What kind of complications are even somewhat possible after rhinoplasty?
Answer: It is possible to classify rhinoplasty complications as either functional (relating to the patient’s ability to breathe) or aesthetic (relating to the patient’s appearance); but, most commonly, there are components of both. The most common causes of complications following rhinoplasty are underresection (in which insufficient tissue is removed), overresection (in which excessive tissue is removed), and/or asymmetry. A complication that might arise following rhinoplasty is aberrant scarring in some cases. In general, it is simpler to correct issues that are related to under-resection since these issues may be corrected by “taking a bit more” after the first resection has been performed. Overresection can result in problems that are slightly more difficult to solve since additional material must be added, and the technical difficulties that arise from the requirement to add tissue must be taken into consideration. In most cases, asymmetries can be improved, and in certain cases, they can even be fully rectified.
What kinds of materials are used in revision rhinoplasty if you need to use grafting material to rebuild my nose?
Answer: You should expect that you and your surgeon will talk about the exact material that will be used in your case. There are many kinds of materials. Most of the time, cartilage is taken from your nose (usually the septum) or your ear. Rib cartilage is used less often. This could be one of your own ribs or a rib from a donor that has been treated and irradiated.
I have very thin skin. Do you do anything different during my second rhinoplasty?
Answer: People with very thin skin may be able to feel or even see even the smallest change. When these things happen, we might use Alloderm. Of course, if this is important to a patient, the surgeon talks to him or her about it before the surgery.
Alloderm is a human dermis that doesn’t have cells. It comes from an organ donor and has been treated with a patented, FDA-approved method. Alloderm is used to improve the look of the face in a number of ways, such as to make the lips bigger, to fix scars, and to change the shape of the nose. When doing revision rhinoplasty on people with very thin skin, Alloderm can be put between the skin and the graft to make the skin thicker and help hide the graft even more.
What’s preventing you from using artificial implants?
Answer: Some surgeons put artificial implants in the nose, like gortex, but we don’t think that’s a good idea. We think that anything made of man-made materials could get infected and start coming out at any time. If these fake implants come out through the skin of the nose, it can damage the nose in a way that can’t be fixed. Several reports about this problem can be found in the medical literature. Some surgeons who use this material say they talk to the patient about this risk and make sure the patient understands it. We think there are better ways to fix your nose, so we’re not willing to take this risk.
What will happen to my ear if you need to take cartilage from it?
Answer: If you need ear cartilage for your revision rhinoplasty, the good news is that taking that cartilage shouldn’t change the way your ear looks or works. Most of the time, the septum is the first choice for grafting. But if you’ve already had a septoplasty or septorhinoplasty, this source of grafting material may have been used. In that case, we’ll use tissue from your ear instead. Most of the time, the incision is made behind the ear, where it can’t be seen. Sometimes, though, like if you wear a hearing aid (which can irritate the incision behind the ear while it heals), we prefer to make the incision on the front side of your ear, in a place where it is hard to see and not as noticeable.
When your nose is fixed, the cartilage from your ear works well. The good news is that taking out this cartilage shouldn’t change the shape of your ear if it’s done right. Sometimes, we see a patient who has already had both ear cartilages used but still needs revision rhinoplasty. In these situations, we sometimes find enough of the patient’s own cartilage in the ear and septum, but we also think about using the patient’s own rib or a rib from a tissue bank that has been treated with radiation.
What about the difficulties associated with breathing and other functions?
Answer: Airway difficulties are complex enough to need their own page, but in a nutshell, the surgeon has to obtain a meticulous medical history and perform a thorough physical exam to determine which of the many potential reasons of nasal breathing difficulty is impacting the patient. During a rhinoplasty procedure, it is essential that every effort be geared toward either preserving or enhancing the patient’s nasal airway. The inability to maintain the function of the nasal airway can be debilitating. It is necessary to investigate and treat the underlying source of the nasal airway blockage.
The tip of my nose gives me problem. What kinds of problems can happen at the tip of the nose?
Answer: Too much reduction, too little reduction, and asymmetry. Over-reduction of the nasal tip can lead to a droopy tip (ptotic tip). Over-resection can cause the nose to get too short, giving it a “pig snout” look. Over-resection can also lead to problems like bossae (unattractive points), alar retraction (unattractive lifting of the side wall of the nose), and nasal collapse.
Underresection could make a problem last longer. Also, if the underresection isn’t even, more serious problems can happen. For example, a “pollybeak” or parrot’s beak deformity can happen if not enough of the lower part of the nasal bridge is cut away but all other parts of the surgery are successful.
Asymmetries of the nasal tip may have been there before surgery, and both the patient and the surgeon may have missed them. Since rhinoplasty is in some ways like “two operations” (a left and a right side), the surgery must be done with a lot of attention to symmetry. Asymmetries can also be caused by surgery, such as when the lower tip cartilages are treated differently. It could also be caused by scars that aren’t the same size. This can happen during the natural healing process and might not show up for months or even years.