Possible consequences after rhinoplasty. When is revision rhinoplasty required? How is straightening a crooked nose performed?

Rhinoplasty is considered one of the most complex plastic surgery operations performed on a person’s face. Of course, many plastic surgeries are considered complex and last more than one hour, but rhinoplasty is a special procedure.

Each patient must be carefully examined and possible nasal imperfections examined.

After this, you need to draw up a precise action plan for correction. And the operation must be performed by an experienced surgeon whose technique has been practiced for years, otherwise complications after rhinoplasty can be very disastrous.

• Complications can appear not only after surgery, but also during surgery, and it is simply impossible to ignore them, since some of them threaten the patient’s life.
• It is more difficult to deal with aesthetic complications, since the future shape of the nose and its tip completely depends on the vision of the surgeon and the desires of the patient.
• Approximately 2% of clients who turn to plastic surgeons need the help of a psychiatrist, since dissatisfaction with their appearance lies in the person’s psycho-emotional disorders.

From a practical point of view, the nose has its own parameters. The ratio of the width and height of frontal, transverse and basal defects. Rhinoplasty allows you to change these parameters and bring them to a normal ratio without affecting the functional structure of the body.

Often, after surgery, the patient remains dissatisfied with the result. This may be due to the following reasons:

• Unprofessional surgeon. Plastic surgery is an expensive procedure that many doctors tend to do to make a lot of money. However, not everyone has sufficient experience and knowledge to carry out the procedure effectively and safely for humans. Feedback from many clients suggests that not every surgeon can do everything right.
• Failure to comply with the rules of preparation for surgery and the postoperative period. Often, clients themselves, ignoring the recommendations of doctors, become guilty of developing certain complications after rhinoplasty.
• Improper scarring of skin tissue, which leads to a change in appearance for the worse.

The doctor prescribes individual recommendations for each client to prepare for surgery and for rehabilitation. They must be strictly adhered to.

• Do not smoke 14-20 days before surgery, as nicotine negatively affects tissue repair.
• Do not take aspirin or other drugs that affect blood clotting.
• During rehabilitation, physical activity is prohibited, which can lead to tissue rupture and bleeding.
• You should only sleep on your back, placing a cushion under your head, which will help quickly remove swelling from your face.
• Do not go to the sauna, bathhouse, swimming pool, or even take hot baths for 15 days, so as not to wet the bandage.

Specific recommendations may also be given:

• For a couple of weeks after the procedure, a plaster bandage is applied to the nose, which cannot be removed under any circumstances.
• Also, during rehabilitation you should not eat hot or cold food.
• Do not blow your nose or wear glasses for up to 2 months, so as not to deform your nose.

Rhinoplasty of the nose: nasal deformation and other consequences

Complications may occur immediately after surgery. The main consequences of nose rhinoplasty are considered to be the creation of a barrier to breathing. After the breathing tube is removed from the nose, doctors begin to suck blood from the organ, which can cause spasms in the larynx. In this case, you need to take medications for muscle relaxation or ventilation. Using tampons or splints is also a common cause of heavy breathing.

An acute allergic reaction may occur after antibiotics are administered during rhinoplasty. There have also been cases of anaphylactic shock with the introduction of tampons with bacitracin.

After injection of vasoconstrictors, some patients partially lose their vision. It may return over time, but there have been cases where vision could not be restored.

In 4%, bleeding occurs, which is easily stopped with vasoconstrictors or cauterization of the torn vessel.

If a hematoma appears, the condensed blood must be sucked out every day to clear the airway. Sometimes it is even necessary to cut the skin and install a drainage device to prevent the formation of an abscess.

In 2% of cases, infections develop. They are removed by drainage or antibiotics.

Sometimes there may be a deformation of the nose after rhinoplasty. There is a variety of displacement, drooping, swelling and tilting in a certain direction.

Attention

One of the unpleasant situations is a step-like deformation, when the boundaries between the bone and cartilage areas of the nasal septum become visible. This defect can develop even in people without nasal injuries.

Patients with small bones, thin skin and large differences in width are susceptible to such changes.

The reason for this change may be a shift in the upper cartilage, which appears after the nasal bridge has drooped. Even when a small nasal hump is removed, the connection of the upper cartilages is disrupted, so they can move downward.

Correcting such a curvature is very difficult. If the appearance has not changed much and the curvature is not so noticeable, the clinic’s doctors do not recommend repeat surgery to correct this error.

• After surgery, an infection may develop and the skin of the nose will begin to die.
• This can ruin the results of even the most successful plastic surgery.
• It is necessary to take special hormonal injections that will reduce the size of the scar.
• After which it is recommended to use lasers and repeat surgery to remove scars.

Attention

Deformation of the nose into a saddle shape does not appear often and occurs due to the fact that the doctor improperly sawed off the cartilaginous back. Perforation of the septum occurs in 3-20% of cases. For small holes, surgical closure is performed.

If the transverse cartilage is improperly cut down, the nasal valve may begin to deteriorate, making it difficult for the patient to breathe and requiring repeat surgery.

The narrowing of the nasal passages is caused by cutting off an excessive amount of tissue from the inside of the nose. The narrowing leads to difficulty breathing and can only be corrected by surgery.

Bumps may also form on the tip of the nose. It’s good if they are formed on both sides and look symmetrical.

Weak or excessive correction of nasal defects can lead to the defect remaining in place or a completely different shape of the nose being formed, which can lead to disruption of its structure and functionality. And revision rhinoplasty can be performed no less than a year later.

Causes of complications: surgeon's error or patient's fault?

It would be wrong to place all the blame on the shoulders of the patient, but blaming the plastic surgeon for everything would also be a big mistake. The reason for the formation of a defect can be either the low qualifications of the specialist or the patient’s inattention to the recommendations received. In a certain percentage of cases, a “crooked nose” and other complications of rhinoplasty are associated with an unfavorable course of regenerative processes, and one cannot blame anyone in such a situation.

And yet, mistakes by plastic surgeons can really cause deformation of the nose after rhinoplasty. Therefore, the choice of a specialist and clinic should be given special importance. You cannot choose a doctor at “low prices”; health and beauty can only be entrusted to an experienced master of his craft. Otherwise, there is a high chance that you will have to pay twice.

Listed below are some possible mistakes made by plastic surgeons and the aesthetic complications of rhinoplasty that they can lead to:

Incorrect placement of grafts. Transplantation of autologous material (cartilage tissue of the patient) or installation of synthetic implants is used quite often in nasal remodeling. If the implants are located asymmetrically, after the tissue has healed, the patient will see a “crooked nose” and pronounced asymmetry.

Asymmetrical correction. Many rhinosurgery operations involve intervention on the bone and cartilaginous elements of the nasal skeleton, including resection of part of the hard tissue. If the resection on the right and left sides is performed unevenly, nasal curvature and asymmetry are observed after rhinoplasty.

Overcorrection. To remove a hump, the plastic surgeon performs an osteotomy, removing part of the bone from the back of the nose. If the doctor removes too much tissue, a depression will form in place of the deficiency, which is called a saddle deformity. Excessive correction of the hump can also be the cause of a defect in the tip of the nose: an upturned tip can be the result of excessive tissue tension against the background of their deficiency in the structures of the nasal skeleton located above.

As already mentioned, the development of aesthetic complications after rhinoplasty is not always the result of a surgeon’s mistake or the patient’s irresponsibility at the rehabilitation stage. The following are the causes of complications that can be called a consequence of an unfavorable combination of circumstances:

Extrusion of the graft. Tissue or implant transplantation is used in many rhinosurgery operations. Unfortunately, the implant can become dislodged during the recovery period. The result will be a crooked nose or asymmetry.

Resorption of cartilage graft. A cartilage graft is a living tissue that is susceptible to the action of body enzymes. If the regenerative processes are unfavorable, part of the transplant may be destroyed by enzymes. The result will be a “crooked nose” or a violation of the symmetry of the right and left halves.

Distortion of the cartilage graft. Distortion is a Latin word that translates as “curvature.” Cartilage has elasticity and flexibility. Under pressure from other anatomical structures of the nasal skeleton, as well as due to severe tissue swelling, it can become deformed. The consequence of this will be a crooked nose.

Violation of the integration of bone and cartilage of the dorsum. During the operation, the connection between the bone and cartilaginous elements that form the bridge of the nose is disrupted. If proper integration of these structures does not occur during the rehabilitation period, a stepwise deformity develops.

Excessive growth of callus. The process of bone regeneration includes an intermediate stage of the formation of bone callus, which will later be replaced by full-fledged bone tissue. If the regenerative processes are too active, excess tissue forms in this place, which externally manifests itself as a hump, “bump” or asymmetry. There may be a deviated nasal septum.

Hypertrophy of scar tissue in the tip area. As a result of the abnormal growth of scar tissue in the area of ​​the tip of the nose, more precisely, directly above the tip, excess tissue is formed, which externally manifests itself as a beak-shaped deformity.

It remains to list some mistakes during the rehabilitation period on the part of the patient, which can lead to curvature and deformation of the nose:

• wearing glasses;
• displacement or self-removal of the plaster retainer;
• self-removal of rhinological splints (tampons in the nasal passages);
• accidental mechanical damage to the nose;
• sneezing with your mouth closed;
• blowing your nose;
• drinking alcohol, smoking during rehabilitation;
• early resumption of sports.

So, what are the causes of asymmetry, deformation and curvature of the nose after rhinoplasty? An aesthetic problem can be a consequence of a surgeon’s error, poor recovery dynamics and patient indiscipline, or the result of a combined effect of the above reasons.

It is no secret that facial defects create biased public perception, which is of no small importance for people’s self-esteem. Often, loss of attractiveness causes depression. That is, it is logical that facial deformities that reduce symmetry reduce the quality of life and self-esteem of patients.

As a rule, patients try to resort to reconstructive surgery to correct facial defects, which, in their opinion, negatively affects their appearance, to restore symmetry.

The visual influence of facial symmetry on the perception of its beauty increases significantly towards the midline. The farther the deformation is from the midline, the less it affects the assessment of attractiveness. Since the nose is located in the center of the face, patients with its curvature are accepted as having facial asymmetry. Nasal asymmetry has the greatest impact on overall beauty ratings.

Causes of curvature

Crooked nose is a general term, which is used to determine deformations associated with the deviation of the nasal pyramid relative to the facial mid-sagittal axis passing through the center and divides the face into equal parts.

The patient's history includes traumatic injuries and congenital nasal deformities. Of all the facial bones, the nasal bones are the most susceptible to fracture, and these fractures often result in aesthetic changes and nasal abnormalities. As a rule, the curvature of the nasal septum occurs due to its deviation; different variants of the curvature of the septum make it possible to straighten it.

A crooked nose can be congenital and/or hereditary. Some patients are born with a deviated nasal septum, so they compensate for facial asymmetry. In reality, many faces are horizontally or vertically asymmetrical when examined closely, and people whose faces are smaller on one side often have a nose that is deviated to the smaller side. If a person with an asymmetrical face straightens the nose completely, the face will look unbalanced. In this case, to ensure a more aesthetically pleasing effect, surgeons prefer not to completely straighten the nose, leaving it with a slight curvature so that the face is in balance.

A crooked nose can also result from asymmetrical growth of nasal structures or rhinoplasty. A nose that has recessed elements may appear crooked, although the structure does not actually deviate from the median axis. Sometimes deformations of the nasal septum occur during childbirth.

How is alignment done?

Today, rhinoplasty is one of the main cosmetic surgeries. performed by plastic surgeons. The main indications for rhinoplasty are functional and cosmetic disorders. Rhinoplasty is a delicate and complex operation from a functional and aesthetic point of view. Therefore, unfortunately, the rate of revision rhinoplasty is quite high.

A crooked nose is the result of complex deformations of structural elements, which includes:

• nasal septum;
• upper and lower lateral cartilages;
• bones of the nasal pyramid.

Which leads to functional and cosmetic disorders. The main cause of curvature is considered to be excessive deviation of the nasal septum.

Deviated septum

A deviated nasal septum can be in the middle, upper or tip area. Dividing the nasal pyramid into three parts, the lower third, the middle and the upper part, is useful for highlighting sectors where the anatomical structures are deformed.

Deformations are divided into two main categories. They include:

• cartilage deviations (lower 2/3);
• bone abnormalities (upper 1/3 of the nose).

Bone deviations in the upper 1/3 are usually corrected by controlled fracture of the nasal bones or osteotomy and displacement to the center line. The goal of osteotomy is to create mobile segments of bone that can be returned to a favorable anatomical orientation and position. The risk of bones shifting to their original curved position is low.

Deviations of nasal cartilages, most often, are among the most complex deformities that are difficult to correct. Many lower 1/3 deviations involve displacement of the main nasal septum. To correct it, its base is leveled, which includes correction of the nasal bones and nasal septum. If there is significant curvature of the cartilaginous part, additional transplantation of cartilage material may be necessary.

Many patients suffer from airway obstruction and will be able to benefit for functional reasons from reconstructive surgery. Most surgeons prefer to use an open or external approach to directly visualize the anatomical structures that are involved in creating the curvature of the nose, especially if the defect is severe.

Rhinoplasty correction

One of the most difficult tasks of rhinoplasty is correcting a crooked nose. The curvature may remain after the first rhinoplasty, or even after the second operation.

The process after rhinoplasty can be quite unpredictable. Typically, revision rhinoplasty to correct deformities after surgery may be required in approximately 3-6% of cases, but in cases of crooked nose this figure can be much higher.

A number of nuances complicate the correction of curvature of the nasal structures:

1. The main factor is considered to be that the curvature of bone and cartilage tissue has a certain level of memory. Cartilage tissue constantly tends to return to its original position. Natural tension exists in the soft tissues and cartilaginous structures, continuing to affect the nose after rhinoplasty, which makes it difficult to achieve a good result after surgery. Thus, the structures of the nose tend to drift towards their original position.
2. Another factor that can lead to the return of the nose to its original curved shape is incomplete correction of the sloping nasal septum. In addition, with a congenital crooked nose, a deviation of the septum can occur in conditions of facial asymmetry. This means that it may be difficult to find the true midsagittal plane in which to try to place a new nose position.

Why is the nose crooked after rhinoplasty?

We must not forget that getting a completely straight nose is quite a challenge. After significant improvement, it may have slight asymmetry or residual deviation. A slight curvature is considered acceptable. The most difficult task is to make the frontal view symmetrical, since the incident lighting casts shadows and the nose can look asymmetrical.

There are many reasons why the nasal septum may be crooked after rhinoplasty. This is possibly the result of drift of asymmetrical swelling and/or nasal soft tissue swelling. Healing after rhinoplasty is a dynamic process.

For the first couple of weeks after surgery, swelling of the structures may be asymmetrical. This may create the illusion that the septum is crooked.

The intensity of swelling after surgery may also vary in different parts of the nasal structure.. Much swelling after rhinoplasty goes away within a month. Much more time will be needed for the last 25% of swelling to resolve, over a year or longer after rhinoplasty. The final effect of the operation may take 20–36 months to appear.

Swelling after rhinoplasty depends significantly on the nature of the nasal structures operated on, the surgical approach, postoperative care and skin thickness. After an open rhinoplasty, if an external incision is made near the base of the nose, the swelling will be longer and greater, unlike a closed rhinoplasty. People with thick skin will experience more swelling.

Swelling occurs under the influence of gravity, which means that the upper part of the back becomes narrower. In general, the nose has a certain degree of swelling throughout the year.

When the septum is aligned and well maintained, then the nose initially looks straighter, and then, most often, deviates after a certain time. At first, swelling will hide abnormalities, which may become more obvious over time.

Repeated rhinoplasty is aimed at correcting defects problems that were not considered during the first operation, such as a deviated septum that causes a distorted appearance, or those resulting from improper rhinoplasty or poor healing.

Rhinoplasty is definitely in itself includes two different procedures, on the left and right sides of the nasal septum. Asymmetry can occur due to uneven correction of the sides, different intensity of scarring during healing. Curvature may result from excessive removal of cartilage on one side. A deviated nasal septum can be corrected. Revision rhinoplasty may involve cartilage transplantation.

The full result of rhinoplasty can be observed after a year of observation. If your nose remains crooked after surgery, you should wait 5-10 months before undergoing revision rhinoplasty. Very early surgery can lead to new problems.

Strict, millimeter-calibrated proportions are the lot of engineers, mathematicians and architects. Nature does not operate with round numbers, so no person can boast of perfectly smooth facial features.

Nose asymmetry occurs in more than 80% of the inhabitants of our planet. It can manifest itself in different sizes or shapes of the nostrils, unequal wings, deviation of the back and tip from the midline. Sometimes such nuances are completely invisible to others, but sometimes they literally catch the eye.

Can this be fixed and if so, how? Should you always seek help from a plastic surgeon? And what to do if a similar problem appeared after the operation?

How does nasal asymmetry occur?

This condition (it should not always be called a defect) can be congenital or acquired:

• In the first option, the cause is the individual characteristics of the structure and development of the facial bones of the skull and cartilages, from minor to very serious, such as and/or. Most often, the nasal septum is to blame: it can grow faster than the outer bones of the nose, become deformed and displace all adjacent anatomical structures. Due to its curvature, nasal breathing is almost always disrupted to one degree or another, differences in the size of the nostrils or wings of the nose are visually noticeable, and the back and tip may shift sideways from the center line.
• Acquired asymmetry can be a consequence of surgery on any part of the face, incl. rhinoplasty or septoplasty. Usually this is not a consequence of the surgeon’s mistakes, but only a temporary imbalance in proportions caused by swelling, which returns to normal after a few weeks or months. Another possible cause is mechanical injury. Here, everything often happens the other way around: the displacement of bone and cartilaginous structures is unnoticeable in the first days and weeks due to swelling and bruises. And after a while, returning everything to its place will be much more difficult than immediately after the damage ( see also article « »).

Can this be fixed?

The only reliable way to correct defects of the septum, nostrils, wings and other nasal structures is plastic surgery - or rhinoseptoplasty. The first step here will be a face-to-face consultation, during which the surgeon will examine the problem area and make a decision on the advisability of intervention (we will talk about why such a decision is not always made “in favor of the patient” below). Next, the nature and causes of the problem are precisely determined and the most suitable technique is selected to eliminate it:

• If the asymmetry of the back, tip, nostrils and/or wings of the nose is caused by septal defects, work is carried out with it. Sometimes it can be relatively easily aligned and installed in a new position; in more complex cases, the curved areas are completely removed, which are then replaced with grafts - they are usually obtained from a piece of the patient's rib. It sounds scary, but in reality it is a relatively simple and low-traumatic procedure ( see also article « »).
• Sometimes the problem is associated with improper placement of the medial crus, a section of cartilage that laterally supports the columella. Its displacement to one side leads to the fact that the nostrils and wings look very different in size, and the tip may deviate from the midline. The correction in this case consists of a slight shift of the leg in the desired direction.
• More serious defects - consequences of injuries, congenital pathologies, etc., may require complex, sometimes multi-stage operations, during which not only the cartilaginous but also the bone structures of the nose are repositioned and the lack of tissue is compensated. There is no single technique here and an individual correction plan is developed for each patient.

Some surgeons allow it to be used to correct minor asymmetries. Typically, dense fillers based on calcium hydroxypatite, polycaprolactone, etc. are used for this, which are injected into the soft tissues and increase their volume. In this way, you can correct the unevenness of the tip and back, but it is not always possible to align the nostrils and wings. And, unlike surgery, the result will last only for 6-12 months, after which the procedure will have to be repeated.

There are also various devices for correcting the shape of the nose. Usually these are some form of clothespins that need to be worn on the face for a long time: supposedly, due to constant pressure, you can change the shape of soft tissues, cartilage and even bones. But, unfortunately, such devices cannot provide a noticeable aesthetic result even with constant use. But they give their owner a false sense of control over the situation, which is what determines the demand for them.

Photo 3 – results of rhinoplasty, nostrils of different shapes and sizes have been corrected:

Photo 4 – irregularities in the back and tip of the nose were corrected using fillers (without surgery):

Asymmetry after rhinoplasty

What could be worse than an initially crooked nose? Only the irregularities left after the already performed plastic surgery, which the patient sees with surprise when the bandage is removed for the first time. And no matter how much the surgeons explain to the disgruntled ladies that everything will return to normal as soon as the swelling completely subsides (and this will happen no earlier than in six months), many rashly begin to prepare for a second operation a week after the first.

What's really going on? The blood supply to the face is fundamentally different from other parts of the body. Significantly more blood flows to the head per unit volume of tissue. This, on the one hand, promotes rapid healing, but, on the other hand, the same rapid increase and long-term (up to 6-8 months) persistence of edema, the “behavior” of which is sometimes quite unpredictable:

• it can move to different parts of the nose, causing its back or tip to deviate in one direction or the other from the midline;
• often intensifies at certain times of the day, for example, in the evening;
• may go away relatively quickly in one area of ​​the nose, but persist for a long time (several months) in another.

Thus, nasal asymmetry after rhinoplasty is normal. At first, the nostrils may be different, and the wings and back often look not quite even, and the tip - too large or displaced. But until the swelling subsides completely, it is absolutely inappropriate to draw conclusions about the aesthetic results of the operation - and, moreover, to plan a repeat one.

Why are such operations not performed on all patients?

For most people, the presence of a slight disproportion is not just the norm, but a part of their individuality that shapes their unique appearance. This is evidenced by numerous studies in which scientists compared images composed of the double left and right halves of the face of one person. Even the recognized beauty Marilyn Monroe was no exception.

As it turns out, the criterion of beauty is often not the mathematical correctness of facial features, but their overall harmony and balance. And its important component can be the asymmetrically located nose, which is slightly shifted towards the narrower half. If such a “defect” is corrected (for example, surgically), then the entire delicate relationship will be disrupted, and the aesthetic result will be unsatisfactory.

Another important factor is our tendency to be overly critical of our own appearance. We are talking about those cases when there is no noticeable cosmetic defect, but a slight displacement of the back or tip of the nose is given “universal” significance. As a result:

• a person is ashamed of his own face;
• believes that this imperfection is noticeable not only to him, but also to others;
• is embarrassed to be photographed or chooses head positions for the photo so that the asymmetry is not noticeable;
• worries a lot about this, up to the appearance of more serious psychological problems, difficulties with communication, being in society, etc.

It is extremely difficult to carry out an operation that would completely satisfy a patient with such complexes. In this case, the initial dissatisfaction with oneself and one’s appearance is usually transferred to the result of plastic surgery, in which minor “irregularities” and “inconsistencies with the ideal” will certainly be found (psychologists call this condition dysmorphophobia).

• American plastic surgeon Ronald V. DeMars has an interesting way of helping patients realize the real extent of their alleged problem. “When a person comes to me for a consultation with a request to remove minor asymmetry of the nose or other part of the face, I give him a glossy magazine and ask him to show me 5 photographs of the most attractive, in his opinion, celebrities. We then look at their faces close up and on each one I point out at least 5 asymmetrical areas. This is not difficult to do, since not a single person in the world has perfectly equal proportions.”

Thus, before looking for ways to correct an existing deficiency, you need to honestly answer the question of why exactly this is needed. Objective reasons for seeking help from a plastic or ENT surgeon are:

• violation of nasal breathing caused by incorrect position of the septum or other osteochondral structures;
• a serious external defect of the nose, which is clearly visible from the outside, clearly distorts facial features and leads to objective difficulties in communicating with people.

The desire to perform an operation to harmonize the face and make it more attractive, if a person understands that rhinoplasty alone cannot correct all the problems in life, is also a very good reason. In other situations, rhinoplasty is unlikely to give the desired result.

Experts' opinions:

leading plastic surgeon at Frau Klinik: Initially, nasal asymmetry is a physiological feature that only intensifies over the years. The operation should be performed if there are problems with nasal breathing or the proportions are disturbed: the septum, the osteochondral part of the external nose, etc. are bent, and therefore the person experiences discomfort. Today, I consider microrhinoplasty to be the safest and most effective method for correcting this problem. It allows you to carefully perform all surgical procedures in an extremely short time (from 50 minutes to 1.5 hours), maintain natural proportions, and minimize injuries to blood vessels and nerve endings. This approach helps not only the surgeon, but also the patient himself - the rehabilitation period is much faster and easier (there are no bruises or hematomas), and you can return to your normal lifestyle within a few days. As for asymmetry that occurs after surgery, this happens quite rarely and depends on the following factors: how significantly the proportions of the nose were initially disrupted; quality of the surgeon's work; the process of scarring, which is associated with the individual characteristics of our body (hormonal levels, skin type, etc.). If you feel like “something has gone wrong,” you need to contact your plastic surgeon to take preventive measures.

plastic surgeon, rhinosurgeon, Sharm clinic: The causes of nasal asymmetry can be congenital (genetic) - they can appear both immediately and during the process of growing up, or acquired - when, due to an injury in childhood, the development of one half of the face could lag behind. In the first case, a violation of proportions is usually associated with different volumes of tissue on the right and left sides of the nose, when the length of the cartilage or wings, the height of the bones are noticeably different, or the septum is curved. Also, a combination of asymmetry with a cleft palate and “cleft lip” is possible. If such a condition causes aesthetic discomfort in the patient, creates complexes, worsens the quality of life, or interferes with breathing, the problem must be solved only surgically. For example, if deviations of the tip of the nose are caused by different lengths/widths of its cartilages, then it is necessary to excise the excess volume and apply special sutures to build a new symmetrical frame. Open rhinoplasty allows you to perform this as accurately as possible. The asymmetry that arises after rhinoplasty is a direct complication, but its likelihood is extremely low; most often the culprit is ordinary swelling, which gradually goes away. If the problem persists for a year, corrective surgery may be required.

plastic surgeon, Arbat Aesthetic clinic: There is no absolute symmetry in any face. Differences between the right and left sides are often noticeable at the level of the wings of the nose, in the shape of the nostrils, etc. It is not always possible to completely rid the patient of such a “flaw”. After all, the bone structure of the skull also matters here, which, like our soft tissues, is also not perfectly smooth. This can only be an indication for surgery if the difference is visible to the naked eye, and not only to the patient in the mirror or in a selfie at a certain angle and lighting (which is most often the case), but really to everyone. This mainly occurs as a result of injury, or is a congenital defect - and in addition to aesthetic problems, it is also accompanied by impaired breathing.

Revision rhinoplasty– an operation aimed at correcting unsuccessful results after already performed plastic surgery to correct the nose. Revision rhinoplasty is the only option for patients who, after rhinoplasty, experience significant visible deformations of the external nose or its functional impairment. So, sometimes after rhinoplasty, patients notice an unnatural divergence of the wings of the nose or their noticeable asymmetry. Sometimes a nose with a hump turns into a “saddle-shaped” one - with the bridge of the nose too low, as the surgeon has removed too much bone or cartilage tissue.

It also happens that the reason for the patient’s dissatisfaction may be associated not with the technique of the operation, but with the individual characteristics of the body. For example, after healing, the scar on the columella becomes large and noticeable. The nasal septum looks more convex and visually lengthens the nose due to a predisposition to unpredictable growth of scar tissue, or as a result of incorrectly performed surgery. Repeated rhinoplasty allows you to solve such problems and return the nose to its natural correct shape, restore nasal breathing functions, and restore the patient’s self-confidence and attractiveness.

Secondary rhinoplasty - approaches and methods

As a rule, patients who apply for secondary rhinoplasty are disappointed, wary people who have little faith in the successful outcome of a repeat operation. During the consultation, we try to collect a thorough medical history and study photographs before rhinoplasty in order to understand what manipulations were performed on what structures of the nose. Before undergoing revision rhinoplasty, we recommend that such patients undergo an MRI - analysis of these data allows us to create an objective picture of the internal structures of the nose, outline a surgical plan and agree with the patient on the possibility of revision rhinoplasty.

Crooked nose after rhinoplasty

One of the main complaints of patients is that after rhinoplasty the nose is crooked, the tip of the nose is not graceful enough, the back of the nose has bulges or depressions. Sometimes nose contouring may be recommended to correct minor defects. But, unfortunately, major deficiencies can only be corrected during a repeat operation.

A full report of this patient's revision rhinoplasty surgery can be found in .

Sometimes the situation allows you to avoid repeated surgery and use the possibilities of drug therapy, as, for example, in the case of excessively prominent scars. To correct minor asymmetry, we recommend non-surgical rhinoplasty - the use of fillers, or the use of botulinum toxin-containing drugs to rotate the tip of the nose. But more often, surgical correction is still required, for example, transplantation of one’s own cartilage tissue to fill the saddle-shaped depression or rotation of the tip of the nose and restoration of the shape of the wings of the nose with correction of the position of the nasal septum and alar cartilages of the nose.

About the possibility of holding revision rhinoplasty we can only talk after 6-8 months after the first nose job. This is due, firstly, to the fact that final tissue restoration takes a long time; within several months after the operation, the shape of the nose changes, and the “defects” that the patient observes immediately after plastic surgery may completely disappear over time. In addition, an operation, even a minimally invasive one, always injures tissues and nerve endings to a greater or lesser extent - therefore, before performing a second operation, you should wait for complete healing.

The latest methods of performing rhinoplasty using micro-instruments are such that the consequences of any unsuccessful operation can be eliminated. The main thing is to seek help from a qualified specialist.