After a rhinoplasty operation performed in a different clinic, the patient, who had a scar on the nose due to tissue necrosis and long-term skin infection in the supratip region, underwent another nose operation and the scar tissue associated with the previous tissue necrosis on the nose became more apparent. When the patient came for examination and treatment, during the endoscopic examination of the nose, it was understood that there was a very thin tissue left in the supratip region, which was easily visible from the outside by light, related to the skin and subcutaneous tissue loss. The patient also stated that there was a downward sagging of the tip of the nose after the supratip necrosis. It was planned for the patient to have the supratip region covered with tissue again using scar removal and temporal fascia.
Surgical Procedure Details
The operation was started under general anesthesia (you can find pre- and post-operative images in the video above and the photographs below). After the local anesthetic injection, a 3 cm skin incision was made in the right temple area and the temporal muscle fascia was removed. The incision site was sutured. After the columellar incision, the tip of the nose and the supratip region were dissected and the skin was lifted. During the procedure, a very delicate skin dissection was performed to prevent accidental entry into the nasal cavity. The scar tissue due to necrosis in the supratip region was cut in an ellipsoid shape with a scalpel and removed. A cap graft was placed on the tip of the nose. The tip of the nose was suspended upwards with a septocolumellar suture. The temporal fascia was placed in two layers under the incision and fixed to the outside of the skin with basket sutures. Subcutaneous and skin sutures were placed. The columellar incision was sutured. Rifocin antibiotic was dropped into the incision area on the nose. The skin in the supratip region was left open and the nose was bandaged. A pressure dressing was applied to the head and the operation was terminated by controlling bleeding.
In patients with long-standing skin and subcutaneous tissue infection and necrosis, such as the one here, it is very important to avoid cautery or bipolar radiofrequency application during the operation, to cover the necrosis area with a tissue with high circulation such as the temporal fascia, and not to disrupt the mucosal barrier between the inside of the nose and the supratip area. No infection was observed in the follow-ups of this patient. I will share the photographs from the follow-ups with you.
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