal tip contracture and the L-shaped nasal bone, and then he separated the depressed position of the nasal tip for re-organization. Afterward, he took out an appropriate amount of ear cartilage from the patient’s right ear and use it to reshape and re-position the nasal tip. Lastly, our surgeon placed the sculptured I-shaped nasal bone at the proper height under the patient’s subperiosteum. After the surgery, his brow and nasal curves became very natural, and he finally got rid of the weird-looking Lord Voldemort type nose.


The bumps and uneven nasal tip and cartilage bulge after rhinoplasty surgery

  1. Preoperative analysis: The patient in this case study underwent rhinoplasty surgery previously. During that previous operation, the surgeon removed too much nasal tip tissues, resulting in the local depression of the nasal tip and the protruding of the superficial cartilage that formed uneven white spots. The patient also complained that her dorso nasal was unnaturally high and her nostrils were too exposed.


  2. Surgical procedures:


    Our surgeon adopted the 2-section nose-sculpturing surgery with closed incision. He firstly removed the entire nasal tip and the previously implanted cartilages, rearranging those removed cartilages to fine-tune the highest point of the patient’s nasal tip. Afterward, our surgeon removed an appropriate amount of ear cartilages and fascia tissues from both ears of the patients, and then he placed the fascia tissues of the ear cartilage in the inner side of the patient’s nostrils to resolve the issue of exposed nostrils. Lastly, our surgeon reduced the height of the I-shaped nasal bone and placed it under the subperiosteal. After the surgery, the patient’s nose no longer had any unnatural depression and bumps.

 

Dr. Yi-Sheng Kao Director | Plastic Surgery Aesthetic Clinic

Copyright © 2011-2016 tag:隔空減脂 平胸手術
All Written Contents and Pictures Created by charm3c

EN

Dr. Yi-Sheng Kao Director | Plastic Surgery Aesthetic Clinic

Copyright © 2011-2016 tag:隔空減脂 平胸手術
All Written Contents and Pictures Created by charm3c

EN