Complicated Revision Rhinoplasty With Temporal Fascia and Rib Cartilage

Revision Nose Job in Turkey

Complicated Revision Rhinoplasty With Temporal Fascia and Rib Cartilage - Revision Nose Job in Istanbul

We performed a revision rhinoplasty operation on a patient who had previously undergone recurrent nasal surgery and then underwent a nose filler injection. During the operation, "Cartilage and temporal fascia were kept in sterile serum supplemented with Rifocin antibiotic." That's the reason for the orange-brown color :)

At the beginning of the operation, local anesthetic infiltrations were performed. Of course the temporal region and the nose ...

In the pre-operative photographs, you can see severe arch and curve in the dorsum of the nose, asymmetry in the tip of the nose, and retraction of the columella.

Removal of Nose Filler During Revision Rhinoplasty Operation

Subcutaneous nose filler materials were surgically removed in the supratip area after skin dissection after columellar incision.

The volume of nose filler materials may mislead the surgeon prior to revision rhinoplasty operation, and this should be taken into account when informing the patient about the additional tissue requirement (muscle membrane, cartilage, etc.) that may be required. When the filler materials were aspirated, it was observed that the nasal raw material became smaller and the roughness of the nasal ridge increased.

In patients who underwent nose filler injection following revision rhinoplasty, it is necessary to share with the patient the information that it may be necessary to remove the temporal muscle fascia before the planned revision nasal aesthetic surgery and that additional cartilage grafts may be needed to provide volume.

Nose Filler Removal During Revision Rhinoplasty Operation

A "complicated" revision rhinoplasty

As shown in the above photo, both adhesion and healing tissues, as well as anatomical changes due to previous surgical procedures and lack of sufficient cartilage tissue for reconstruction after filler removal cause the present operation to be "complicated".

Temporal Fascia - The Natural Filler or Nose Augmentation Material

Temporal Fascia - The Natural Filler or Nose Augmentation Material - Revision Rhinoplasty in Istanbul

After the nose filler removal, a left temporal muscle fascia graft was taken for augmentation of the volume loss on the nasal ridge. This process takes about 20-40 minutes. Revision rhinoplasty operation is a unique natural material that is planned and used for augmentation of the nose dorsum and camouflage asymmetrical areas.

Temporal muscle fascia can be obtained unilaterally or bilaterally in any desired size. During this operation, only the fascia graft was removed in the right temporal region. Two fastening stitches were placed on the fascia. In the following photos, you can see how the temporal fascia is placed and before and after.

Planned Bone Fracture: Osteotomies

Internal and external ostetomies were performed to correct the nasal axis after dissection of the nasal back and cartilages. I usually prefer to perform ostetomy by cutting a bone through a secret tunnel.

Septal Reconstruction and Nose Tip Plasty

Septal Reconstruction and Nose Tip Plasty - Revision Rhinoplasty Operation

Perhaps one of the most difficult parts of revision rhinoplasty operation operations is nasal tip shaping. This patient had asymmetric alar cartilages, insufficient nasal tip support, and the camouflage effect of the injected nose filler material before the operation. During the operation, skin dissection was performed after the columellar incision and filler material at the tip of the nose were aspirated. Asymmetric upper lateral cartilages in the supratip region and cartilage grafts were prepared for insufficient nasal tip support.

Spreader Graft - L Strut Graft - Revision Rhinoplasty Operation

As shown in the photo above, "L Strut Graft" was prepared from "bilateral spreader graft" rib cartilage and sutured with 4/0 PDS suture material.

It should be emphasized that the risks of revision rhinoplasty operation in patients who have undergone previous nasal aesthetic surgery and that the procedure is a "surprise box opening" operation. As shown here, both temporal fascia and additional cartilage grafts were required from the patient. Not all of these details can be understood before the operation.

Thicker Spreader Graft - L Strut Graft - Revision Rhinoplasty in Istanbul

In the supratip region of the patient, because there was more space in the right side, the "right spreader graft was thicker." In the supratip region of the patient, because there was more space in the right side, the "right spreader graft was thicker". It is especially important to use spreader grft in patients with weak upper lateral cartilage, nasal valve insufficiency, nasal axial deviation or inverted V nasal deformity.

Spreader Graft - L Strut Graft - Revision Rhinoplasty Operation

When the suture of the "spreader graft" and "L stut graft" was completed on the upper part of the nasal septum, the last remaining sutures were placed between the upper lateral cartilages and these inserted cartilage grafts. In this way, a large part of the back of the nose was completed.

The next step, the nasal tip aesthetics and the nasal tip, was initiated. The inner legs of the alar cartilages at the tip of the nose were sutured to the L strut.

Alar Rim Graft, Cap Graft and Columellar Graft Placed and Nasal Tip Grafts Wrapped With Temporal Fascia

As seen on the photo above, alar wings, dome, columella or cartilage grafts were placed. The outermost part was wrapped with temporal fascia for camouflage.

Alar Rim Graft, Cap Graft and Columellar Graft Placed and Nasal Tip Grafts Wrapped With Temporal Fascia

The right wing region (right side of the patient) was more collapsed and a thicker rim graft was placed on the outer leg of the right alar cartilage, as shown in the pre- and post-photograph below. The temporal fascia was also wound asymmetrically. In revision rhinoplasty, perhaps a principle is that "the last state you leave is important, not what you have taken or added!" it is that.

Alar Rim Graft, Cap Graft and Columellar Graft Placed and Nasal Tip Grafts Wrapped With Temporal Fascia

Upper lateral cartilages, nasal septum and spreader grafts were sutured to each other, alar cartilages, columellar grafts and rim grafts were sutured to each other. and temporal fascia. At this stage, the augmentation step was started with the tempral fascia to the dorsum of the nose.

Augmentation and Camouflage of The Nasal Dorsum With Temporal Fascia

Augmentation and Camouflage of The Nasal Dorsum With Temporal Fascia
- Placement of the temporal fascia on the nose

As seen in the pre- and postoperative photographs below, the patient had severe volume loss in the nasal dosrum. However, when the subcutaneous filling material was aspirated, the volume deficiency was found to be greater. A thick and wide material, the temporal fascia can be used both for augmentation of the nose dorsum (augmentation revision rhinoplasty) and for camouflage asymmetric areas on the nose.

Placement of the temporal fascia on the nose

After the temporal fascia is prepared, it is fixed with two self-absorbing sutures. In the above photo you can see 5/0 rapid vicryl sewing materials in the areas marked with arrows.

Placement of the temporal fascia on the nose

The top point of the temporal fascia is marked with a dental syringe needle and the needle of these two sutures is taken from both sides. The temporal fascia is detected by pulling upwards under the skin.

Complicated Revision Rhinoplasty With Temporal Fascia and Rib Cartilage

In the above photo and in the following, you can see how the augmentation and volume gain of the nasal dorsum after laying the temporal fascia on the nasal dorsum.

Complicated Revision Rhinoplasty With Temporal Fascia and Rib Cartilage

In the above photo and in the following, it can be seen that with the effect of spreader grafts and temporal fascia, the dorsum of the nose is filled, the inverse V reflection is eliminated, and the light refraction areas are completely eliminated.

In the above photo and in the following, it can be seen that with the effect of spreader grafts and temporal fascia, the dorsum of the nose is filled, the inverse V reflection is eliminated, and the light refraction areas are completely eliminated.