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In this chapter I will
give you a glimpse into the challenges faced by a surgeon performing a revision
rhinoplasty. This chapter will be less dry and technical than the
others. I shall pelt you with some of my philosophy on the difficulty of
this operation and rant about the dangers of selecting a plastic surgeon at random to
operate on your nose. The patients whose noses you will see had unsatisfactory
rhinoplasty surgery elsewhere, and I was trying to correct the problems that
resulted.
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Let's start by
taking another peek at normal nasal tip anatomy. The pictures above show
normal lower lateral cartilages (green) at the beginning of a first-time
rhinoplasty. They are strong, smooth, regular, intact, easy to see. Now look
at the picture below. We find no recognizable cartilage structure at the
beginning of the operation. What is left of her lower lateral cartilages
is encased in a mass of scar tissue.
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| | Click on any image in this tutorial to see a greatly-enlarged version |
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Every nose responds to
surgery by making a layer of scar tissue underneath the skin, but with proper
technique the scar tissue doesn't interfere with the appearance of the nose and
doesn't stand in the way of achieving the desired results.
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Above we see slightly
different views of the same patients: normal on the left, abnormal on the right.
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(Use the page links, immediately below this paragraph, to navigate through the pages of this chapter.) |
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