A Revision Nose Job on a Patient with Nostril Stenosis, Alar Retraction, and Pollybeak Deformity
A patient presented to our clinic for treatment after developing severe nasal obstruction and various deformities following three prior rhinoplasty procedures at a different clinic. Examination of the patient revealed the following:
- Soft-tissue "pollybeak" deformity
- Left nostril stenosis and severe narrowing of the internal nasal passage
- Retracted ala (more pronounced on the left)
- Left alar collapse
- Various scars on the columella
- A depressed scar area with a protruding hair, located immediately to the left of the columella
A fourth revision rhinoplasty using an open technique was planned. A temporal fascia graft was harvested from the right side; as the patient's own nasal cartilage was sufficient, no additional rib cartilage graft was required.
The procedures performed on the patient were as follows:
- Two-level dissection and subcutaneous tissue excision in the supratip area
- Resection of stenotic tissue and placement of bilateral marginal rim grafts (with greater emphasis on the left side)
- Placement of a septal extension graft
- Placement of a cap graft
- Resection of the columellar scar area containing a protruding hair
- Covering of the nasal tip cartilages with fascia graft and placement of fascia graft in the area of the retracted left ala
- Smoothing of the nasal dorsum using a micromotor
- Placement of a fascia graft over the nasal dorsum
The PDS sutures visible on the patient's nasal tip and dorsum are the sutures securing the basket grafts. Removal of these sutures was planned for one week post-operatively.
Before-and-after images of the procedure are provided below:
Risks and Surgical Challenges of the Complex Revision Rhinoplasty Performed on the Patient
- Since repeated surgeries involve progressively altered anatomy and the formation of additional scar tissue, tissue dissection during the operation is significantly more difficult.
- To minimize the risk of circulatory impairment and infection post-operatively, surgical trauma must be kept to an absolute minimum.
- The patient's skin is quite irregular and altered. There is a risk of skin perforation and infection in areas affected by previous scarring or infection.
- Had there been insufficient cartilaginous support, it might have been necessary to harvest a graft from the patient's own rib.
- Nostril stenosis—resulting in the near-total closure of the left nasal airway—is a recurrent condition that is difficult to treat. Prolonged use of internal silicone nasal splints post-operatively may be beneficial.
- The patient presents with a "pollybeak" deformity in the supratip region due to thick subcutaneous tissue. To prevent excessive soft tissue regrowth post-operatively, the patient may need to perform nasal taping and use medication—such as Zoretanin tablets—that inhibits fibro-adipose tissue formation.
- In general, the recovery period following revision rhinoplasty is longer.
- After placing grafts in the retracted alar region, the skin incision could not be closed directly; instead, the cartilage grafts were covered with fascia. Suturing is difficult when grafts are placed in retraction zones characterized by already tight and scarred tissue.
You can read articles related to "nostril stenosis" prepared by Dr. Murat Enöz and published on this website via this search result link (you can see the articles by clicking on "more posts" at the end of the page) >> https://www.ent-istanbul.com/search?q=nostril+stenosis
You can read articles related to "complicated rhinoplasty" prepared by Dr. Murat Enöz and published on this website via this search result link (you can see the articles by clicking on "more posts" at the end of the page) >> https://www.ent-istanbul.com/search?q=complicated+rhinoplasty
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon
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Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
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