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Rhinoplasty, commonly called a “nose job,” is one of the most performed cosmetic surgeries worldwide. It aims to enhance the aesthetic appearance of the nose or correct functional issues such as breathing difficulties. While rhinoplasty yields beautiful results, complications occur from time to time. One of the most severe complications is necrosis. Recognising the signs of necrosis after rhinoplasty and understanding the associated risks, potential complications, and recovery phase is crucial for anyone considering this surgery.

This comprehensive guide will explore these aspects, providing great insights to help patients make optimal decisions.

What Is Necrosis After Rhinoplasty?

Necrosis is a serious complication that may occur after rhinoplasty. It involves the death of tissue due to a lack of adequate blood supply. This condition can have significant implications for the surgery’s cosmetic and functional outcomes. Understanding necrosis, its causes, and early signs is important for patients and cosmetic surgeons to ensure timely intervention and management.

Discolouration Of The Skin

signs of necrosis after rhinoplasty resultsNecrosis may appear as discolouration of the nasal skin. Patients may notice the skin appearing unusually pale, dark, or black. This change in colour results from reduced or completely obstructed blood flow to the affected area, leading to tissue death.

The severity of discolouration can vary depending on the extent of the necrosis and the specific areas involved. Early recognition of this symptom is critical, as it can minimise further complications and facilitate timely medical intervention.

Persistent Pain

While some level of discomfort is expected after rhinoplasty, persistent or worsening pain can indicate a problem. Pain associated with necrosis is typically more severe and may not respond well to standard pain relief measures.

Unlike normal post-surgical pain, which usually diminishes over time, the pain from necrosis may increase and become more localised to the affected area. This type of pain requires an immediate medical evaluation to assess the extent of tissue damage and initiate appropriate measures.

Unusual Swelling

Swelling is a common side effect after rhinoplasty; however, abnormal or persistent swelling, especially if it worsens over time, can be a sign of necrosis. Normal post-operative swelling tends to decrease gradually, but if it intensifies or does not resolve as expected, it could indicate complications.

This swelling may also be accompanied by firmness or a change in skin texture over the affected area. Recognising abnormal swelling patterns can help in the early detection and management of necrosis.

Blistering Or Skin Breakdown

Another potential sign of necrosis is the development of blisters, sores, or open wounds on the nasal skin. These symptoms occur when the skin and underlying tissues begin to deteriorate due to an insufficient blood supply.

Blistering or skin breakdown can increase the risk of infection and complicate the healing process. Immediate medical attention is necessary to manage these symptoms and, if possible, prevent further tissue loss. Management may include wound care, antibiotics, and, in severe cases, surgical intervention.

Foul Odour

A stinky smell emanating from the surgical site is a significant warning sign of necrosis and potential infection. This odour is often due to necrotic tissue and bacterial overgrowth. It is a serious symptom that requires urgent medical evaluation, as it may indicate advanced tissue necrosis and infection.

Prompt attention is essential to controlling the spread of infection and managing necrosis. This may involve debridement (removal of dead tissue), antibiotics, and supportive care to aid in recovery.

Causes Of Necrosis After Rhinoplasty

Understanding the causes of necrosis is essential for both preventing this complication and addressing it properly if it occurs. Several factors can contribute to necrosis following rhinoplasty, primarily related to the surgical technique, patient factors, and post-operative care.

Surgical Techniques

The surgical techniques used during rhinoplasty may substantially increase the risk of necrosis. Procedures that involve extensive reshaping or reduction of nasal structures may inadvertently damage blood vessels, reducing the blood flow to the nasal tissues.

This risk is higher in cases requiring substantial alteration of the cartilage and bone, such as in revision rhinoplasty or when addressing complex deformities. Surgeons must use precise techniques to preserve the blood supply while achieving the desired aesthetic and functional outcomes.

Smoking

Smoking is a major risk factor for issues in surgical procedures, including rhinoplasty. Nicotine and other chemicals that are in tobacco products constrict blood vessels, decreasing blood flow and oxygen delivery to tissues. This constriction significantly increases the risk of necrosis, as the nasal tissues may not receive adequate oxygen and nutrients necessary for healing.

Patients are strongly advised to quit smoking well before and after the surgery to minimise this risk. A non-smoker has a much lower risk of complications compared to a smoker.

Infection

Post-operative infections can compromise the healing process and contribute to the development of necrosis. Infections can disrupt the normal blood supply to the tissues, leading to inflammation, swelling, and tissue death.

Proper hygiene, antibiotic prophylaxis, and monitoring for signs of infection are critical components of post-operative care. Patients should follow their surgeon’s instructions closely and report any signs of infection, such as redness, heightened pain, or discharge from the surgical site.

Trauma

signs of necrosis after rhinoplasty resultsPost-operative trauma, such as an accidental impact on the nose, can disrupt the delicate blood vessels and tissues, potentially leading to necrosis. Even minor trauma can compromise the blood supply, especially during the early stages of healing when the tissues are still vulnerable.

Patients must take extra precautions to safeguard their noses against accidental bumps or injuries. Important preventive measures include wearing protective gear during physical activities and avoiding situations where the nose could be at risk.

Other Risks Of Rhinoplasty

While necrosis is not a complication that happens every time, rhinoplasty carries other potential risks that patients should be aware of. Understanding these risks helps set realistic expectations and underscores the importance of choosing a skilled, qualified surgeon.

Scarring

Scarring is an inherent risk of any surgery that involves incisions. Rhinoplasty may result in internal scars, but they should not be visible.

Skilled surgeons can often place incisions in natural creases or inside the nostrils to minimise visible scarring. While some scarring is unavoidable, proper post-operative care and following the surgeon’s recommendations can help reduce scar visibility.

Asymmetry

Achieving perfect symmetry in rhinoplasty is challenging, and minor asymmetries are common. While surgeons strive to create a balanced and harmonious appearance, factors such as pre-existing asymmetries, differences in healing, and individual anatomical variations may result in slight differences between the two sides of the nose.

Patients should discuss their expectations with their cosmetic surgeons and understand that some degree of asymmetry may be unavoidable.

Breathing Difficulties

Rhinoplasty can sometimes result in breathing difficulties, especially when significant changes are made to the nose’s inner parts, including the nasal septum and turbinates. These issues can arise if the airway becomes obstructed due to swelling, scar tissue, or changes in the nasal anatomy.

Functional rhinoplasty, which aims to improve breathing, can address pre-existing issues, but there is also a risk of creating new breathing problems if complications arise. Patients experiencing difficulty breathing after surgery should consult their surgeon, as additional treatments or procedures may be necessary.

Altered Sensation

After rhinoplasty, temporary numbness or altered sensation in the nose and surrounding areas is a common side effect. This occurs due to the disruption of sensory nerves during surgery. While this numbness usually resolves as the nerves heal, it can sometimes take several months to fully recover.

In some cases, patients may experience permanent changes in sensation. Discussing potential nerve-related outcomes with the surgeon before the procedure can help set realistic expectations.

Why People Get Rhinoplasty

Rhinoplasty is sought after for various reasons, from cosmetic enhancements to functional improvements. Understanding these motivations can help patients clarify their goals and communicate them accurately with their surgeon.

Cosmetic Improvements

The primary reason many people opt for rhinoplasty is to enhance the aesthetic appearance of their nose. Common cosmetic goals include:

  • Refining the nasal tip.
  • Reducing a dorsal hump.
  • Narrowing wide nostrils.
  • Achieving overall facial rejuvenation.

These changes can significantly impact a person’s self-esteem and confidence. Cosmetic rhinoplasty is highly individualised, with surgeons tailoring the procedure to meet each patient’s unique facial features and aesthetic desires.

Correcting Structural Issues

Rhinoplasty is also performed to correct structural issues that affect nasal function. A deviated septum is one of the most common functional problems addressed through rhinoplasty, which can cause breathing difficulties, chronic congestion, and snoring.

Functional rhinoplasty can improve airflow and overall nasal function by straightening the septum and making other necessary adjustments. This aspect of the surgery enhances physical well-being and improves the quality of life for many patients.

Reconstruction After Trauma

Injuries to the nose, whether from accidents, sports, or other incidents, can result in both cosmetic and functional deformities. Rhinoplasty can help restore the nose’s original appearance and function, providing a sense of normalcy and confidence.

Trauma-related rhinoplasty often involves reconstructive techniques to repair fractures, reshape distorted nasal structures, and address any functional impairments. The goal is to restore both form and function, allowing patients to breathe comfortably and regain their pre-injury appearance.

Congenital Deformities

Some individuals seek rhinoplasty to correct congenital deformities present since birth. These may include conditions like a cleft nose or other congenital anomalies that affect the nose’s shape and function.

Addressing these issues can significantly enhance the individual’s quality of life aesthetically and functionally. Congenital deformities often require a particular approach, and patients may need multiple procedures to achieve the desired outcomes.

What To Expect When Getting Rhinoplasty

The decision to undergo rhinoplasty is significant, involving careful consideration and planning. Understanding what to anticipate before, during, and after the procedure can help patients feel more comfortable and prepared.

Consultation And Planning

An initial consultation with a highly qualified cosmetic surgeon is a critical step in rhinoplasty. During this meeting, the surgeon will discuss the patient’s goals, evaluate their nasal anatomy, and assess their overall health.

This is also an opportunity for patients to ask questions, view before-and-after photos, and discuss the surgical plan. The surgeon will explain the available surgical techniques, potential risks, and expected outcomes. This thorough planning phase ensures the patient’s goals are realistic and achievable.

The Surgical Procedure

Rhinoplasty can be done under general or local anaesthesia, depending on the complexity of the surgical procedure and the patient’s preferences. The procedure usually takes between one and three hours, depending on the degree of the alterations being made. The surgeon may use either an open or closed approach during the procedure.

In an open rhinoplasty, an incision is made across the columella, allowing the surgeon greater visibility and access to the nasal structures.

In a closed rhinoplasty, all incisions are made inside the nostrils. The choice of technique depends on each patient’s specific goals and anatomical considerations.

Post-Operative Care

After the operation, patients may experience swelling, bruising, and discomfort, which are normal aspects of the healing process. The nose may be packed with gauze, and a splint is usually placed outside to support the new shape during healing.

Patients will receive detailed post-operative care instructions, including managing pain, reducing swelling, and caring for the surgical site. It is crucial to adhere to these instructions closely to ensure a pleasant recovery and minimise the risk of complications.

Patients may return to work and light activities within a week, but full recovery may take several months as the final shape of the nose gradually emerges.

Follow-Up Visits

Follow-up visits with the cosmetic surgeon are essential for observing the healing process and dealing with any concerns. These sessions allow the surgeon to assess the results, ensure proper healing, and detect any early signs of complications, such as infection or necrosis. Patients should attend scheduled follow-up appointments and promptly report unusual symptoms or changes.

Ongoing communication with the surgeon helps ensure an optimal outcome and allows for timely intervention if any issues arise.

 

 

How To Adequately Go Through The Recovery Process Of Rhinoplasty

The recovery process after rhinoplasty is a critical phase that requires patience and adherence to the surgeon’s guidelines. Proper care during this period can significantly influence the final outcome and help minimise complications.

Managing Swelling And Bruising

Swelling and bruising are common after rhinoplasty and can last for several weeks. To lessen the degree of swelling, patients are advised to keep their heads elevated, apply cold compresses, and avoid activities that elevate blood flow to the face, like bending over or lifting.

While most swelling subsides within a few weeks, residual swelling may persist for several months, especially in the nasal tip. Patients must be patient and understand that the final results will gradually become salient as the swelling decreases.

Avoiding Trauma

Protecting the nose from trauma during the recovery period is crucial. Patients should avoid contact sports, crowded places, and any activities where the nose could be accidentally bumped or injured. Even minor trauma can influence the healing process and potentially affect the final results.

Wearing protective gear, like a face mask, can provide additional protection if needed. It is also advisable to avoid wearing spectacles that rest on the bridge of the nose until the surgeon gives clearance.

Nutrition And Hydration

Proper nutrition and hydration are important in the healing process. A diet full of essential nutrients, like vitamins, minerals, and proteins, boosts tissue repair and strengthens the immune system.

Patients should also stay well-hydrated to help reduce swelling and promote overall well-being. Avoiding foods high in sodium can help minimise fluid retention and swelling. Patients with dietary restrictions or concerns should consult their healthcare provider for personalised recommendations.

Avoiding Smoking And Alcohol

Smoking and alcohol consumption may significantly impede the healing process. Smoking constricts blood vessels, reducing blood flow and oxygen delivery to the healing tissues, which increases the risk of complications, including necrosis.

Alcohol can also increase swelling and interfere with the body’s natural healing mechanisms. Patients are strongly advised to abstain from smoking and alcohol for several weeks before and after surgery. Quitting smoking altogether can have long-term health benefits and minimise adverse outcomes.

Monitoring For Complications

Patients should closely monitor their recovery and be vigilant for any signs of complications. Common warning signs include increased pain, swelling, redness, discharge, or fever. If any of these symptoms occur, it is essential to contact the surgeon promptly for evaluation and management.

Early detection and management of complications can prevent more serious issues and promote a more comfortable recovery. Patients should not hesitate to contact their surgeons with any concerns or questions during recovery.

Frequently Asked Questions

Can necrosis be handled if it occurs?

Yes, necrosis can often be managed if detected early. Treatment options may include medications to improve blood flow, care for wound healing, and, in severe cases, surgical intervention to remove necrotic tissue. The specific treatment approach will depend on the severity and location of the necrosis.

How long does it take to see the final results of rhinoplasty?

The final rhinoplasty results may not be fully visible for up to a year, as residual swelling can take time to subside. Patients should follow their surgeon’s guidance throughout the healing process. Regular follow-up visits help observe progress and ensure the best possible outcome.

What should I do if I notice unusual symptoms after rhinoplasty?

Contact your surgeon immediately if you notice any unusual symptoms, such as increased pain, swelling, redness, or discharge. Early intervention can prevent complications and ensure proper healing.

Understanding The Full Picture Of Rhinoplasty: A Final Remark

Rhinoplasty is a transformative cosmetic surgery that can enhance the nose’s aesthetic appearance and functional aspects. While the surgery is usually okay, understanding the potential risks, including necrosis, is essential for anyone considering it.

signs of necrosis after rhinoplasty surgeryPatients can minimise complications and achieve a positive outcome by recognising the signs of necrosis after rhinoplasty, choosing a qualified surgeon, and following post-operative care guidelines.

Whether for cosmetic reasons, functional improvements, or reconstruction after trauma, rhinoplasty offers a path to a more harmonious and confident appearance.

Remember, a well-informed patient is well-prepared, and taking the time to understand all aspects of the procedure is a crucial step towards a positive experience and outcome.

If you’re considering rhinoplasty or have questions about the procedure, contact Dr Alan Evans in Miranda, NSW, today at (02) 9158 6375 for a comfortable and rewarding experience.

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Sources:

Climan, Anastasia, RDN, CD-N. “Nose Surgery (Rhinoplasty): Everything You Need to Know.” Verywell Health, 15 Aug. 2023, www.verywellhealth.com/nose-surgery-rhinoplasty-5095757. Accessed 5 Aug. 2024.

Edens Hurst, Anna C. “Necrosis.” MedlinePlus Medical Encyclopedia, 18 Sept. 2023, medlineplus.gov/ency/article/002266.htm. Accessed 5 Aug. 2024.

Fernandes, S. Valentine. “Complications of Rhinoplasty: Background, Problem, Epidemiology.” Medscape, edited by Arlen D Meyers, 22 July 2022, emedicine.medscape.com/article/843439-overview. Accessed 5 Aug. 2024.

Ferzli, George, et al. “Skin Necrosis Following Rhinoplasty: A Review and Proposed Strategy on Identifying High-Risk Patients.” Facial Plastic Surgery, vol. 37, no. 04, June 2021, pp. 543–49. https://doi.org/10.1055/s-0041-1730384.

Gallagher, Grace. “Everything to Know About a Closed Rhinoplasty.” Healthline, 20 Aug. 2021, www.healthline.com/health/cosmetic-surgery/closed-rhinoplasty. Accessed 5 Aug. 2024.

Mohamed, Salma, et al. “Nasal Obstruction: A Common Presentation in Primary Care.” British Journal of General Practice, vol. 69, no. 689, June 2019, pp. 628–29. https://doi.org/10.3399/bjgp19x707057.

WebMD Editorial Contributors. “Cosmetic Surgery for the Nose.” WebMD, 2 Oct. 2021, www.webmd.com/beauty/cosmetic-procedures-nose-job-rhinoplasty. Accessed 5 Aug. 2024.

Whitlock, Jennifer, RN, MSN, FN. “Necrosis Causes and Symptoms in the Human Body.” Verywell Health, 16 Jan. 2024, www.verywellhealth.com/what-is-necrotic-tissue-3157120. Accessed 5 Aug. 2024.

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