Resumen

Objectives: We present a minimally invasive technique that utilizes known complications of rhinoplasties to the patient’s benefit. Introduction: Revision Rhinoplasty is one of the harder and sometimes dreaded but necessary aesthetic surgeries to perform. The scarring encountered makes it difficult and sometimes nigh impossible to delineate the planes between the skin and cartilage. Blood supply is also tenuous and changes in skin quality is evident. We present a simple technique for a patient who sustained pan facial fractures in 2009 and underwent 4 rhinoplasties thereafter in attempts to correct her nasal deformity. The latest of which was a dorsal augmentation with a silicone implant in 2013. Materials / method: She had a deviation of the implant to the right, shortened nose with a contracted right soft triangle and alar retraction. Fat harvested from abdomen (120cc) and Centrifuged 3 mins at 3000 rpm and was nano processed. A stab incision was made through previous right infracartilaginous incision. Severe scaring was noted but capsule surrounding the previous silicone implant was identified. Sharp dissection to her glabella and, right nasal dorsum tip and alar was carried out.1cc of fat was then injected into multiple small aliquots into the intracapsular plane and molded to symmetry. Results: The nasal tip deviation was improved, with increased suppleness in scar tissue and decreased scar contracture noted. The patient was pleased with the outcome and reported minimal pain post operatively owing to the endonasal approach undertaken. Conclusion: Less may very well be more in a situation whereby multiple attempts at revision rhinoplasties resulted in minimal improvement. By taking advantage of a complication whereby a stable capsule has been formed and considering a more minimalist approach in problem solving, there can be good outcomes for the patient as demonstrated.