Revision Rhinoplasty

Revision Nose Job is the most difficult of aesthetic rhinoplasties, while revision rhinoplasty (secondary rhinoplasty) is much more complicated and difficult. Successful and unsuccessful results in revision rhinoplasty are determined by the differences such as only 1-2 mm. In fact, the best result is obtained from the first operated nose, so it is very important for person who will firstly be operated to investigate and select the surgeon and to aim for the first and last surgery. For revision rhinoplasty, the surgeon must be well researched and experienced in this area to obtain successful rhinoplasty results. Contributing to the developments in the field with the new techniques, training provided and contributing in the literature on revision surgery can measure this experience.

Patients of Dr. Eren Taştan consist of 50% revision patients. These are often difficult patients referred to by other colleagues or previous patients. Although problems in revision rhinoplasty can sometimes be corrected by the correct application of basic surgical techniques, they often require re-establishing skeletal support. The nasal skeleton is difficult to establish correctly and requires a three-dimensional perception of the anatomy of the nose. The most difficult aspect of revision rhinoplasty is the deterioration of subcutaneous scar tissue and skin quality due to previous surgery. The cartilage skeleton can be corrected by replacing deficiencies, by supporting or removing excess, but the skin quality cannot be fully restored. Considering all this, it will be understood that revision rhinoplasty is a much more difficult operation than primary rhinoplasty (first-time rhinoplasty).

Common complications after rhinoplasty can be asymmetric in the nasal tip and back, nasal tip ptosis, excessive reduction of nasal tip, being excessive weakening of side wall, collapse-withdrawals in the wings, remaining gap in the valve of nasal bone, deformity of inverted V, being both functional and aesthetical problems as a result of the excessive reduction of nasal cartilage and bone side walls, deterioration in the quality of skin, insufficient correction or excessive weakening of septum - middle section of nose, collapse in the nose, septum perforation ( perforation of middle section of nose), continuation of previous problems due to the insufficient intervention.

In order to prevent such complications in primary rhinoplasty, a detailed analysis of the problems and proper application of patient-specific surgical techniques are sufficient. In revision rhinoplasty, which involves a wide variety of problems, the surgeon must make a more complex plan and apply it meticulously to solve these problems. All these problems can be corrected by reconstructing the normal nasal anatomy using cartilage tissue. The most important step in revision rhinoplasty is the reconstruction of the septum as the septum forms the basis of the nose. In revision surgery, this basis, which is usually impaired, is re-established. The most suitable source of cartilage is its own cartilage, in other words it is septum. If it is not present in the septum, ear cartilage is appropriate, and if the ear cartilage cannot meet the need, rib cartilage is used. It is very important to obtain, prepare and use rib cartilage with the right technique in patients who do not have enough cartilage left in the nose and whose ear cartilage is not suitable. Dr. Eren Taştan has developed the Oblique Split Method (The Oblique Split Method: A Novel Technique for Carving Costal Cartilage Grafts), which allows the use of the required cartilage of the required fineness and size in difficult revision cases, and maintains the shape of the nose after surgery. In revision rhinoplasty, all cartilages of different sizes and shapes required to reconstruct the normal nasal anatomy can be obtained by the correct use of the Oblique Split Method. For instance, the formation of the septum, which is the basis of the nose, is of particular importance. Dr. Eren Taştan explains the details of this in his article “Oblique Split Technique in Septal Reconstruction”. He shares the details of the techniques gained in the world literature with his colleagues by inviting them from national and international meetings and provides solutions to the problems of difficult revision patients.

It is useful to share information generally to eliminate the lack of information on the use of rib cartilage. Rhinoplasty surgeons behave usually timid because of scarring about using the rib cartilage, pain, complications at the time of surgery, and the inherent risk of cartilage distortion. The most important problem is the risk of distortion, which causes failure in the postoperative period, and it was solved by Oblique Split Method developed by Dr. Eren Taştan. Other risks are related to the surgeon's more gentle, tissue-respectful work, full mastery of the anatomy of this area, and experience in this area. These risks are minimized in the approach of Dr. Eren Taştan. Approximately 1-1,5 cm cut is appropriate for taking cartilage and this cut cannot attract attention as it can be hidden in women under the breast curvature. In order to reach the surface of the ribs, the muscles are separated by protecting them and the sheath on the rib surface is opened as a leaf under the endoscopic view and the cartilage boundaries are determined in accordance with the Oblique Split Method, like a cucumber slice, and the cartilage slice is carefully removed by leaving a thin layer on the ground. The gap formed on the surface of the rib is about one-quarter compared to the classic technique, and when the rib sheath is repaired, this area is filled with new cartilage tissue. This recovery has been shown in the experimental research named “An Enhanced Method of Rapid Cartilage Healing After Costal Cartilage Resection” made with Dr. Eren Taştan and his chest surgeon colleagues. Dr. Eren Taştan makes all these surgical procedures with special hand tools and micro-saws developed in order to take rib cartilage. Half of Patients of Dr. Eren Taştan consist of revision rhinoplasty and most of them require rib cartilage. In this field, where he gained experience over many years, he pays attention to each detail separately in the steps of taking, preparing and using the cartilage to control patient comfort and the outcome of the surgery. It is possible to have a good and permanent result of the operation by having a better domination of these details.

The other issue is the excessive narrowing of the nose valve and the sidewall, called the nasal valve. It is best to narrow as much as necessary in the first surgery and support the weak areas. If these basic principles are not followed, the extremely narrow valve and the weak sidewall cause serious functional and aesthetic problems. Dr. Eren Taştan has also developed a new technique for correcting these problems: H-Graft technique that provides the width and support of the nose valve in accordance with normal anatomy, "A Novel Method for Internal Nasal Valve Reconstruction: H-graft Technique". In difficult revision patients, problems can be solved easily by using H-Graft Technique and its modifications.

Another important functional problem due to unsuccessful rhinoplasty is the septum perforation (a hole on the middle part of the nose). It is less well known because of its relatively being in the small number of patients and it is in the nose, but it causes very important problems. Perforation repair is a difficult surgery where few surgeons can achieve successful results. Dr. Eren Taştan has also developed a new surgical technique for the correction of septum perforation: “Inferior Turbinate Composite Graft for Repair of Nasal Septal Perforation”.

The emergence of these new techniques published in the most reputable journals in the field has become possible with dedication of all energy and mind of Dr. Eren Taştan to functional and aesthetic rhinoplasty. This field is called rhinology in medical science and its surgery includes headings such as rhinoplasty, septoplasty, concha surgery, nasal valve surgery, and functional endoscopic sinus surgery. Gaining experience in each of these surgeries requires years of work. In fact, mastering the details in the work is possible with choosing to be a master in a job rather than an apprentice in every job ”. In rhinoplasty, there is enough detail to fill the life of a surgeon, and it takes all of his time and energy to use it in order to achieve successful results.

Dr. Eren Taştan is careful to choose the most suitable technique for the patient and uses the techniques developed or the techniques of other globally known masters. It aims to achieve permanent, natural results by modifying these techniques according to the patient and finding special solutions for the patient and making the operation as the last operation of the patient. Revision Rhinoplasty