Tertiary Revision Nose Job For
Patient With Necrosis and Holes in Different Areas on the Tip of the Nose
As a result of the examination of the patient, who had previously undergone two rhinoplasty operations in different clinics and presented with different deformities in the nose, the following problems were detected:
- Tissue loss as a result of necrosis in the columella
- Drooping nose tip
- Collapse under the skin due to necrosis in the nasal wing and tip of the nose
- Perforation on the wing of the nose (such as a piercing hole)
- Synechiae on the right side of the nose (between deviated septum and left inferior turbinate)
- Irregularities were detected in the nasal skin.
Harvesting of Temporalis Fascia
Video - Preparation of the temple area before graft removal
The temple area where the temporalis fascia will be obtained is wiped with an antiseptic solution such as batikon, and after a horizontal incision of approximately 2-3 cm, the temporal fascia is excised and removed.
Preoperative and postoperative practical information about harvesting of temporalis fascia
. For temporalis fascia harvesting, a haircut is not necessary.
. The incision area made during temporalis fascia grafting usually becomes invisible within a few weeks.
. Stitches placed in the grafted area can usually be removed after 10-12 days.
. It is sufficient to apply a pressure head bandage for 1-2 days after the procedure (this bandage is applied to prevent hematoma).
. There is usually no serious pain after the procedure, except for pain due to the compressive head wrap.
Temporalis fascia is a unique camouflage tissue in revision rhinoplasty!
Temporalis Fascia as Biomaterial
Temporalis fascia is a highly circulatory tissue that belongs to the patient and is used as a natural camouflage material under the skin, especially in patients with subcutaneous irregularities and repeated nose surgeries. It is very useful to obtain such a viable material, especially in patients at risk of circulatory disorders.
While it can be used to repair nasal septum perforation, it can also be used to fill collapsed areas of the skin and to close the perforation on the wing of the nose, as in this case.
The role of temporalis fascia
At the heart of this innovative approach lies the utilization of Temporalis Fascia, a thin, pliable tissue harvested from the patient's own temporal region. This autologous material offers unique advantages, such as biocompatibility and reduced risk of rejection, enhancing the safety and effectiveness of the surgery.
Tertiary Revision Nose Aesthetic Surgery With Temporalis Fascia
The patient underwent revision rhinoplasty using rib cartilage and temoralis fascia. During the operation, two-layer grafts containing cartilage + fascia were prepared and placed on the areas of necrosis on the forehead. The necrotic area in the columella was removed and a graft in the form of an extension graft was placed on the septa. Cap grafts and different cartilage grafts were placed on the dome points of the alar cartilages. Left lateral alar crural graft, batten graft, and right marginal rim graft were placed. Mucosal adhesion - synechiae (intranasal adhesion) in the right nasal cavity was cut, septoplasty and left inferior turbinate radiofrequency were performed. The skin in the necrotic hole area on the nasal wing was cut and excised. It was sutured with 5/0 prolene suture material. Under the skin at the tip of the nose, the cartilage grafts were wrapped with thermoporal fascia graft. Stitches were placed and at the end of the procedure, grafts prepared from cartilage and thermal fascia were placed in the hollow areas under the skin as camouflage grafts and were removed from the nasal skin as a single tongue. Although it is a very detailed operation, it is shared as summary information. Due to the irregularity of the patient's nasal skin and the presence of serious irregularities, this surgery is a complicated revision rhinoplasty operation.
Understanding Skin Necrosis at the Tip of the Nose After Rhinoplasty
Rhinoplasty, commonly known as a nose job, is a surgical procedure that aims to reshape or reconstruct the nose for both cosmetic and functional purposes. While it is generally considered a safe procedure with high success rates, like any surgery, it carries certain risks and potential complications. One such rare complication is skin necrosis at the tip of the nose, a condition that can cause significant distress for both the patient and the surgeon.
Causes of Skin Necrosis
Skin necrosis refers to the death of skin tissue, and when it occurs at the tip of the nose after rhinoplasty, several factors may contribute to its development.
Poor Blood Supply
The nose has a complex vascular network that supplies blood to the skin and underlying tissues. During rhinoplasty, the blood supply to the nasal tip can be compromised, leading to reduced oxygen and nutrient delivery. Factors such as excessive tissue manipulation, trauma, or disruption of blood vessels can contribute to poor blood supply, resulting in skin necrosis.
Infections can occur after surgery and, if left untreated, may contribute to skin necrosis. Bacterial infiltration can compromise the blood vessels and lead to tissue death. Surgeons take precautions to minimize the risk of infection during and after the procedure, but it remains a potential factor.
Tension and Pressure
Excessive tension or pressure on the skin at the nasal tip can impede blood flow. Swelling, hematoma (accumulation of blood outside blood vessels), or tight bandaging may cause increased pressure, leading to compromised blood circulation and subsequent skin necrosis.
Underlying Medical Conditions:
Pre-existing medical conditions, such as vascular disorders or autoimmune diseases, can affect the healing process and increase the risk of complications. Patients with these conditions may have a higher likelihood of developing skin necrosis after rhinoplasty.
Prevention and Management
Preventing skin necrosis involves careful preoperative assessment, meticulous surgical technique, and postoperative monitoring. Surgeons take precautions to preserve the blood supply, minimize tissue trauma, and reduce the risk of infection.
In cases where skin necrosis does occur, prompt intervention is crucial. Treatment may include:
Topical Treatments: Applying specialized dressings, ointments, or medications to promote healing and prevent infection.
Debridement: Removal of necrotic tissue to encourage healthy tissue regeneration.
Reconstruction: In severe cases, reconstructive surgery may be necessary to address the damaged tissue and restore the aesthetics of the nose.
While skin necrosis at the tip of the nose after rhinoplasty is a rare complication, understanding its potential causes is essential for both patients and surgeons. A thorough preoperative assessment, adherence to surgical best practices, and vigilant postoperative care can significantly reduce the risk of this complication. In the event that skin necrosis does occur, timely and appropriate intervention is key to achieving optimal outcomes and minimizing long-term consequences for the patient.
The link where you can read the articles I have previously published about revision rhinoplasty on this website >> https://www.ent-istanbul.com/search?q=revision+rhinoplasty
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon
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
Mobile phone: +90 533 6550199
Mobile phone: +90 533 6550199
Fax: +90 212 542 74 47