Complicated Revision Rhinoplasty With Rib Cartilage

Micromotor Assisted Revision Nose Aesthetic Surgery

The patient, who had undergone rhinoplasty in a different clinic 20 years ago, applied to our clinic because of collapse of the left nasal wing, sagging at the tip of the nose, appearance of different asymmetric protrusions on the nose and nasal congestion at the same time. As a result of the patient's otolaryngology and endoscopic nasal examination, we determined the following problems:

- open roof deformity

- nasal valve collapse (left side)

- insufficient nasal cartilage support and drooping nasal tip

- C nose deformity (crooked or twisted nose)

- nasal septum deviation

Micromotor assisted open technique rhinoplasty operation was planned for the patient. Cadaveric rib cartilage was used during the operation. Bilateral low to high osteotomies were performed for the treatment of the open roof deformity of the nasal ridge and subcutaneous tissue obtained from the tip of the nose was placed on the nasal dorsum. Alar batten graft and spreader grafts were used for the treatment of nasal valve collapse. L-Strut graft was prepared to increase the cartilage support of the tip of the nose. In order to treat the deviation of the nasal septum deviation, septoplasty operation was performed.

Dom point points were replaced with dom stitche techniques in order to treat the crooked tip of the nose. Cap grafts were placed on the tip of the nose and marginal rim grafts were placed on the sides.

Unilateral alar base resection was performed to reduce the asymmetry between the nostrils.

As in the patient I shared with you above, it is not easy to repair all cartilage and bone tissue in a way that full symmetry is achieved in noses with severely altered anatomy.  Not only the altered anatomy, but also many factors such as healing reaction, suture reaction, and decreased circulation complicate the planned operation.  The information that a large amount of additional cartilage graft may be needed during the operation in patients with more than one deformity accompanying and previously operated should be shared with the patients during the preoperative examination.  In the above patient, the auricular cartilages obtained from the auricle alone will not be sufficient due to both its size and its elastic structure.  Our patient was informed that he would especially need cartilage for the shell.  After the age of 40, the risk of ossification in the rib cartilages, possible risks during and after rib cartilage grafting was explained to our patient.  Many patients choose a rib cartilage graft obtained from another human cadaver in order to shorten the operation time, avoid additional surgery, and reduce the duration of additional anesthesia. You can look this detailed article >> Premature Calcifications of Costal Cartilages: A Different Problem For Revision Rhinoplasty Operations

In this way, long-term use of Nostril Retainer may be beneficial after asymmetric rhinoplasty operations. Normally, up to 6 months, although its effect is controversial; It may be appropriate to use these products for the healing of the nostrils.

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

E-Mail: muratenoz@gmail.com 
Mobile phone: +90 533 6550199

Fax: +90 212 542 74 47