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      Rinoplastia estética primaria cerrada. Revisiones durante tres años Translated title: Closed primary cosmetic rhinoplasty. Three years revisions

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          Abstract

          Resumen Introducción y objetivo. Para conocer con más certeza, cuáles eran los problemas de nuestras rinoplastias primarias y el porcentaje de revisiones, buscamos y estudiamos los casos operados en un periodo de 3 años en nuestro Centro de Cirugía Estética. Creemos que este es un tema complejo que tiene pocos reportes en la literatura mundial dentro de la especialidad de Cirugía Plástica. Material y método. Analizamos retrospectivamente en un periodo de 3 años (2015-2017), cuál fue la proporción de rinoplastias primarias cerradas y las revisiones realizadas en ese mismo período, así como qué áreas de la nariz fueron las afectadas. Estudiamos las 4 zonas más frecuentemente sometidas a revisión, denominadas subunidades estéticas: dorso cartilaginoso, dorso óseo, punta y alas nasales y las látero-desviaciones nasales. Todas las revisiones se realizaron con una disección limitada, solo del área a tratar, con rinoplastia cerrada y con anestesia local. Resultados. En el periodo estudiado realizamos 183 rinoplastias primarias de las cuales efectuamos 15 revisiones, lo que significa un porcentaje del 8.19%. Las revisiones más frecuentes fueron de la punta nasal y ala nasal. Conclusiones. En nuestra experiencia, el porcentaje de revisiones obtenido fue comparable con el presentado en otras publicaciones sobre rinoplastia cerrada y abierta, considerando la creciente popularidad de las técnicas abiertas.

          Translated abstract

          Abstract Background and objective. In order to know our problems after primary rhinoplasty and our percentage of revisions, we studied the cases operated during 3 years in our outpatient Aesthetic Surgery Center. In our opinion, revision rhinoplasty is a complex issue with few reports in the international literature. Methods: A retrospective study was conducted in a 3 year period (2015-2017) studying the proportion of primary closed rhinoplasty, the revisions made, and also the nasal areas affected. The 4 most frequent aesthetic subunits of review were identified: cartilaginous dorsum, bone humps, nasal tip and alar areas and nasal deviations. All revisions were performed using closed rhinoplasty techniques, local anesthesia and a limited dissection to the affected area. Results. In that period, 183 primary rhinoplasties were performed and 15 revisions were carried out, which means a percentage of 8.19%. The most frequent areas were the nasal tip and the lateral alar areas. Conclusions. In our experience, the percentage of revisions was comparable to other reports about revisions in open and close rhinoplasties, considering the increased popularity of the open rhinoplasty.

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          Cosmetic rhinoplasty: revision rates revisited.

          Cosmetic rhinoplasty has great potential to change a patient's appearance. It also carries the very real risk of patient dissatisfaction and request for revision. Although there have been many published patient series studying various aspects of rhinoplasty, questions remain regarding revision rates, as well as risk factors for complications, dissatisfaction, and revision.
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            Postoperative sequelae and complications of rhinoplasty.

            This article has overviewed complications of rhinoplasty. Generally, these complications fall into two categories: aesthetic (that is, cosmetic sequelae that may require a revision rhinoplasty) and nonaesthetic. Of the nonaesthetic complications, infection has the widest span of severity. A localized Staphylococcus aureus abscess or Pseudomonas infection of the nose may occur postoperatively. Owing to the proximity of the nose to the cranium, a cavernous sinus thrombosis or basilar meningitis may result. Postoperative toxic-shock syndrome is a rare occurrence that surgeons should be aware of; most cases have occurred with the presence of nasal packing, but a case using only plastic nasal splints has been reported also. Bacteremia seems to be uncommon during rhinoplasty. Infection after rhinoplasty is generally much less frequent than one would expect from an operation in an unsterile field. Antibiotics are frequently utilized electively. Postoperative nasal-periorbital edema and ecchymosis are regarded as unavoidable but may be lessened significantly by postoperative head elevation and cold packs. The possibility of postoperative bleeding must be evaluated by the surgeon preoperatively. This sequela usually occurs either within 72 hours postoperatively or at around 10 days postoperatively. Many different causes exist for chronic postoperative nasal obstruction, from poorly supported nasal valves closing upon inspiration to an enhanced allergic rhinitis leading to chronic nasal mucosal edema. The latter may be treated by injection of steroid into the turbinates. Among aesthetic complications, supratip prominence, saddle deformity, and persistent hump are among the more commonly reported. Supratip prominence--"polly-beak"--can be caused by inadequate reduction of tip cartilaginous or soft-tissue elements, especially in relation to the reduction of the dorsum. An over-reduced dorsum will leave an otherwise normal nasal tip with a relative prominence. An accumulation of blood or a mucous cyst occurring under the skin of the tip will produce a prominence. Poor tip projection, tip ptosis, and alar collapse are the result of overreduction of tip elements. A dislocated alar cartilage can appear as an asymmetric nasal bossa. Saddle-nose deformity occurs after overaggressive bony and/or cartilaginous hump removal. Infractured nasal bones that subsequently drop into the piriform aperture can create a bony saddle. Persistent hump is due to inadequate reduction of a bony or cartilaginous hump. If the septal cartilage reduction is disproportionate to the bony septum reduction, the appearance of either a hump or a saddle is possible.(ABSTRACT TRUNCATED AT 400 WORDS)
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              Revision Rhinoplasty: What Can We Learn from Error Patterns? An Analysis of Revision Surgery.

              Of the many challenges in rhinoplasty, achieving a satisfactory outcome at the first operation is important. There are multiple reasons for secondary surgery, and generally revisions can be broadly classified into minor (often one area of deficit) or a total redo. Understanding the common technical reasons for failure in primary surgery by analyzing the deformities has resulted in various error patterns emerging. Understanding these patterns means we can modify techniques in primary surgery to reduce the incidence of revision. This article describes our prospective revision rhinoplasty experience over 5 and then 2 years, highlighting the main error patterns encountered. We also describe a stepwise analysis of four frequently encountered key problem areas alongside techniques to address them and offer pearls to help prevent further revision. Comparison of two cohorts of patients from a teaching hospital setting and private practice with the same operating surgeon indicates an increasing tendency to the open approach for revisions. The re-revision rates for these groups are 15.7 and 9%, respectively. Revision rhinoplasty is a difficult operation to perform to the satisfaction of both the surgeon and the patient. Understanding the common technical reasons for failure in primary surgery by fully analyzing the deformities means we can modify techniques in primary surgery to reduce the incidence of revision.
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                Author and article information

                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                0376-7892
                1989-2055
                September 2020
                : 46
                : 3
                : 283-289
                Affiliations
                [2] Córdoba orgnameCentro de Cirugía Estética Dr. Mottura Argentina
                [1] Córdoba orgnameUniversidad de Córdoba Argentina
                Article
                S0376-78922020000400005 S0376-7892(20)04600300005
                10.4321/s0376-78922020000400005
                c2e73b23-626a-4d9b-9c38-6b9dd533084f

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 22 January 2020
                : 20 August 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 9, Pages: 7
                Product

                SciELO Spain

                Categories
                Estética

                Revisión rinoplastia,Rhinoplasty,Rinoplastia,Revision rhinoplasty

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