Rhinoplasty is one of the most frequently performed plastic surgery procedures in the world, in the United states, and with SurgeonGate; in fact in accordance with a recent report by the national plastic surgery statistics published in the year 2017, it is stated to be the third most commonly carried out cosmetic surgery procedure. SurgeonGate is an organization dedicated to connecting patients with the most experienced and specialized plastic surgeons in Michigan.
Despite being a highly complex procedure, implementation of diligent care on part of both the physician as well as the patient can culminate in highly satisfactory results in addition to a smooth and speedy recovery. Over recent years, the procedure employed by many expert plastic surgeons has evolved to generate highly agreeable results, however, the procedure remains far from impeccable, comprising of risks and complications that require assiduous attention to enhance outcomes.
What are some of the complications and risks you can anticipate after plastic surgery?
Rhinoplasty can present various complications when the expectations of the physician and the patient do not correspond. Reduction rhinoplasty is associated with breathing disturbances in as many as 70% of the cases (2). The main risks associated with transplant material is distortion, resorption, and extrusion as well as infections (3). However, these risks are not commonly encountered in actual clinical settings and the overall incidence is as low as 1% (4).
Despite being rare, some infections such as toxic shock syndrome can be quite serious and may even be life-threatening if appropriate interventions are not implemented. Furthermore, patients often complain of a sensation of blocked nose owing to the loss of mucosal sensation and the presence of surgical scars. Several skin and soft tissue complications have been reported such as skin necrosis, hematomas, swelling, atrophy and fibrosis
(5). The major risks associated with rhinoplasty continue to be postoperative deformities which often mandate revision surgeries in as many as 5-15% of the cases (6). The most common indication of revision rhinoplasty in approximately half of the cases is ‘pollybeak’ which is encountered when a cartilaginous hump or is seen preoperatively in plastic surgery is associated with a myriad of theoretical risks and complications, the outcomes seen in clinical practice can be achieved with remarkable safety by rigorous clinician expertise and experience and adherence on account of the patient.
What role can a qualified surgeon play in minimizing the complications associated with rhinoplasty?
Rhinoplasty is a fairly common surgical procedure that requires thorough attention from a qualified professional. Several complications can be correctly addressed if the correct method and material are employed. For instance, silicone implants predispose to a complication rate of 5-20% (8). On the other hand, fewer complications are encountered with materials like polytetrafluoroethylene (PTFE, Gore-Tex) or polyethene (PHDPE), even in long term follow up (9).
If the procedure of rhinoplasty is performed with meticulous care, complications such as distortion and extrusions can be significantly reduced. Additionally, enhanced care in matters of sterilization and hygiene in addition to the appropriate use of systemic and topical antibiotics can significantly curb the infection rate.
The risks for rhinoplasty associated complications can be significantly reduced when plastic surgeons are earnest and exceedingly qualified. Therefore, the most momentous physician related factor is to ensure that an extremely skilled and highly experienced professional performs this cosmetic surgery procedure who is not only well aware of the risks associated with the procedure but can also take appropriate steps to guarantee they do not occur.
What can the patient do to minimize complications of rhinoplasty and speed up recovery?
Rhinoplasty is frequently opted by various people for a diverse range of reasons. Regardless of the cause of undergoing the procedure, the most significant tip patients can employ in achieving a timely recovery, is to set clear goals of what they require. Most of the female patients that request the rhinoplasty procedures are well aware of what they want their noses to look like (10).
On the other hand, men undergoing rhinoplasty are less aware of what they want. Teenagers often know what they want but do not possess the required vocabulary to explicitly express their wishes. Teens may also change their mind frequently so it is not only essential to establish effective communication with them but with their parents as well.
When patients have successfully communicated their wishes to the plastic surgeon, the entire surgical team would be in a better position to comprehend the psychology of the complex procedure of rhinoplasty and set unequivocal goals of what the final results would look like (10). Sketches can often aid greatly in creating an unambiguous image of what results are expected and are likely to enhance patients satisfaction.
Throughout the cosmetic surgery process, it is mandatory for patients to listen to their physicians, and make sure they follow all instructions religiously including taking care of the surgical site and wounds to prevent infections and taking prescribed medicines regularly. It is recommended that patients keep their heads elevated when sleeping with the help of prop up pillows for a minimum duration of at least six weeks following the procedure in order to minimize swelling and bruising and also prevent displacement of the nose (11).
Ice bags and cold compresses can aid in depreciating any swelling that may occur postoperatively. It is essential for patients to follow a healthy routine, eat a balanced diet and ensure they get adequate sleep and rest so they recover in a timely manner. However, plastic surgeons often recommend avoiding rigorous exercise for at least a period of one to two months following rhinoplasty, but patients may perform light exercises as directed by physicians upon discharge. Patients are advised to refrain from caffeine, alcohol and smoking before and after surgery for at least one month duration.
Although recent research failed to establish any quantifiable association between smoking status and the operation outcomes as well as postoperative complications of rhinoplasty, tobacco smoking is still discouraged due to established harmful effects and possible restriction of nasal blood supply by nicotine that may hamper recovery (12).
Additionally, patients are recommended to avoid blowing their nose and to keep away from sunlight since the skin of the surgical site may be more prone to sunburns in the weeks following the procedure (13). Patients who wear glasses may also have to temporarily refrain from wearing glasses until advised.
Caution is also advised when brushing teeth or applying make-up to ensure that no undue pressure is placed anywhere near the surgical site of the nose. Consequently, it is pertinent that all patients stay in regular contact with their respective cosmetic surgeons and follow their advice strictly in addition to responsibly reporting any new symptoms so they can be addressed before they turn into grave complications. This process is also seen in the recovery after Lasik surgery at Yaldo Eye Center.
The recovery times depend mainly on the type of procedure performed and can vary from as little as five days to a few weeks, however, the healing process can continue for over one to three years.
In conclusion, rhinoplasty is a complex surgical procedure, holding high stakes for both the plastic surgeon and the patient. Skill and experience on the part of the physician and effective communication and adherence to advice on part of the patient are crucial in obtaining the desired results with minimal complications.
References:
- Foda, H. M. (2005). Rhinoplasty for the multiply revised nose. American journal of otolaryngology, 26(1), 28-34.
- Stoll, W. (1997). Complications following implantation or transplantation in rhinoplasty. Facial plastic surgery, 13(01), 45-50.
- Vuyk, H. D., Watts, S. J., & Vindayak, B. (2000). Revision rhinoplasty: review of deformities, aetiology and treatment strategies. Clinical Otolaryngology & Allied Sciences, 25(6), 476-481.
- Rettinger, G., & Zenkel, M. (1997). Skin and soft tissue complications. Facial plastic surgery, 13(01), 51-59.
- Cvjetković, N., & Lustica, I. (1997). Secondary rhinoplasty (analysis of failures over a 5-year period). Lijecnicki vjesnik, 119(2), 68-71.
- Constantian, M. B. (2000). Four common anatomic variants that predispose to unfavorable rhinoplasty results: a study based on 150 consecutive secondary rhinoplasties. Plastic and reconstructive surgery, 105(1), 316
- Ham, K. S., Chung, S. C., & Lee, S. H. (1983). Complications of Oriental augmentation rhinoplasty. Annals of the Academy of Medicine, Singapore, 12(2 Suppl), 460-462.
- Baran, C. N., Tiftikcioglu, Y. O., & Baran, N. K. (2005). The use of alloplastic materials in secondary rhinoplasties: 32 years of clinical experience. Plastic and reconstructive surgery, 116(5), 1502-1516.
- Taylor, J. R. (2010). Things I wish I had been taught about rhinoplasty.
- Nooraei, N., Dabbagh, A., Niazi, F., Mohammadi, S., Mohajerani, S. A., Radmand, G., & Hashemian, S. M. R. (2013). The impact of reverse trendelenburg versus head-up position on intraoperative bleeding of elective rhinoplasty. International journal of preventive medicine, 4(12),
- Yazici, Z. M., Sayin, I., Erdim, I., Gunes, S., & Kayhan, F. T. (2015). The effect of tobacco smoking on septoplasty outcomes: a prospective controlled study. Hippokratia, 19(3), 219.
- Shadfar, S., Deal, A. M., Jarchow, A. M., Yang, H., & Shockley, W. W. (2014). Practice patterns in the perioperative treatment of patients undergoing septorhinoplasty: a survey of facial plastic surgeons. JAMA facial plastic surgery, 16(2), 113-119.
Hospital Safety in plastic surgery
Whether a patient in a hospital or a staff member at a healthcare facility, you will most likely encounter dozens of occupational hazards, even on a daily basis if you begin to pay attention to your surroundings. It is critical that we as consumers, and future healthcare practitioners, are educated and informed on these hazards so that we can make a positive impact on institutional change. In the material covered thus far, we have learned about many different occupational hazards and many different ways to categorize them.
The two points of focus are hazards and risks. A risk is merely the chance that a hazard will cause harm or that a specific event will occur. The main types of hazards found in a healthcare setting include biological, physical, chemical, ergonomic and psychological. The book also goes into detail specifically on occupational hazards which are specifically experienced in the workplace. The main types of occupational hazards include heat, noise, mental strains, ergonomic strains, biological and chemical hazards, and exposure to radiation.
I occupational hazard that I found interesting and decided to research is mold. There are over 150 thousand types of fungi and many of them are present no threat to our health. With that in mind, there are a few that pose a serious risk for disease and are a serious hazard in any healthcare setting. Aspergillus fumigatus is the most common species of fungi to cause disease in people suffering from immunodeficiencies. Many patients in hospitals are already immunocompromised and such exposure could possibly be fatal. Nevertheless, exposure to Aspergillus fumigatus could cause such a patient to become further ill, and leave them worse off than they were before entering the hospital. This is a very critical hazard that the hospital must keep in check and monitor constantly.
In order to properly control the spread of mold in a healthcare facility, administrators must monitor ventilation parameters such as filters and AC systems, the building infrastructure, as well as microbe concentration in the air, water, and on surfaces within the facility. This is a major issue for hospitals who have recently experienced water intrusions such as a flood or leaks as this can concentrate mold growth and pose a serious risk for patients, nurses, and physicians.
In order to professionally handle mold in a healthcare setting, hospitals usually contract companies to monitor their facility on a weekly or monthly basis. The tricky thing about mold is that it thrives in places that are dark and damp. Mold spores will often begin to begin deep in the walls of a building around a small pipe that may be leaking. The factor that caused the mold may not be an issue and maybe something that engineers would not have noticed for months. For this reason, it requires an extremely thorough inspection and most importantly, measurements of air quality. Because it can be so difficult to find mold in a building, a search usually begins when a sample of the air or water from a drinking fountain is tested and fungi levels are high.
The hospital is meant to be a place where patients can heal, without the thought of exposure to a dangerous substance such as mold. Unfortunately, many hospitals contain more biological and chemical contaminants than many may be exposed to in their home or office. This is a hazard that definitely requires institutional change and cannot be dealt with on an individual level by staff such as doctors or nurses.
Abdominoplasty, the removal of excess skin combined along with muscle mass plication of an individual’s abdominal region, may give feeling free to postoperative outcomes alone, but incorporating substantial concurrent circumferential abdominal liposuction surgery to the technique may greatly boost the overall shape and contour of the end product. The recognized danger of performing this combined operation entails possible skin necrosis coming from devascularization of the stomach flap, however, when carried out along with appropriate strategy– including complete tumescent infiltration and vascular conservation during the liposuction portion– the method delivers first-rate end results along with a low risk of anemia and death.
Abdominoplasty has been actually performed because 1899, when Kelly to begin with explained the reduced, cross, longitudinal removal of stomach skin layer. Since that time, lots of refinements have actually been created to the operation, giving improved outcomes. Professional abdominoplasty usually entails elevation of the abdominal skin layer and fat from a reduced, cross incision to the degree of the costal frames and xiphoid. This skin layer altitude requires the department of the boring ships that program with the rectus abdominis muscle mass in to the stomach subcutaneous tissue and skin layer. This weakening is actually needed to leave open the rooting abdominal wall surface, which allows significant former rectus skin plication to attain lesser stomach flattening and also an enhanced waistline. This generates a central area of skin layer as well as subcutaneous tissue in the midline of the high flap that is much less vascularized than the tissues that stay adherent to the rooting stomach wall surface.
In the course of abdominoplasty, the blood stream supply to the stomach skin and also subcutaneous tissue is dramatically altered. The shallow substandard epigastric veins and shallow circumflex iliac veins are divided. (B) Most significantly, the general perforators stemming from the rectus muscle are actually divided to permit solid myofascial plication. This may create a family member anemia to the staying central skin layer as well as subcutaneous cells of the abdominal area.
Abdominoplasty alone (without any kind of lipo) could be linked with anemia and death, specifically in the location promptly beyond the cut in a midline, inverted triangle with its pinnacle towards the recently situated umbilicus (). As the stomach skin layer as well as body fat rise, the blood stream within the microvasculature of the skin layer cover may end up being stationary and is actually susceptible to microthrombi buildup as a result of the launch of thrombogenic mediators. Lessened blood stream circulation is the result, and also this is actually substantially behind ischemia as well as necrosis when abdominoplasty is actually performed without liposuction surgery. Elements that increase the threat for vascular concession or ischemia– including cigarette smoking, compression, or conventional liposuction along with general injury and bleeding– ought to as a result be actually prevented.
The absolute most badly perfused location observing abdominoplasty is an inferiorly-based cuneate area starting at the umbilicus and also encompassing the laceration. Failing to sustain the general supply coming from the intercostal boats perfusing this region can result in anemia and also necrosis. This could be seen in clients undergoing abdominoplasty without lipo and also those along with liposuction, if vascularity is not kept to this area.
Liposuction surgery, 1st done in 1977 through Illouz, has actually additionally undergone a lot of innovations that have attended to enhanced security as well as improved results., These noteworthy improvements feature boosted amounts of invasion liquid having adrenaline to lessen bleeding and also the application of small-diameter cannulae to help keep general functionality. Along with detailed tumescent infiltration, the subcutaneous tissues in that location are virtually exsanguinated of all blood stream, the canals as well as blood vessels are substantially pressed (providing all of them smaller sized and a lot more resilient to cannula trauma), as well as there is no sluggish blood stream to launch arbitrators that can adversely influence flap survival.
Tumescent liquid invasion produces a profound exsanguination of the addressed cells. This removes the opportunity of blood stream stagnancy with the deleterious release of thrombogenic mediators. The squeezed and also extended ships are actually alleviated most successfully through the adrenaline in the tumescent fluid. These vessels come to be incredibly tiny in dimension, that makes them a much smaller intended for the liposuction cannula. Additionally, the completely moisturized cells give considerably a lot less resistance to cannula passage, and also as a result the general cells injury is actually significantly lessened, better reducing postoperative bleeding.
Incorporating these 2 approaches by performing abdominoplasty with detailed simultaneous circumferential abdominal liposuction is a logical marital relationship of 2 corresponding operations. Without effective subcutaneous tissue penetration, nonetheless, liposuction surgery cause considerable blood loss throughout the suctioned cells. This blood loss can easily minimize the vascularity of the cells, resulting in ischemia and also death. To help surgeons prevent these possible conditions, the writers illustrate specifically their surgical method for abdominoplasty.
Indicators And Contraindications For Abdominoplasty
Effective abdominoplasty needs to remove unnecessary skin as well as subcutaneous tissue, send back the abdominal wall structure musculature and contour to its premorbid or even prepregnancy condition, elevate the outside mons, minimize or even do away with striae, and plicate the myofascia. The majority of patients providing for abdominoplasty likewise have notable excess adiposity of the hip rolls; when this region is actually properly alleviated, the overall last shape is dramatically enhanced. Aesthetically talking, the goals of an abdominoplasty technique include reducing scarring, normalizing umbilical positioning and appeal, specifying the midsection, and also considerably flattening/tightening the abdominal area.
Clients with skin laxity; excess adiposity of the hip rolls, abdominal area, and also mons; rectus diastasis; and also a need for considerable contour enlargement are good applicants for the combined method. As a whole, these patients ought to lack substantial health and wellness concerns or comorbidities.