"Revision" Rhinoplasty in Noses With "Thick Skin Properties"

Revision Nose Aesthetics in Thick Skinned Noses

Revision Nasal Surgery in Thick Skinned Noses

In revision nasal aesthetic surgeries, since the operation performed means shaping a tissue with anatomical changes 1 or more times, it means a difficult surgical operation in itself; performing this operation on a nose with thick skin characteristics may mean that the procedure may be even more difficult. Revision rhinoplasty operation in noses with "thick skin characteristics" is more difficult and complicated than classical thin skin and primary nasal aesthetic operations. 

The nose is the most remarkable organ on the human face and the most important organ that changes the expression. A beautiful and proportioned nose is the dream of both women and men. Nose ranks first in the most performed cosmetic surgery operations in our country and in the world. Nose aesthetics now means a natural nose. Having the ideal exterior appearance and restoring one's self-confidence stands out among the pluses of nose aesthetics.

First of all, since nasal esthetic surgery is a shaping surgery, soft tissue covering, ie nasal skin, is a factor that directly affects the success of this operation and should never be ignored. In the nose shaping surgery, after the bone and cartilage tissue under the skin is shaped, it is necessary to adapt to the underlying structure and fit to the tiny spots we want to make the nose look beautiful and as we want. In thin-skinned nose patients, we can observe that the shaping we make at the bottom is very nice to the outside, while in thin-skinned patients we observe that the fine details given in the alk are not reflected to the outside and that the skin camouflages this beautiful image.

Skin thickness is very important

The skin thickness of the patient is one of the main determinants of postoperative results. Nasal skin is removed during surgery and cartilage and bones underneath are shaped. After this process, the skin is expected to adapt to the newly formed skeleton. Skin thickness gains importance in this adaptation process, and skins of different thickness adapt to the skeleton at different times.

Revision Rhinoplasty in Thick Skinned Noses

The most difficult nose surgery for surgeons is the type of nose, which is the operation protocol of the thick-skinned noses and the recovery process after. It is very important to talk to the patient in detail and inform the person beforehand. What is important here is that the patient knows that he cannot have a very small and thin nose, but that a nose that suits his face shape can be made.

Nasal surgeons shape the bone and cartilage tissues that make up the nasal skeleton in nasal surgery. Then the nasal skin to cover this skeleton and wants to take the shape of the bottom mold. Because even the smallest asymmetry will manifest itself from the outside. In patients with thick nasal skin, many of the asymmetry and deformations of the underlying bone and cartilage tissue are masked and unobtrusive. The disadvantage of the thick-skinned nose structure for the surgeon is that he sees the underlying bone and cartilage tissue only when opened during surgery.

Thin skin adapts immediately

It is easier for thin skins to adapt to the newly formed skeleton and the thin skin shows the details of the underlying skeleton more clearly. For thick leathers, the situation is slightly different, this adaptation process is longer. At the same time, the thick skin can mask the sharp line and angles at the bottom. Postoperative edema is more common in patients with thick skin and the regression process may take longer. For these reasons, many people avoid aesthetic nose surgery for fear that they will not get good results.

Very thick skin properties and additional problems

As the skin thickness rises above a critical level, it becomes such that the nasal skeleton is formed by the skin layer itself. No action on the bone and cartilage roof causes a change in the shape of the nose. The nose can be seen from the outside like a pile of meat. This type of nose (bulbous nose) is also called in general terms. In the bulbous nose structure, unlike outside skin, cartilage tissue is often large but extremely thin and weak. This situation also forces the surgeon to try to give a permanent shape to the cartilage during surgery.

Thick skin nose aesthetics can not be completely solved by thinning the skin of the nose, thinning the skin and removing the excess tissue is important to sit on the bone tissue without abundance. Another important point to keep in mind is that edema formation in thick skinned noses will be more and it will take 2 years and even longer for the nose to take full shape.

Personalized techniques

Some methods are preferred for successful results in patients with thick nasal skin. These;

- Preservation of cartilage support tissue and placement of additional support grafts
- Skin thinning in appropriate patients to protect muscle and connective tissues
- Fixing the skin to the bottom frame with internal stitches to increase the fit
- Removal of tissue from the base, especially in patients with significant thickness in the wings.
- Avoiding dead spaces under the skin

Various edible products can be used as an anti-edema and treatment aid after the procedure. The use of ot ino Isotretinoin ’’ active substances, which is a derivative of vitamin A, is also a method. However, although these drugs provide theoretically thinning of the skin, they are rarely used for this purpose because of the possibility of side effects.

Discussion of skin thinning in thick-skinned nose esthetics

Bilevel dissection and removal of subcutaneous tissue is a method of choice in patients with thick skin structure. It can be done in thick-skinned nose esthetics is the stripping of subcutaneous tissue. The most important reason for the thickness is the layer of loose connective tissue, adipose tissue and muscle layer in the subcutaneous tissue. The nose skin is removed from the bone and cartilage tissue during nasal surgery. After the skeleton has been shaped properly, it is possible to remove the subcutaneous tissue from the skin very carefully and throughout the skin, ensuring at least 50% thinning of the skin. It is extremely important to increase the resistance of the cartilage skeleton by placing abundant supports while shaping the cartilage tissue.

The following discussion may be presented in relation to this technique:

1. Thickness of the skin is a genetic feature and it is possible to produce this tissue again during the healing period after subcutaneous tissue removal and thinning.

2. In the skin thinning process, deep layers are technically removed. That is, in thick-skinned noses, when the lower ligaments are removed, the nasal wing movements may be adversely affected (here I would like to add an appeal sentence, grafting and cartilage forming operations can be performed on the narrowest airway regions within the nose).

Nasal taping during sleeping time, salt restriction, drinking green tea may be beneficial.

I wish you luck in the surgery ...

You can find more detils at >> Revision Rhinoplasty in Istanbul

Source link >> An anatomic basis for revision rhinoplasty

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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