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
The nose-sculpturing reconstruction surgery after two L-shaped rhinoplasty surgeries that caused capsular contracture
The exposed nostrils and overly-long nasal columella after multiple rhinoplasty surgeries
Contracture and upturned nasal tip after rhinoplasty surgery
Upturned nose after multiple rhinoplasty surgeries
Reconstruction surgery on hook nose after two rhinoplasty surgeries
The bumps and uneven nasal tip and cartilage bulge after rhinoplasty surgery
Dr. Yi-Sheng Kao Director | Plastic Surgery Aesthetic Clinic
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