The nose occupies the center of the face, a prominent position, so small changes in its shape can cause an unpleasant psychological nuisance, which Anna Freud called the “Cyrano complex”, in reference to the literary character Cyrano de Bergerac, who had His personality totally influenced by the huge nose. If Cyrano had undergone plastic nose surgery, he certainly would not have shoved his beloved Roxana into the arms of his Christian friend.
Rhinoplasty emerged in India – where the punishment of cutting off the nose of thieves and adulterous women was common – for the purpose of patchwork and recomposing what had been mutilated. Even today, one of the flaps used for nose reconstruction is known as the Indian flap. In the sacred book of science and religion Sushruta Samhita, written around 600 BC, technical descriptions of rhinoplasty are already found.
Nose surgery is considered one of the most challenging within plastic surgery. It requires the surgeon to have a high degree of surgical ability and artistic sensitivity to plan and sculpt the nose in harmony with the face and thus preserve naturalness. There is no ideal nose model. Each case is studied in detail and the expectations and limitations with the patient are discussed. Surgeon and patient should always agree on the possible outcome to be obtained.
Rhinoplasty or Plastic Surgery of the Nose has a high degree of complexity mainly due to the difficult anatomy in the nose. For performing a nose plastic surgery requires a lot of skill and artistic sensitivity from the plastic surgeon. Due to advances in Rhinoplasty techniques it is possible to reshape the nose, reduce or increase its size, change the shape, reduce the nostrils or change the angle between the nose and upper lip, always aiming at aesthetic and functional benefit to the patient.
When it comes to secondary rhinopathy, the complexity is even greater, due to the alteration of the anatomy and scar tissue of the nose resulting from the previous surgery.
With this, it is necessary that the surgeon be highly qualified, since the second nose surgery is always more difficult than the first, aiming to correct aesthetic defects left by the first Rhinoplasty and if the correct technique is not used (or the patient’s body (Fibrosis), the result may not be the desired one. For the doctor, the challenge is always great.
Secondary rhinoplasty should always be viewed by the patient as an attempt to improve, as results are limited. Patients who are going to undergo Secondary Rhinoplasty should be aware of the surgical limitations and the difference in results of the Primary Rhinoplasty, where all desires can be more easily achieved by the surgeon.
The first observation that the surgeon at the Secondary Rhinoplasty should pay attention to is the patient’s skin type. Patients with thin skin have more facility in making visible the grafts used in the surgery, to remodel the new nose.
The best candidate for secondary rhinoplasty is the patient with medium thickness skin. Rhinoplasty, both Primary and much more Secondary, will have a harder time seeing the same result in patients with thick skin. This is due to the fact that the larger the thickness of the skin, the smaller the contraction of the skin on the sculpture made in the nose. Therefore, even though all the correct techniques are done by the surgeon, it is often not possible to see the work performed by the physician. In addition to the swelling getting much larger in patients with thick skin, the delay in reaching the result is also much greater.
We emphasize that there is a possibility that the tip of the nose does not reach the desired result. Therefore, the nose with thick skin can not be greatly reduced in its frontal size, this should be very clear to the patient before the Secondary Rhinoplasty, because it will guide the surgeon’s limitation in making the nose small in the frontal view.
The thickness of the skin of the nose is also directly related to the surgical recovery after Secondary Rhinoplasty. Patients with thin skin will also have their swelling (edema) diminished rapidly when compared to other patients with thick skin.
In general, patients who seek Secondary Rhinoplasty demonstrate frustration and sadness, so it is very important for the success of the result that the patient is aware of listening, talking about all desires and understanding all the limitations of the new surgery.
Regardless of the professional chosen, there are several reasons that may contribute to the failure of Rhinoplasty, indicating the need for a Secondary Rhinoplasty:
– Expectations unrealistic of the patient, bringing eternal dissatisfaction to the patient;
– Very thick skin, fibrotic skin (due to other surgeries), skin adhered to the nasal skeleton or insufficient nasal lining are considered characteristics unfavorable to the surgeon;
– Poor technical execution of the surgery previously used in Primary Rhinoplasty;
– Non-recommended products, such as Pmma-Poli, the use of alloplastic fillers and silicone implants in the nose can have serious consequences and irreparable damage to the nose. These products, after a few months / years in the body, can cause rejection, causing infection on the spot, pain, swelling, redness and in more serious cases even loss of part of the nose;
– Trauma or improper handling of the nose after surgery;
– Misalignment of the cartilage of the tip, causing a part of the cartilage to be visible or palpable;
– Unpredictable response of the patient’s body, especially in relation to the production of scar tissue (fibrosis).
– Action of respiratory forces on the skeleton of the nose
It is very important that the surgeon perform a thorough examination to perform the surgical planning and clearly show the patient the benefits and limitations of Secondary Rhinoplasty.
The Surgeon chosen to perform the Secondary Rhinoplasty has to have much experience in Rhinoplasty and Secondary Rhinoplasty. You should use the more advanced and more elaborate techniques to achieve a better result, but the patient has to remember that the surgery will be performed using structures already covered surgically and, therefore, without the ideal conditions of the Primary.
Performing a second rhinoplasty depends on the patient’s degree of dissatisfaction. If he is very dissatisfied, he should do the surgery, remembering that there is no perfect nose and surgery will not reach perfection. If the discomfort is small, you should rethink a lot about the desire to perform the surgery, because perfection does not exist, much less at Secondary Rhinoplasty.
The professional chosen to perform the Secondary Rhinoplasty should always be a specialist in the subject and a member of the National Society of Plastic Surgery (SBCP).
Return as many times as necessary in the consultation before the decision to perform the Secondary Rhinoplasty :