Complications of Rhinoplasty Publications (1996)


Complications of Rhinoplasty Publications

Aesthetic Plast Surg
Aesthetic Plast Surg 2017 Jan 7. Epub 2017 Jan 7.
Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi, 30, 20097, San Donato Milanese, Milan, Italy.

Necrotizing fasciitis (NF) is a rare, potentially fatal, infective complication that can occur after surgery. Diagnosis is still difficult and mainly based on clinical data. Only a prompt pharmacological and surgical therapy can avoid dramatic consequences. Read More

There are few reports regarding NF as a complication after aesthetic surgical procedures, and a systematic review still lacks.
We have performed a systematic review of English literature on PubMed, covering a period of 30 years. Keywords used were "necrotising fasciitis" matched with "aesthetic surgery complications", "breast surgery", "mammoplasty", "blepharoplasty", "liposuction", "facelift", "rhinoplasty fasciitis", "arm lift", "thigh lift", "otoplasty" and "abdominoplasty fasciitis". No additional search and temporal limitation were set.
Among 3782 papers concerning NF, only 18 were related to NF after an aesthetic surgical procedure. Liposuction was the most affected procedure, with buttocks and lower extremity the most involved anatomical regions. The majority of the infections were monomicrobial, promoted by Streptococcus pyogenes. In most cases, NF occurred within the third post-operative day with non-specific signs and symptoms. In 14 cases, a single or multiple surgical interventions were performed and survival was achieved in 11 patients.
In case of infection after aesthetic surgery, we should always bear in mind NF. Clinical hallmarks still guide NF management. Because early signs and symptoms are usually non-specific, a strict clinical control is highly suggested. Once clinical suspicion is raised, prompt antibacterial therapy should be administered, followed by surgical debridement in case of ineffective response.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .

Int Arch Otorhinolaryngol
Int Arch Otorhinolaryngol 2017 Jan 22;21(1):97-101. Epub 2016 Sep 22.
Ophthalmology and Otorhinolaryngology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Facial Plast Surg
Facial Plast Surg 2016 Dec 29;32(6):664-670. Epub 2016 Dec 29.
Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata," Rome, Italy.

Dome division can still be regarded as a valid surgical procedure today in some particular cases of revision rhinoplasty where the scarring is so extensive as to make precise isolation of the alar cartilages impossible. The presence of asymmetry of the nasal tip, a recurrent feature in the results of rhinoplasty, constitutes the primary indication, as division makes it immediately possible to restore balance between the two domes in such cases. The technique also proves useful in cases of overprojection of the tip as a result of rhinoplasty. Read More

Moreover, the procedure has been improved by precise suturing of the cartilaginous stumps so as to avoid its frequently reported complications, arising essentially from the vulnerability of the domal arch to the distorting forces of cicatricial retraction and its resulting lack of stability over time. In this connection, the authors attach crucial importance to direct suturing of the cartilaginous stumps in accordance with a now standardized method that is easy to execute and offers lasting, stable results. This approach makes it possible to re-establish continuity of the cartilaginous domal arch in a form unquestionably closer to the physiological anatomical conformation.

Facial Plast Surg
Facial Plast Surg 2016 Dec 29;32(6):615-619. Epub 2016 Dec 29.
Department of Otolaryngology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, The Republic of Korea.
Aesthetic Plast Surg
Aesthetic Plast Surg 2016 Dec 28. Epub 2016 Dec 28.
Department of Plastic and Reconstructive Surgery, Chonbuk National University Medical School, 20, Geonji-ro, Deokjin-Gu, Jeonju-si, 561-712, Republic of Korea.

Over the past few years, conchal cartilage has been most often used in rhinoplasty. The donor site complications following conchal cartilage graft harvesting are scar formation, hematoma formation, and delayed wound healing, although hematoma is one of the most important and common complications. A complete conchal defect as a complication of auricular cartilage graft harvesting has not been previously reported in the literature. Read More

The authors report an unusual case of an iatrogenic conchal defect resulting from conchal cartilage graft harvesting that was treated using a posterior auricular island flap.
A 24-year-old male with a left conchal inflammation and perforation visited our plastic surgery department after receiving augmentation rhinoplasty and tip plasty using a conchal cartilage graft. A tight dressing had been applied to the ear, and postoperative infection was uncontrolled, which resulted in iatrogenic conchal perforation.
A tie-over bolster dressing has been widely used to prevent hematoma following conchal cartilage graft harvesting with an associated donor site complication. However, a tight tie-over dressing and inappropriate postoperative care can cause complete through-and-through conchal defects. The posterior auricular island flap provides an elegant means of reconstructing conchal defects.
In the described case, aesthetic reconstruction of a conspicuous iatrogenic conchal defect was achieved with minimal scarring using the posterior auricular island flap. To the best of our knowledge, this report is the first to describe reconstruction of an iatrogenic defect in the concha as a complication of auricular cartilage graft harvesting.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .

Aesthetic Plast Surg
Aesthetic Plast Surg 2016 Dec 28. Epub 2016 Dec 28.
Plastik Rekonstrüktif ve Estetik Cerrahi Kliniği, Kayseri Eğitim ve Araştırma Hastanesi, Sanayi Mahallesi, Atatürk Bulvarı, Hastane Caddesi, No: 78, 38010, Kocasinan, Kayseri, Turkey.

Resection of the nasal hump is one of the most critical steps of the rhinoplasty procedure, which is quite prone to complications when performed improperly or inappropriately. In this article, a practical, facile and minimally traumatic hump resection technique using Kazanjian bone-cutting forceps is presented with excellent cosmetic and functional results.
Fifty-seven consecutive primary (septo-)rhinoplasty patients with wide nasal bases, and various sizes of nasal humps, were enrolled in the study. Read More

Following reduction of the cartilaginous dorsum height, L-strut shaping of the septum, and septoplasty procedures, Kazanjian bone-cutting forceps were used for resection of the bony nasal hump. Lateral osteotomies were then performed, and the surgery was completed following insertion of the structural grafts, tip procedures and turbinate surgery. A computer software was used to measure the nasal hump. The "Rhinoplasty Outcome Evaluation" questionnaire was used to evaluate patient satisfaction 12 months after the operation.
The technique presented here was performed on 19 male and 38 female patients with a mean age of 24.95 ± 6.07 years. The mean height of the nasal hump was 4.65 ± 1.56 mm. No patient had complications requiring further corrective surgery. The "Rhinoplasty Outcome Evaluation" questionnaire showed that all patients remained in the group of happy subjects.
Long-term patient satisfaction indicates that the proposed technique could be used as an alternative procedure to other hump resection techniques. The technique described is an effective, reliable and atraumatic method of resection of any size nasal hump.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .

Plast. Reconstr. Surg.
Plast Reconstr Surg 2017 Jan;139(1):29e-37e
Konya, Turkey From the Department of Plastic and Reconstructive and Aesthetic Surgery, Faculty of Meram Medicine, Necmettin Erbakan University.

The aim of this study was to compare the techniques used for resection of the long side of the base and the top of the bone based on the patient's perspective, surgeon's approach, aesthetic results, complications, and need for secondary surgery in patients with asymmetric nasal bones. This study also aimed to determine the perspective of another plastic surgeon who did not perform rhinoplasty in comparison with the perspective of the primary plastic surgeon.
One hundred sixty-six patients with nasal bone asymmetry between 2010 and 2015 were included in this study. Read More

Patients were divided into two groups: group 1, those treated with wedge resection of the bony nasal pyramid from the base of the nasal bone; and group 2, those treated with an oblique hump resection. Three different plastic surgeons and plastic surgery nurses who had no information regarding the randomization, patients, and primary plastic surgeon evaluated the surgical results.
The mean secondary surgery rate was significantly greater in group 2 than in group 1. The mean satisfaction ratio was significantly decreased with different plastic surgeons than with the primary plastic surgeon. Base nasal bone resection was more successful than oblique hump resection in patients with greater than or equal to 0.5-cm nasal bone asymmetry.
Surgeons who did not perform the rhinoplasties can evaluate the results differently from the primary surgeon. Performing base bone resection may reduce the secondary surgery rate in patients with greater than or equal to 0.5-cm nasal bone asymmetry.
Therapeutic, II.

Int. J. Pediatr. Otorhinolaryngol.
Int J Pediatr Otorhinolaryngol 2017 Jan 26;92:11-16. Epub 2016 Oct 26.
Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA; Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.

Pediatric rhinoplasty has traditionally raised numerous concerns, including its impact on growth as well as the psychological sequelae of undergoing a potentially appearance-altering procedure. Our objective was to critically evaluate available individual patient data relevant to pediatric rhinoplasty, and further discuss perioperative considerations.
A systematic review was conducted using PubMed/MEDLINE databases. Read More

Data extracted and analyzed from included studies included patient demographics, surgical indications, operative approaches, outcomes, complications, revision rates, and other clinical considerations.
Seven studies encompassing 253 patients were included, with age ranging from 7 months to 19 years. Two-thirds of patients were male. 41.7% reported antecedent trauma, and common overall surgical indications included "functional aesthetic" (24.5%) followed by cleft lip nasal deformity (15.8%). The majority (79.1%) underwent open approaches, and 71.1% of patients underwent concomitant septal intervention. The most frequently used grafting materials were septal cartilage (52.8%) and conchal cartilage (16.5%). Surgical outcomes were heterogeneous among these studies. Complication rates were only specified in 5 of the 7 studies and totaled 57 patients (39.6%). Aesthetic dissatisfaction (11.8%) and postoperative nasal obstruction (5.6%) were the most commonly reported complications. Revisions were performed in 13.5%.
Rhinoplasty is safe in the pediatric population, although revisions rates appear greater than those reported in adults. This study of 253 represents the largest pooled sample size to date; nonetheless, non-standardized outcome measures, minimal long-term followup data, and lack of discussion regarding psychological sequelae all contribute to the need for further high-quality studies evaluating this topic.

J Craniofac Surg
J Craniofac Surg 2016 Nov;27(8):2110-2112
Department of Otorhinolaryngology, Head and Neck Surgery, Solingen Municipal Hospital, Solingen, Germany.

Nasal dermoid sinus cysts are rare congenital lesions that may lead to recurrent soft tissue infections and severe intracranial complications. In case of an intracranial extension, the traditional surgical approach includes a frontal craniotomy with significant morbidity. As a less invasive alternative, a transnasal endoscopic approach has been recommended. Read More

This report describes the transnasal endoscopic resection of an intracranial nasal dermoid sinus cyst via an open rhinoplasty approach, which achieved a wide surgical exposure with minimal invasivity and ideal aesthetic results. An intraoperative video demonstrates this combination of techniques in this rare skull base/intracranial pathology.

Plast Reconstr Surg Glob Open
Plast Reconstr Surg Glob Open 2016 Nov 28;4(11):e1120. Epub 2016 Nov 28.
Akademikliniken, Stockholm, Sweden.

Rhinoplasty has traditionally been preferred for correction of nasal defects. Long-term clinical experience with hyaluronic acid (HA) injection as an alternative or complement to rhinoplasty is presented.
A retrospective review of the author's clinical experience with HA gel for nasal reshaping from 1997 to 2012 was conducted, with treatments performed during 1998, 2005, and 2012 selected for detailed review. Read More

More than 250 patients were treated for nasal reshaping with HA since 1997. In addition to being a complement to surgery, HA injection successfully addressed nasal defects that would have been difficult to correct surgically. The effect persisted for >1 year in most patients (>5 y in some patients), with individual variations. No serious complications occurred. When comparing the 3 years reviewed in detail, new indications for nasal reshaping with HA gel became evident over time, which was also reflected by the increase in number of patients treated (1998: n = 2; 2005: n = 22; 2012: n = 51). Of these patients, 55 (73%) received HA injection instead of rhinoplasty, 20 (27%) received HA injection after rhinoplasty, and 5 (7%) underwent rhinoplasty after HA injection. The mean injection volume was 0.4 mL HA gel/treatment. All patients were satisfied with the primary outcome of treatment. Retreatment was performed in 32 patients (43%).
Injection of HA gel is a valuable tool for nasal reshaping. It can also be used for correction of minor postrhinoplasty defects in appropriate patients.