Chapter 14 Rhinoplasty and Time Element
Online Contents
AnimationsIn this Chapter Online at experconsult.com
Development of Midvault Weakness after Surgery Animation 14.1
Development of a Dorsal Depression after Surgery Animation 14.2
Development of Midvault Narrowing and Tip Derotation Animation 14.3
Pearls
• The nose should appear close to optimal a year after surgery as the major soft tissue swelling subsides and should retain the desired shape for the rest of the patient’s life.
• The results of rhinoplasty continuously evolve due to the effects of gravity and aging.
• A common example of a flaw that may not easily be detected during the surgery but may become discernible over a period of years is an inverted V deformity related to a medial shift of the upper lateral cartilage.
• Violation of the nasal muscles could result in some irregularities on animation months or years later that are not noticeable during the immediate postoperative period.
• The firmer the structure under the skin, the more likely it is that the overlying soft tissues will become thinner with time.
• It is crucial to bevel the graft margins to avoid a harsh appearance of the frame over a long term follow up.
• On patients with thinner skin, use of conchal cartilage as an onlay graft with preserved perichondrium draped over it or a gently bruised septal cartilage graft is superior to intact septal or costal cartilage graft.
• One common post-rhinoplasty occurrence is tip rotation caudally. This can be prevented with a tip rotation suture using a permanent material such as 5-0 clear nylon.
• Patients who smoke experience a loss of skin elasticity and thickness more quickly in the cephalic half of the nose, while they have a greater propensity to develop supratip deformity due to hyperactive sebaceous glands and thickening of the soft tissues with time.
• Sun exposure also accelerates aging and reduces skin elasticity, resulting in the loss of soft tissue volume, thus revealing minor imperfections over a period of years.
