Simple Camouflage Grafting in Final Control of Rhinoplasty Operation

Small Camouflage Grafts With Suture Placed Under the Skin in the Final Stage of Nose Aesthetic Surgery

When rhinoplasty surgeries are completed, the skin stitches can be partially removed and final checks can be made. Generally, the surgeon needs to check the nose from every angle and side. At this last stage, we can camouflage the sunken areas at the tip of the nose by using only small grafts. As seen in the photo above, at the end of the procedure, we can place small cartilage grafts with only one fixation suture.

How to mark where to place simple camouflage grafts?

After marking the center of the hollow or depressed areas with a dental needle, cartilage grafts or subcutaneous fibroadipose tissue can be used depending on the amount and width of the depression in the area to be placed. I usually use self-absorbing suture materials such as 5/0 PDS or 5/0 rapid vicryl to fix these grafts. In the photo above, there is a small camouflage graft placed at two points under the skin with 5/0 PDS. After one week, these sutures will be cut from the bottom of the skin.

This graft technique is very useful in leaving no dead space under the skin and in revision rhinoplasty

The photo above belongs to a patient who underwent a 3rd revision rhinoplasty. In this patient, collapsed areas were noticed on the upper parts of the wings of the nose after surgery and one small cartilage graft was placed in these areas. In these patients, when the surgery is terminated by laying the skin, these simple grafts are made as a rough finishing touch. These grafts are preferred by many nasal surgeons. They can be easily placed especially on the wings of the nose, valve area and marginal rim area. When the fixation sutures are cut from the outside of the skin after 1 week, the healing tissue continues to stabilize the grafts. These fixation stitches, which are visible from the outside, are hidden under the bandage during bandage. During the doctor's check-up 1 week later, when the tapes and external cast are removed, the parts of these fixation stitches visible through the skin are cut. Since the part that comes into contact with the cartilage graft under the skin is already self-dissolving in the body, there is no problem.

Before the bandage is applied, when the rhinoplasty surgery is completed, these simple camouflage grafts can be easily placed on the tip of the nose when viewed from different light angles. 

Below, I have shared the preoperative and postoperative images of the patient in whom I performed "3rd Revision Rhinoplasty Secondary Rib Cartilage Grafts Removal". In this patient, 3 camouflage grafts were placed with 5/0 rapid vicryl in the collapsed area on the right nasal wing immediately after the surgery, after the last control was performed. 

Tertiary Revision Nose Job Rib Cartilage Grafts Removal

In the photos and videos below, we performed a revision rhinoplasty operation on a patient with c nasal deformity who had previously undergone rhinoplasty surgery twice in different clinics. The twisted rib cartilage grafts were removed. The very thick appearance of the columella was the result of the placement of many rib cartilage grafts in this area. The patient underwent micromotor-assisted bone reshaping. Different cartilage grafts were used to eliminate the asymmetric areas at the tip of the nose. Since revision rhinoplasty operations are like opening a surprise box, many details can be understood during surgery. Generally, minor procedures and a minimally traumatic surgery should be planned.

The extremely thick appearance of the patient's columella and the fact that the nares are different from each other can be easily noticed before the surgery. There are simple subcutaneous camouflage devices on the patient's right nose wing, fixed with 3 fixing stitches (5/0 rapid vicryl). After the surgery, unilateral alar base resection - alar plasty was also performed. The nostrils are made quite symmetrical. Long-term use of nostril retanier was also recommended for this patient after surgery.

At this angle, it can be seen that the columella was sagging before surgery. Cartilage grafts placed in the columella were shaved and cartilage reconstruction was performed using the tongue in groove technique. After the procedure, it can be seen that the hanging columella is treated and a more natural appearance is achieved.

In this viewing angle, the c nose reflection on the nose can be seen in the preoperative photograph. In the photograph taken immediately after the surgery, it can be seen that the light reflection on the dorsum of the nose is in the midline.

From this angle of view, it is seen that the tip of the nose is turned to the left and there is a nose deformity. Three fixing stitches are visible as simple camouflage grafts were placed in the hollow areas on the patient's right nose wing.

In the images above, a typical natural male rhinoplasty operation has been attempted. An attempt was made to create a triangular nose tip shape for the patient, with no curves and no obvious nostrils.

To read my previous articles about camouflage graft on this website, you can click on the link group >> https://www.ent-istanbul.com/search?q=Camouflage+Graft

Source links >> Rhinoplasty: Aesthetic Augmentation With Improvement of Dorsal Aesthetic Lines | Aesthetic Surgery Journal / Male Rhinoplasty: Update : Plastic and Reconstructive Surgery

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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