Rhinoplasty Surgical Errors – what can go wrong?
Rhinoplasty is a complicated and delicate nasal surgery with both aesthetic and functional aspects that take years of surgical experience to master. Some of the most common problems that arise after rhinoplasty are:
Polly Beak Deformity-Cartilaginous or Soft Tissue
In a natural-looking nose, there is a slight depression as the nose transitions from the bridge to the tip. In the case of the polly beak deformity, however, this bridge area above the tip is too high, giving the nose an appearance like a parrot’s beak. Three different complications during rhinoplasty can lead to this problem, which is one of the most common seen after rhinoplasty surgery.
A cartilaginous polly beak deformity occurs when too much cartilage is left after surgery, and revision rhinoplasty to correct this would involve shaving down the extra cartilage.
A soft tissue Polly beak deformity occurs when a surgeon removes too much soft tissue on a patient with thick skin so the skin doesn’t properly contract and flatten out, causing excessive scar tissue to form in the area.
Lack of Nose Tip Support: where the original surgeon fails to leave enough support for the tip of the nose and it droops over time, making the area above the tip appear to project too far. Revision rhinoplasty to address the problem requires the surgeon to reconstruct the nasal tip so it has adequate support.
Profile Deformity: Persistent Bump or Scooped Out Bridge
The “Middle Vault,” also known as the “Inverted V Deformity,” occurs when a bump is removed from the central nose, but inadequate support is provided. The center of the nose collapses, both inhibiting breathing and making the nasal bones visible to the naked eye in the shape of an inverted “V.” Breathing will also be inhibited when the removal of a bump causes the collapse of the narrowest area inside the nose, the internal nasal valve. As with a scooped out bridge, a revision rhinoplasty to address a collapsed central nose or internal valve collapse involves rebuilding the missing area with the patient’s own cartilage.
Other general aesthetic concerns relating to the bridge can occur after a rhinoplasty procedure. The central nose forms the transition from the bridge to the tip and must be in proper proportion to seamlessly blend the two together in an aesthetically harmonious relationship.
Deviated Nose Issues after Surgery
A deviated nose is a nose with twist-either in the upper, middle, or tip of the nose. It is one of the most difficult problems to address through rhinoplasty and can persist after a original rhinoplasty or a revision rhinoplasty. It can even be introduced through a rhinoplasty or revision rhinoplasty procedure.
One of the most common mistakes seen following rhinoplasty is the over-projected tip. Once a prominent bump is removed, patients often discover that the tip of the nose projects too far from the face.
Tip Bossae (Knuckling)
If the two projecting points of cartilage that support the nose tip are too aggressively removed they will lose their springy structure and remaining cartilage will begin to bend and twist. This causes a problem called “bossae” or “knuckling” where the cartilage turns upon itself and the weakest points at the joints of the cartilage form very noticeable bumps or “knuckles.”
Rhinoplasty involves two separate procedures, one to the right side of the nose and one to the left. In every stage of the surgery, great attention must be paid to symmetry. The cartilage on both sides of the nose tip must be removed to exactly the same degree or and asymmetric tip will result. Asymmetries may also occur due to unequal scarring during the healing process and not reveal themselves until months or even years after the fact.
Rhinoplasty Terms: The terms set out below give a brief description of the types of Rhinoplasty offered in Ireland
Rhinoplasty : a surgery that changes the form (or shape) and function (breathing) of the nose.
Functional Rhinoplasty: To improve or restore breathing function through the nose. This surgery may also change the shape of the nose.
Cosmetic Rhinoplasty : To change the shape of the nose for aesthetic reasons.
Open Approach Rhinoplasty: this leaves an external scar on the columella but gives an advantage of improved access which may be necessary in some cases.
Closed Approach Rhinoplasty : operation through nares (nose openings) with no external scars.
Nose Tip Plasty : usually a cosmetic surgery procedure to modify the shape of the tip of the nose.
Nasal Valve Surgery : to improve breathing when the nasal valves are dysfunctional or compromised.
Paediatric Rhinoplasty : Rhinoplasty in a child under eighteen years of age, usually to restore or improve functionality of the breathing process through the nose.
Nasal bone fractures : injury to nasal bones may necessitate formal rhinoplasty in the future, if not addressed adequately in time.
Acute Septal cartilage fractures : nose injury leading to nasal cartilage dislocation or fracture. Septoplasty may be required if nasal obstruction persists. This is routinely performed after 6-12 months (interval septoplasty) allowing the scar tissues to mature and to allow predictable results after correction.
Septoplasty : surgery for correction of nasal blockage caused by bent septal cartilage. The Septum is the party wall that divides the nose into right and left cavities.
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