The nose above shows a
mass of smooth, thick scar tissue, without any view of the tip cartilages.
The first part of this operation will be to attempt to meticulously carve away
the scar tissue and find the lower lateral cartilages underneath. This
task is not easy. The scar tissue hugs the underlying cartilages
tightly. It doesn't just peel off. It is possible to tear the
cartilages in the process of finding them in this mass of scar, or to fail to
find them entirely.
Also, I don't know
what the cartilages in this nose look like yet. If I did, I could picture them
underneath the scar, and be extra careful when I thought I had dug down far
enough to be close to the cartilage surface. But some of the cartilages were
undoubtedly removed in the previous operation, so I don't know what shape the
remaining cartilage has, or even if there is any left. As you'll see later
in this chapter, cartilage trimming during a poor rhinoplasty can be random and
haphazard.
And the previous
written operation report, if one is available, is rarely of assistance. It
is much easier to dictate words related to nasal surgery than it is to perform
the operation with skill. Frequently, a terrible rhinoplasty will be
accompanied by an immaculate, organized, professional-sounding operation report.
The rhinoplasty operation is much, much more
difficult than a face lift or eyelid surgery or any other cosmetic operation that
a plastic surgeon performs, because everyone's nose is so different and there are
so many techniques that the surgeon needs to have at his fingertips to select
judiciously and carry out skillfully.
Revision rhinoplasty
is even far more difficult than primary rhinoplasty ("primary"
rhinoplasty means "first time" rhinoplasty). Fighting through
the scar tissue you see above, locating what remains of the cartilage structure
of the nose without damaging it further, and being able to reconstruct the
inside to yield a satisfactory appearance to the nose can be extremely
difficult, even in the best of hands.
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