Evaluation of results and complications of primary surgical correction of aesthetic deformities of the nose

Abstract

Introduction. Rhinoplasty is one of the most technically complex operations of all surgical interventions on the face, especially given the numerous complications that can occur both in the early and late postoperative period. About 5–15% of patients undergoing rhinoplasty subsequently undergo revision surgery. The study and in-depth scientific analysis of complications and consequences associated with rhinoplasty is an urgent task of plastic surgery, which is important for their prevention, choosing the right tactics to reduce their frequency, and optimizing the elimination of defects in case of their occurrence. Aim of the study: to determine the most characteristic and weighty complications of rhinoplasty in a cosmetic sense, the possibilities and perspectives of their operative correction and preventive measures. Methodology and methods: We have analyzed the results of the treatment of 68 patients operated on in the surgical department of the Lviv municipal cosmetology hospital between 2016 and 2019, who underwent primary rhinoplasty for similar aesthetic deformities of the nose. For this reason, the age of the patients was from 18 to 48 years. Esthetic complaints concerned the outer appearance, and esthetic discomfort from perception of one’s face and appearance. Functional complaints were presented by 63 patients (92.6%). Esthetic assessment of the face and the surgeon’s esthetic vision and feeling of proportions were reflected using VPPS (Virtual Plastic Surgery Software) or Adobe Photoshop. Subsequently, photography and filming were performed 1 month, 6 months, and 1 year after surgery. In all cases, rhinoplasty was conducted under general anesthesia combined with controlled hypotension and topical anesthesia. In all cases, marginal surgical access was utilized, along the caudal margin of the major alar cartilage. In open rhinoplasty cases this was combined with transcolumellar access. Upon access, soft tissues were separated from cartilage and bones of the nose en bloc, thus ensuring good visibility of all structures of the tip and the dorsum of the nose. In all cases, resection and osteotomy was utilized to decrease the projection and the width of the nose. Modification of the cartilaginous dorsum of the nose and shaping of the tip were achieved by conservative suturing techniques combined with resection, as required to decrease the projection and the length of the cartilage. Once the bony and cartilaginous framework was created, access was closed with sutures. In all cases, a thermoplastic external fixation bandage was applied for 7 days, along with intranasal splints and Merocel dressing. Final assessment of rhinoplasty outcomes was done during follow-up visits one year after surgery. Results and discussion: In 2 cases, i.e. 1.4%, nasal bony callus was observed. In one case, i.e. 0.7%, primary rhinoplasty was complicated with V-shaped deformity. Pollybeak deformity was observed in 14 cases, i.e. 20.6%. Of these, in 11 cases (16.2%), mild Pollybeak deformity was observed, which required brief conservative treatment. The remaining 3 patients (4.4%) developed a moderate or severe deformity required long-term medical treatment in 2 cases, and surgery combined with medical treatment in one cases. It has been shown in a study, that the most frequent esthetic complication of primary rhinoplasty, requiring long-term medical treatment and, in some cases, surgery, was Pollybeak deformation of nose. The incidence of this complication in our study was 20.6%, as opposer to 5 to 39% in other studies, indicates that this problem is relevant and requires deeper investigation. Conclusions. 1. Rhinoplasty is a complex surgery that must be performed by highly specialized experts. 2. Considering the complexity of rhinoplasty and the large number of various techniques and combinations of techniques, as well as variable anatomy of the nose and nasal structures, the risk and percentage of complications is high. 3. Pollybeak deformity is the most frequent complication after primary rhinoplasty. 4. Pollybeak deformity as a complication of primary rhinoplasty requires deeper study and analysis in order to eliminate its causes and develop prevention strategies to decrease the incidence of this complication.