Nose Sagging After Septum Deviation Surgery!
Septum deviation can cause narrowing of the airways and nasal congestion in the nose. Link to the detailed article I wrote about the symptoms, diagnosis, types and treatment of nasal septum deviation >> Nasal Septum Deviation - Symptoms, Diagnosis and Treatment
In patients with nasal obstruction, if nasal septum deviation and associated airway stenosis are detected in the endoscopic nasal examination, if the patients have symptoms such as sleeping with an open mouth related to nasal obstruction, breathing with an open mouth while walking on the road, and decreased sleep quality, septoplasty operation can be planned. The procedure performed here consists only of resection of the curved areas in the nasal septum. In other words, the least possible atomic change is aimed. Especially in patients with caudal septum deviation, since the deviated nasal septum contains the "caudal septum", which is one of the basic structures responsible for nasal tip support, severe nasal tip support tissue loss, softening of the nasal tip and backward - downwards after resection of this area only. can cause correct movement in other words, the lack of replacement of the resected caudal septum with a new cartilage graft during the caudal septoplasty operation and the decrease in the nasal type support tissue due to this can be counted as the first reason. After the septoplasty operation, the second reason for sagging at the tip of the nose is "traumatic surgery", "excessive septal resection". Each tissue in the nose has a different importance and specific task. Although it is not curved, after excessive resection of the nasal septum, very different deformities such as sagging at the tip of the nose, collapse of the nasal dorsum (saddle nsoe deformity), boxer's nose may occur. "Minimal surgical intervention" and "respect for anatomy" are the most important rules.
Health Insurances Don't Cover "Nose Tip Aesthetics Operation" During The Caudal Septoplasty
The caudal part of the nasal septum may be dilated and become both an aesthetic and functional problem, which can also be seen from the tip of the nose, in patients who fall on the tip of the nose as a child or in patients who receive a direct blow to the tip of the nose for various reasons. In many countries, general health insurances and private health insurances cover the septoplasty operation, which includes resection and removal of the caudal septum or partial replacement of the caudal septum; It does not include surgery that includes cartilage graft placement at the tip of the nose and restructuring of the nasal cartilage support, considering it as "nasal tip aesthetics". Since many patients are told that they can "reshape the nose tip" at the same time if an additional fee is paid, patients only accept the operation in the form of caudal septum resection. In this case, sagging at the tip of the nose and downward orientation is inevitable.
As Soon As Caudal Septum Resection Is Performed, Re-Cartilage Graft Application Is Required!
In patients with deviation of the cubal septum, if the dislocation is not severe, the caudal septum can be re-dissected and placed posterior to the columella in the midline. You can check the link about this subject and the swinging door technique >> Caudal Septal Deviation
When the deviation of the caudal septum (or anterior septal dislocation) is so advanced that it protrudes into the nostril at the tip of the nose, the curved septum section is resected and a cartilage graft such as a columellar strut graft can be placed in place of the resected section at the same time. During this operation, instead of removing the caudal septum and throwing away the resected cartilage; Immediate restructuring of the nasal tip cartilage support is appropriate. Planning a second operation, instead of removing the rib cartilage or auricular cartilage from the patient, the emergence of nasal deformity, giving unnecessary anesthesia for the second time, since there is not enough cartilage; It is appropriate to perform both caudal septoplasty and nasal tip operation at the same time. After a limited amount of caudal septum resection, the procedure may not be necessary, but if there is softening of the nasal tip and loss of support tissue after the procedure, it is appropriate to perform the nasal tip surgery at the same time. In patients with advanced caudal septum deviation, I generally prefer to complete the procedure as an open technique septoplasty operation.
Treatment Plan for Dropped Nose Tip After Septoplasty
In patients with nasal tip drooping or sagging at the tip of the nose after nasal surgery, a treatment plan can be determined after a detailed nasal examination of the patient.
In patients with excessively soft nasal tip and insufficient cartilage support during the examination, it may be planned to use an additional cartilage graft such as the patient's auricle, the patient's rib or cadaver cartilage.
By using additional cartilage grafts, it can be planned to apply different grafts and suturing techniques such as L strut, Septal extension graft, columellar strut graft, septocolumellar suture technique, alar dome suture techniques, cap graft. The nasal tip support, which was removed and weakened in the previous nose surgery, is tried to be strengthened by placing a cartilage graft again. This operation is also personal and different techniques can be used in patients.
Auricular cartilage is not very suitable for nose tip lifting!
Since the cartilage of the auricle is very soft, it is more ideal to use rib cartilage in patients with very weak nasal cartilage support (patients who have undergone severe septal resection and do not have enough cartilage graft space). The endurance of the auricle cartilages against gravity may not be enough, and over time, sagging or falling off the tip of the nose may occur again. As a simple logic, the rib cartilage is resistant to very severe pressure and regular force application, it is a thicker and harder cartilage than the nasal septum, besides, the auricle cartilages are very soft in order to only shape our ear and flex with repetitive motion, so its load-bearing feature is like rib cartilage. is not.
Grafts obtained from the auricle can be used as an alar batten graft placed on the sides of the nose wings, as a spreader graft placed to widen the nasal valve area, and as a graft placed on the tip of the nose. The auricle cartilage is not ideal for grafts such as L strut graft, columellar strut graft, septal extension graft, which are used to increase or reconstruct the nasal tip support. It is used more frequently in revision nose surgeries because the rib cartilage has a very strong structure and is more resistant to pressure. Oblique incision techniques are available to reduce the risk of spontaneous bending and deformation of the rib fracture by at least six. In patients with weakened nasal tip test cartilages, nasal tip cartilage reconstruction can be achieved by using graphics obtained from rib cartilages. It is more appropriate to use rib cartilages because the cartilage obtained from the auricle is very curved and elastic, and the amount of craft that can be taken is limited. rib cartilages can be used both from the patient's own rib region and as cadaver rib cartilage belonging to another human being.
Nasal tip suspension stitche technique alone is not enough for patients with nasal tip drooping after septoplasty operation!
The technique of suspending the nasal tip cartilages upwards, which is a method of nasal tip lifting, which I do not like very much, using non-dissolvable stitche, alone is not sufficient for these patients who have nasal tip drooping after nasal surgery. It is the ideal application to place the cartilages similar to those found at the tip of the nose in normal anatomy as grafts and to construct a permanent nasal cartilage support. In other words, in patients with sagging and spreading at the tip of the nose after septoplasty operation, not simple suture techniques; cartilage graft applications, including larger surgical applications, are required.
A Case Example of Nasal Tip Sagging and Nasal Deformity After Septoplasty Operation
A 23-year-old male patient had deformity of the nasal tip and nasal blockage after a previous blow to the tip of the nose. In a different country, a diagnosis of caudal septum dislocation was made and a closed technique septoplasty was performed (probably a dislocated caudal septum resection, which lasted 10-20 minutes). In the patient's statement, it was said that since additional plastic surgery would be required, an operation in the form of nasal tip aesthetics could be performed at the same time if an additional fee was paid. After the cartilages resected here were removed from the nose, a shape change began within a few months, starting at the tip of the nose, drooping down, spreading at the tip of the nose when laughing, and elongation and enlargement of the nose when viewed from the front. When the patient came to our office, we found that the tip of the nose was quite soft and broad. We performed an open technique rhinoplasty operation using rib cartilage. In the patient, the L strut was reconstructed. When viewed from the side, the preoperative nose photos looked as if there was a nasal bridge, as there was severe drooping and backward drooping at the tip of the nose. At the tip of the nose, it was directed anteriorly and upwards with cartilage grafts, and the nasal bridge became less visible. Here, the tip of the nose in the post-operative images will move slightly backwards and downwards in a few months. It may seem uplifted to you, but after a few months it will feel much more natural.
Images of the patient before and after:
While Only Septum Resection with Closed Technique is a Few Minutes; Complicated Nose Surgery May Be Required For The Treatment Of Deformity That May Occur!
After the septoplasty operation, many different problems such as sagging at the tip of the nose, nasal septum perforation, saddle nose deformity may occur. As in the patient I shared with you above; It may be necessary to perform long-lasting major nose surgeries in which rib cartilage is used unnecessarily. In septoplasty operations, it is appropriate to preserve the septum cartilage as much as possible, especially in the septum, and to preserve the L-shaped septum so that the nasal support is not disturbed. In other words, the most anterior part and the lowest part of the virtual septum should be protected as a block. How easy is it to cut out a tissue; it can be so difficult to create a replica of the same texture and place it.
In the video above, you can see the images before and after the open technique septoplasty + nose tip lifting operation performed on a patient with severe support tissue loss at the tip of the nose. In this patient, no shape changes were made at the tip of the nose and a limited amount of nasal tip lift was performed, and the nasal tip cartilage support was reconstructed. In this process, the result is permanent and the "nose tip suspension with stitche" technique, which is made with simple sewing techniques, is not used.
You can find information about "Droopy Nose Tip - Nasal Tip plasty in Men Istanbul" in the video above.
You can find information about "Nose Tip Plasty Operation For Treatment of "Droopy or Ptotic Nasal Tip" in the video above.
You can find information about "Nose Tip Plasty – Nose Tip Lifting in Istanbul, Turkey" in the video above.
You can find information about "Nose Tip Plasty" in the video above.
In the video above, there are pictures of the nose before and after the operation of the patient who underwent nasal tipplasty with a limited amount of hump reduction together.
You can find information about "Nose Tip Lifting + Nose Root Filling Without Hump Reduction and Bone Touching" in the video above.
You can find information about "Treatment of Nose Tip Drooping and Nasal Valve Collapse Due to Previous Nasal Surgery and Trauma" in the video above.
You can find information about "Micromotor Assisted Tertiary Revision Rhinoplasty For Thick Skinned Nose" in the video above. In this video, cartilage grafts were placed on the patient's nose tip, and the nose tip was lifted.
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon
Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
Appointment Phone: +90 212 561 00 52
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