One-Stage/Multi-Stage Rhinoplasty

View the research papers from The Plus Plastic Surgery medical team.

Understanding One-Stage/Multi-Stage Rhinoplasty

Traditionally, most nose reconstruction surgeries involve removing implants from patients with severe issues and then performing surgery after a waiting period of 6 months to 1 year. However, the decision to opt for a one-stage surgery or a multi stage surgery depends on various factors, including the type of complications. It’s often confusing due to the ambiguous classification and indications. In most cases, multi-stage surgery is performed when there is inflammation or poor blood circulation in the skin flap. Therefore, the choice between step-by-step surgery or immediate one-time surgery is a complex issue for both patients and doctors. The probability of success is relatively high when the surgery is performed by a medical team with extensive experience and proficiency in nose reconstruction surgery.

Considerations During One-Stage/Multi-Stage Rhinoplasty

Hydro dissection using local anesthesia: During reoperation, where normal anatomical structures are hard to distinguish due to scars and contractions, the surgery’s outcome heavily depends on the the local anesthesia stage.
Selection of the columella incision line: The scar shape from the previous surgery varies greatly, necessitating careful observation and medical history investigation. The wrong choice of incision line can cause problems such as skin flap scarring, delayed wound healing, and tissue construction, making the incision line choice crucial in reoperation.
Careful manipulation of skin tissue: Unlike in the first surgery, careless or excessive manipulation can cause skin damage, leading to delayed wound healing or construction after surgery. Therefore, more careful manipulation is needed.
Surgical approach: As it is a reoperation, the anatomical structure is twisted and deformed. It is important to secure a safe skin flap, separate the scar tissue and normal tissue safely, and secure a healthy flap.
Selection of appropriate graft: It is important to check how much cartilage was used using a thorough medical history investigation before surgery and to conduct a direct physical examination to confirm as much as possible whether the actual cartilage was used.
Selection of implant or autologous tissue: During reoperation, there are cases where it is possible to use an implant, but it cannot be used it due to unexpected variables during surgery. Therefore autologous (one’s own) tissue is used instead.

Before and After One-Stage/Multi-Stage Rhinoplasty

Case 1: One-Stage

Patient Information: A woman in her late 20s visited the clinic with a too narrow and high nasal bridge, visibility of the implant, and excessive protrusion and deviation of the nasal tip. She had a history of two nose surgeries, one was an open approach and the other was an intranasal approach. The patient’s nasal skin was quite thin.

Surgery Plan:

Reduce the overall height of the nose and shorten the length.
Correct the displacement and visibility of the nasal tip.
Supplement the thinned nasal bridge or visible skin (considered using deep temporal fascia etc.).

Before

After

See more before and after surgery photos.

Case 2: Multi-Stage Rhinoplasty

Patient Information: The patient has a collapsed nasal tip due to multiple surgeries.

Surgery Plan:

Fill the insufficient skin tissue with the septal cartilage during the first surgery on the nasal tip.
After the blood circulation has improved, perform a second surgery to correct the insufficient tissue in the nasal tip with a composite graft.