Reconstructive Rhinoplasty

The Rhinoplasty Clinic Pte Ltd.

Post Trauma

Overview

According to studies, of all the facial structures, the nose is considered as one of the most frequently broken bones on an individual’s face. Following activities can cause damage to a person’s nose:

  • Outdoor activities
  • Rigorous exercises
  • Sports
  • Boxing

According to the recent research findings, contact sports (including baseballs, soccer balls, elbows, etc.) are primarily the leading causes of the nose fractures, amounting to nearly 25% of the total broken noses worldwide.

Trauma is common in high energy injuries in which the septum is fractured beyond “salvage” and rib harvest may be necessary. Unfortunately, whether the septum is “salvageable” or not can be only discovered during the surgery. Therefore, you should always explore with your surgeon beforehand (72 hours post trauma) what are the options available, should the septum be “non salvageable”.

Injured Nose After Rhinoplasty

A nose structure is a sensitive area of the human anatomy. It is composed of intricate and small parts, which are interconnected to create an appropriate shape of the nose. Post trauma, especially in an injured nose after rhinoplasty, a number of catastrophic changes may occur, including damaged cartilage, internal deviations, broken bones, difficulty in breathing, and asymmetries (both inside and outside the nose). In addition, bleeding may also occur, which may cause blood clots around the fractured nose’ nasal septum. This may block off the regular blood flow in the nose, eventually causing the septal hematoma (i.e. severe damage to the cartilage partition of the nose airways). As a

Treatment

Fixing a damaged nose due to an accident or a trauma is the trickiest job, which might take into account the reconstruction of numerous parts of the damaged nose. Such damage may affect a person’s:

  • Nasal bones
  • Cartilage
  • Soft tissues
  • Septum
  • Nose skin

In fact, a fractured septum and/or displaced nasal bones can lead to nasal obstruction, which in turn, can further cause breathing problems. Therefore, selecting an experienced surgeon capable of performing corrective rhinoplasty is critical.

In a reconstructive rhinoplasty, the facial plastic surgeon will straighten the crooked nose, rebuilt a saddle nose, and reopen the blocked airways. This can significantly improve a patient’s regular quality of life by correcting their exercise tolerance, energy level, and sleeping process.

Saddle Nose

A saddle nose is a medical condition linked to nasal trauma, wherein a person’s nose bridge has a visible concavity. This nose deformity mainly results from the collapse of the keystone area. This is often the result of a septoplasty or SMR procedure performed for nasal obstruction whereby too much cartilage was taken from the patient’s nose. Due to the loss of this internal cartilage support, a deformity develops in the patient’s nose leading to a foreshortened or excessively up-turned nose tip along with the retraction of the columella. Trauma or previous infections can similarly cause collapse of the keystone resulting in a saddle nose. The ideal correction to fix saddle nose is to restore the structural supports that had been disrupted.

Saddle Nose Deformity Causes

Some of the common factors that instigate a saddle nose deformity in a person include:

Congenital Malformations: These imperfections appear in the foetus itself and are a result of the exposure of a pregnant woman to peripheral factors in the initial months of pregnancy.

Hereditary or Genetic Factors: Such people have either a big nose or mushroom/small nose.

Drug Abuse: Another reason of saddle nose deformity in a person is Cocaine addiction.

Leprosy: It is an infectious disease that leads to nose and skin issues.

Venereal Diseases: Some of the sexually transmitted diseases may infect both the mother as well as may be passed to the foetus, thus causing saddle nose deformation.

Malignant Tumors: These cancerous tumours infect a person’s skin, which may in turn, lead to nose distortion.

Wrong Nose Surgery: Rhinoplasty surgeries may, at times, result in damage to the supporting nose bones.

Injury: Accidents and rigorous exercises may also lead to fractures in the nose bones causing distortions.

Rhinophyma: Inflation in the fatty skin glands of the adults is also a reason of an nose abnormal nose.

Types of saddle Nose

Depending on the degree of distortion, a saddle nose may be:

Severe Deformity: Such people have acutely depressed nasal dorsum, accompanied by external nasal deformity.

Mild Deformity: In this case, the individuals suffer from an insignificant nasal collapse with mildly flattened nasal dorsum, which makes their nasal appearance unnatural.

Moderate Deformity: Such people have a wide nose bridge and flat nasal tip leading to shorter length of their nose.

Saddle Nose Treatment

Some of the common ways of treating a saddle nose deformity include:

Septal Operation: In this procedure, septal structures are manipulated to achieve a correct alignment along with counteracting the nose deformity.

Nose Elevation: The procedure includes elevating a depressed nasal tab with a mechanical device. This method is, however, considered as a poor way of curing the saddle nose as it may lead to serious injuries and complications.

Skin Grafting/ Rib Grafting: In this procedure, a person’s saddle nose deformity is corrected by using his/her own cartilage or rib grafts, which are used for building the nasal dorsum

Rhinoplasty: A reconstructive rhinoplasty procedure can treat a person’s nasal septum.

Inferior Turbinate Surgery: In this surgery, the patient’s inferior turbinate is sectioned and dissected with scissors to leave the periosteum intact. This procedure is particularly favorable for reshaping the saddle nose as its cost is relatively low compared to other methods.

Silicon Droplet Method: A microdroplet method makes use of silicone for correcting the nose deformity. This method may cause fibroblastic reaction that may take months to correct the area while causing infection, skin necrosis, granuloma formation, and small vessel thrombosis.

Filler Necrosis

A filler is a material injected by a surgeon to augment volume in certain parts of the body. In non-surgical rhinoplasty, surgeons use injectable fillers (such as Juvederm, Restylane, and Radiesse) to modify and alter the shape of a person’s nose without using invasive surgery.

Even though these fillers (especially silicone fillers) have been used for decades to fix minor deformities related to the nose, they are associated with dreaded complications in the long term. For instance, in some cases, it has been observed that the blood vessel may get blocked from the filler injection and cause the tissues supplied by that particular blood vessel to die. In pathology, it is referred as necrosis. As a consequence of this, redness and pain can occur in a patient within hours of injection.

In this regard, it is imperative to seek expert advice immediately to avoid the disastrous consequence of skin gangrene. In cases where the skin has turned gangrenous, it may eventually lead to scarring and disfiguring of the nose. Often, corrective surgery is performed in such cases. This involves moving fresh skin from the face to replace the destroyed skin.

Risks & Complications Associated with Fillers

There are some common complications associated with non-surgical rhinoplasty, such as:

  • Bruising
  • Scars
  • Lumps
  • Swelling may occur in the injected area (lasting up to 48 hours)
  • Asymmetry: as one side of the patient’s nose can become better than other post treatment
  • Prolonged redness in the injected area

However, the surgery can have some critical side effects as well. Listed below are some of the signs of necrosis after rhinoplasty:

  • Infection: It is a very rare complication and can become a life-threatening disease like toxic shock syndrome.
  • Necrosis of Eyelids: It may even lead to blindness.
  • Vascular Compression: If excessive amounts of dermal fillers are used in a surgery, it may cause vascular compression of nose and skin.
  • Rhinoliquorrhea
  • Brain Damage
  • Discoloration of Incisors

Reconstructing The Deformities

In those cases where the previous rhinoplasty went wrong, patients may develop a serious infection, which in turn, may destroy some of their good nasal tissues. By reconstructing the nose from the person’s own body parts (including cartilage from ribs, ear, or skin grafts from thigh area, etc.), a rhinoplasty surgeon can replace the damaged or missing tissues.

Since the reconstruction of nasal tissues is an intricate procedure, it requires specialized knowledge to achieve the desired results. Dr. Tan is the best nose surgeon with in-depth expertise in performing reconstruction nose surgeries.

Cleft Nose and other congenital deformities

Cleft Noses & Other Congenital Deformities

Development of congenital nasal abnormalities encompasses diverse conditions, such as:

  • Hypoplasia & Atrophy
  • Neoplasms & vascular anomalies
  • Hyperplasia & duplications
  • Clefts

These anomalies, including clefts, occur due to a spectrum of malformations that range from minor grooves developed at the side of a person’s nose to major nose defects necessitating complex surgery. These congenital deformities are frequently associated with problems like Goldenhar’s syndrome and cleft lip and palate.

Cleft noses are disfiguring and can cause significant psychosocial problems. These can be corrected to restore to a normal appearance. However, this may take several surgeries over a course of months to years to achieve the desired result.

Cleft Nose Rhinoplasty

The reconstruction of a cleft nose deformity or cleft nose rhinoplasty is considered as a significantly different and difficult procedure in comparison to a standard rhinoplasty procedure as the anatomy of an individual’s cleft nose is twisted with misrepresented cartilage shape. In addition, their nose is often depicted with a scar tissue as a result of previously performed surgeries.

It is important to note that:

  • Cleft lip nose revision is usually performed for patient below the age of one year
  • In some patient with post cleft nose rhinoplasty, the nasal deformity may continue to persist
  • An open rhinoplasty technique is usually performed to modify and adjust the nose cartilage in an appropriate proper position

Dr. Tan combines the principles of nasal reconstruction to cosmetic rhinoplasty in order to restore the function of the patient’s nose while fixing the cleft nasal deformity. He deploys individualized techniques to shape the nose of each patient and uses a sequence of suture as well as cartilage grafting methods to attain the desired outcomes. Being the best rhinoplasty surgeon, he aims at improving the nasal function and appearance of each cleft nose.

Post Cleft Nose Rhinoplasty

Patients with cleft nose deformity reconstruction may occasionally experience bruise around their cheeks and eyes as well as nose swelling for following the surgery. Therefore, a nasal stent or nasal splint may be applied to the patient’s nose for seven days to minimize swelling. However, the patients can resume their normal activities after two weeks.

Nasal Cancers

Tumors established within a person’s nose area can be either malignant (cancerous) or benign (non-cancerous). In all cases, those affected with nasal cancer frequently go through an advanced surgical procedure to confiscate the cancerous tissue/s. This is subsequently followed by a reconstructive rhinoplasty to help the person restore or improve the former shape of the nose.

Nasal cancers often leave large defects in the nose. Proper reconstruction should aim not just to “patch the hole”, but to restore a normal looking nose.

Symptoms of Nasal Cancer

Some of the common nasal cancer symptoms include:

Nasal Cancer Treatment

Once the nasal cavity cancer is diagnosed by the doctor, a number of tests are performed to identify if the cancer cells have multiplied to other parts of the patient’s body. Afterward, surgical removal of the nasal cancerous cells is excised by using radiation therapy or chemotherapy. The process prolongs until the patient’s nasal layer is cancer-free.

Reconstructive Rhinoplasty – The Next Step

Following the radiation therapy, many patients develop wounds. In order to repair these wounds, best plastic surgery clinics in Korea have top rhinoplasty surgeons to perform reconstructive nose plastic surgery.

Reconstructive rhinoplasty surgery for the nose cancer comprises of the replacement of the nose skin, nasal bone, cartilage, and other surrounding tissues. Following are the procedure followed by a rhinoplasty surgeon:

  1. In most cases, using a patient’s own tissue for the nasal reconstruction is preferred by a rhinoplasty surgeon in order to avert the potential risks of rejection. If your surgeon has removed cartilage during the cancer treatment, a cartilage graft is required for reshaping the nose.
  2. In case a patient has developed a scar tissue during the therapy, then advanced treatment methods (such as dermabrasion or laser resurfacing) may be used to address the condition.
  3. If a patient’s nose is disfigured during the cancer treatment, often cosmetic or reconstructive (or a combination of the two) rhinoplasty is performed to reshape the nose and restore the person’s aesthetic appearance.

Risks of Reconstructive Rhinoplasty

Some of the potential risks involved in performing reconstructive rhinoplasty post the nasal cancer treatment are:

  • Development of nose infection
  • Tenderness or pain at the site of surgery
  • Hematoma
  • Wound Bleeding
  • Itching
  • Temporary numbness
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