Dent After 3rd Rhinoplasty - Complicated 4th Revision Rhinoplasty

Dent at the Tip of the Nose as a Result of à Wengen Implant and Permanent Stitch Reaction

Attention: The content in this video and the photographs in this link may be disturbing!

The patient, who had previously undergone nasal surgery 3 times in different clinics, applied to our clinic due to a dent in the tip of the nose. In the patient's anamnesis, it was learned that in his last surgery, the Breathe Implant àWengen, made of titanium, was placed in the nose due to the collapse of the nasal wings. During the examination, a dent area with a diameter of approximately 6-7 mm was detected on the nose skin. An open technique revision rhinoplasty operation was planned for the patient.

The tip of the nose is the area of the nose that attracts the most attention and is very important in facial expression. Even minor asymmetries here can sometimes be disturbing for patients. The patient I shared here stated that he did not want to take photographs and that this indentation on nose after rhinoplasty was visible from every angle. Unfortunately, due to the change in the subcutaneous tissue and the formation of scar tissue, it is not possible to fill this dent area with a simple filler injection. As I shared with you here, it is ideal to remove the underlying suture materials and foreign body that caused this area to form, and to place a cartilage graft or soft tissue for filling purposes in this area. Sometimes, when dissecting areas with dents in the skin, perforation and skin injury may occur in this area. Therefore, the surgeon must be very careful when elevating the skin.

Revision rhinoplasty surgeries are always, as I always say, a process akin to "unboxing a surprise box." In cases like this patient, addressing both the elevation of the depressed area in the skin is challenging, and understanding the underlying issue is not easy. The persistent, non-absorbable suture reaction and recurrent inflammatory processes have led to this alteration. In cases like these, treatment with the closed technique is quite challenging. Open rhinoplasty, controlled tissue dissection, understanding and addressing the cause, and supporting the depressed area under the skin with an adequate amount of graft are fundamental treatment principles.

Understanding and Managing Dents After Rhinoplasty

Rhinoplasty, commonly known as a nose job, is a surgical procedure performed to reshape or reconstruct the nose. While the primary goal is to enhance facial harmony and improve aesthetic appearance, patients may occasionally experience complications or side effects. One such complication is the development of dents or irregularities in the nasal contour post-rhinoplasty.

Breathe Implant à Wengen,4. revision nose job, Dent After Rhinoplasty, Complicated 4th Revision Rhinoplasty, Nasal contour irregularities, Postoperative dent issues, Revision rhinoplasty challenges, Rhinoplasty side effects, Nasal structural integrity,

Causes of Dents After Rhinoplasty

Inadequate Cartilage Support

Dents may occur if the cartilage framework supporting the nose is insufficient or weakened. This can happen when the surgeon removes too much cartilage during the procedure, leading to a lack of structural support.

Permanent stitch reaction (foreign body reaction)

As I shared with you in this case, the recurrent foreign body reaction and tissue changes caused by the prolene suture material seen in blue color caused a dent in the skin. Breathe Implant à Wengen is made of titanium and is placed to open the nasal valve and support the lateral nasal cartilages. When fixing these implants, they should be covered with a thick layer of skin as much as possible, in other words, permanent suture materials should not be close to the skin. When the foreign body reaction to prolene sutures begins, the suture materials move towards the surface. This dent occurred due to the inability of the suture material fixed with the titanium implant to move towards the surface and permanent changes in the skin.

Scar Tissue Formation

The formation of excessive scar tissue during the healing process can contribute to irregularities or dents. Scar tissue may contract or distort the nasal structure, resulting in an uneven surface.

Over-resection of Bone or Cartilage

Aggressive removal of bone or cartilage can lead to an unnatural appearance and the formation of dents. Striking the right balance between achieving the desired aesthetic outcome and maintaining structural integrity is crucial.

Poor Healing or Tissue Necrosis

Complications such as poor healing or tissue necrosis can compromise the overall outcome of rhinoplasty. Inadequate blood supply to certain areas of the nose may contribute to the development of dents.

Managing and Preventing Dents

Choose an Experienced Surgeon

Selecting a board-certified and experienced plastic surgeon is paramount to minimizing the risk of complications. An experienced surgeon will carefully evaluate your facial anatomy, discuss realistic expectations, and employ techniques that prioritize both aesthetics and functionality.

Open Communication with Your Surgeon

Clear communication with your surgeon is essential. Discuss your concerns, expectations, and any apprehensions you may have before the procedure. This ensures that your surgeon understands your goals and can tailor the approach accordingly.

Follow Post-Operative Care Instructions

Adhering to post-operative care instructions is crucial for a successful recovery. This includes avoiding activities that could put stress on the nose, following medication schedules, and attending follow-up appointments as advised.

Consider Revision Rhinoplasty

In cases where dents have already developed, revision rhinoplasty may be considered. This involves correcting the existing issues and improving the overall aesthetic outcome. It is essential to wait until the initial healing is complete before considering revision surgery.

Dent Treatment After Rhinoplasty

It is important to understand the underlying cause and to make the skin surface smooth again by filling the dent area with grafts such as soft tissue, temporalis fascia and cartilage during the surgery. An open technique 4th revision rhinoplasty operation was planned for the patient whose photos are presented above, and during the surgery, the underlying permanent suture materials (prolene thread) and Breathe Implant àWengen were removed from the dent area. Camouflage grafts consisting of soft tissue and cartilage were placed in the collapsed skin area and all permanent threads were removed. Different cartilage grafts (obtained from rib cartilage) were placed at the tip of the nose and nose wings to support them.

While dents after rhinoplasty can be a source of concern, understanding the potential causes and taking preventive measures can contribute to a more successful outcome. Choosing a skilled and experienced surgeon, maintaining open communication, and following post-operative care instructions are key steps in minimizing the risk of complications and achieving the desired aesthetic results. If dents do occur, timely consultation with your surgeon can help explore appropriate solutions, including revision rhinoplasty, to address the issues and restore a natural and pleasing nasal contour.

Below are the preoperative, intraoperative, postoperative and postoperative 1st week photographs.