Out of all the facial features the nose out stand and so as Nasal deformities.Some people are born with bad nose some have a deformed nose after a trivial trauma in Childhood but those who had a good looking face and nose ,when they get a unexpected nasal disfigurement it is sever Psychological Shock.
At the time of initial trauma bleeding, head injury and other life threatening conditions have priority ,Nose is not very important at that time usually managed by Junior on call doctors or not so experienced doctors, after the initial period these otherwise normal persons when they see themselves in mirror they have severe psychological disturbances.When all the wounds heal the Nasal disfigurement remains and affects the over all personality,many times functional problems such as Nasal blockage and sinusitis which the patient never experienced can appear.This man with a post traumatic nasal deformity covers his face whenever goes out of house.
Case 1-One soft ware engineer had a accident head injury facial trauma was hospitalized for several days recovered from head injury ,the nasal fracture was reduced ,after the healing completed ,he had a sever saddle nose deformity hated himself for the disfigured face , left job and confined himself inside house,
Case -2 A house wife survived in a major Car accident lost a closed family member ,primary care was given at the site and moved to a large hospital several days of hospitalization ,attempted Fracture nasal bone reduction but left with a ugly depressed nose. She adopted a deep silence and stopped talking to any one except the bare minimum .Otherwise a beautiful lady disfigured nose after accident seeing a psychiatrist and taking anti depressant
Case 3-A factory worker injured his nose on work deep cut and multiple fracture ,sever bleeding ,fracture reduction with repair of lacerated wound done but left with a sever depressed crooked nose with nasal obstruction
Case 4- A young man had a sever facial trauma with scared forehead and totally collapsed nose-He was ridiculed by his friends and family even his wife used to pass nasty comments ,He was considered as unlucky man by the villagers so much that he considered committing suicide but stopped short because of young children.A gave him his life back
Secondary Rhinoplasty in these cases have limitation ,a thorough counselling is required and they should understand they may not achieve the pre injury nose, the scars may be less visible but they cannot disappear
Steps of surgery-
1)Exposure-Even if there is a scar on dorsum try to expose the nasal frame work through a External Rhinoplasty Exposure
2)Open up the septum and assess the abity of the septum to support the nose,partly damaged septum can be restrenthen if there are multiple fractures it is important to build a nasal frame work which is strong and stable,the pieces of septal cartilage/Ethmoid/vomer are very useful graft material and can be used to built up the entire nose,a rib cartilage provides a strong and stable foundation and is used a invisible graft for making the nasal frame work
3)Septal perforation can be repaired at this stage
4)A floating columellar strut gives mobility to tip as well improves tip projection
5)Dorsum Augmentation-can be done by cartilage/diced cartilage/facia-A scarred skin can be expanded only up to a limit resit the temptation to achieve the perfect nose.You can augment only as much the skin permit avoid using dorsal rib cartilage grafts they very often curls and give a crooked appearance to the dorsum
6)Facial blanket below the skin-Temporalis fascia/Fascia Lata used underlying a severely scarred and damaged skin helps in giving a smooth contour ,masks graft outline which might be visible several months after the initial surgery
7)Scar Revision -If required should be done in the end
see the VDO on You tube
Most of these patients are very grateful if we can bring them even close to their appearance before the accident.One of the most exciting moment of my life when the Husband of one of my patient called me in late evenning ,saying doc thanks After many months I saw a smile on my wifes face.Thanks for giving back her real life
Akash Nose clinic Bicholi Mardana ,Indore,India Tel-91-731-2496038,4064080,09926564989
For Zoom video consultation contact on what’s app 91-7470864561 consultation fee @1000 Rs.
Typically, tip rhinoplasty procedure involves modification of cartilage of the tip of the nose.
Tip Rhinoplasty is a surgical procedure of the tip of the nose to improve nasal function by repairing an existing defect or to enhance the appearance.
Typically, tip rhinoplasty involves modification of cartilage of the tip of the nose, including excision (removal), dissection (cutting), repositioning, or augmentation to create the desired outcome.
Tip Rhinoplasty is an important part of Rhinoplasty, specially if the predominant deformity is concerning Nasal Tip such as
over projecting Nasal tip nasal tip
- Under projected Nasal tip –
“Parrot beak” or hooked nose
In this stage, the tip cartilage is modified by partial excision, dissection, repositioning, and augmentation to form a supportive framework.
Rhinoplasty is performed with general or local anesthesia to make you unconscious or numb throughout the procedure.
Tip Rhinoplasty may be performed by:
- : In this technique the surgeon makes an incision across the columella (narrow strip of tissue between the nostrils).
Once the surgeon makes an incision, defects are corrected and the incision is closed.
Broad nasal tip–
Secondary Rhinoplasty(Revision Rhinoplasty)
Secondary rhinoplasty is performed when the result of primary rhinoplasty requires further improvement.
A splint or tape is used to fix the position of the nasal bones and cartilages for one week. The patient is monitored for about 6 to 12 months.
Because this is a less invasive procedure, serious side effects are rare. Infection and numbness can occur but are very unusual. The micro-oedema over the Nasal tip takes long to settle may take 6 months to a year for Final results
Tip Rhinoplasty in thick skin patient –Thick oily skin with excess subcutaneous fat can mask the changes made in the skeletal frame work need special techniques ,may require post operative skin care and results may take 1 to 1and half year for stabilization
, Sharing full text link of our paper on septal extension graft, you can read it but can not down load ithttps://rdcu.be/cjYXJ
Silicone Implant in Rhinoplasty
1) Its economical – much cheaper than cartilage Rhinoplasty
2) Day surgery takes 30 minutes to an hour
3) Immediate results happy patient and doctor –though the Joy may be short
4) Can be done by even Doctors with limited experience in Rhinoplasty(common practice in so called cosmetic surgery clinics),No Rhinoplasty surgeon of repute will suggest Silicone implant in Modern practice ,we had revision cases where implant was placed by dermatologist and in one case by a orthopedics surgeon
Stories of patients doing well with implant at 1 year/2 year –yes but every implant will come out some day or other
we have removed implants14 years after primary operation when they come out leaves behind a severely damaged nose, sometime popping up through the skin, very difficult to salvage
Usually two surgeons are involved one who puts in the implant the other removes it. Many times the primary surgeon is not aware of the fate of the implant ,as the patient may not visit him again
The long term risks associated with silicone implants in the face outweigh the benefits and patients should be aware of the problems they can cause.
Silicone implants in the Nose can cause serious complications.
How well does the body react to silicone in the face? Often not that well. Here are some common problems with synthetic facial implants:
- Material limitations: Silicone never incorporates with the body’s surrounding tissue. Instead, the body attempts to “wall off” these implants Therefore, they can never defend themselves from infection or trauma.
- Movement: Silicone implants can shift position or get significantly displaced either while healing, or any time in the future, making the outcome less predictable.
- Imperfect matches: Many silicone implants are pre-shaped, which means that they may not conform well to an individual’s facial or nose anatomy.
- Erosion of underlying bone: Facial implants can put pressure on the facial bones on which they sit. Over time, this can cause erosion and absorption of the underlying bone.
- Infection: Silicone implants in the Nose have a significant risk of infection. Occasionally this infection occurs many years after surgery. Once infected, a facial implant must be removed.
Newer materials like Medpore ,Gortex has been developed ,suppose to have less complication but none is perfect nose does not well tolerate artificial materials
A big no to any artificial implant in Nose
Patients with cleft deformity have cosmetic problems and impaired nasal airflow as a result of distorted anatomy.These patients have septal deflections, atretic nostrils, turbinate hypertrophy, and cleft lips and palates
Cleft lip nasal deformity offers a unique challenge to the reconstructive surgeon for many reasons.
1) clinical presentation of cleft lip varies widely, requiring a host of surgical techniques.
2) deformity may be quite severely asymmetric, making surgical correction difficult.
3) patients with cleft lip may have been previously subjected to numerous surgical interventions, leading to significant scar tissue in the operative site.
Unfortunately a Good cleft lip surgeon may be not be so well skilled in Nose surgery very often patient goes back to the cleft surgeon ,who tries to correct but the results may be not be most satisfactory ,a specialist Rhinoplasty surgeon can be of better help
4) Timing of rhinoplasty, whether synchronous or staged with…
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- Rhinoplasty patients with thick skin have a significant subcutaneous fatty layer beneath the skin and this layer can hold swelling fluids (edema) for a very long time.
- Pre opreative skin preparation about 2 to 4 weeks before my exfoliants like salcylic acid face wash and topical retinoic acid may be useful
- Use of Oral Isotretion to improve the acne prone skin and reduce thickness ,though useful but Isotretion may have several side effects and need to be taken under strict medical supervision .The liver functions need to be monitored by regular blood tests.Pregnancy need to be avoided for up to 6 months after stopping Isotretion to avoid possible teratogenic side effects. We use a very low dose Isotretion 10 to 20 mg per day to reduce the incidence of side effects this need to be continued for 6 to 8 months
- Patients must be warned that it may take long…
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