Rhinoplasty Dr Bashar Bizrah Article on: PostRhinoplasty Probleins and Revision Surgery Part 8: Postoperative problems related to patients

27. Postoperative problems related to patients:

1. Patient not following postoperative instructions.
   • Early pulling of sutures:
     In particular marginal incision sutures while cleaning the nares, causing alar collapse.
   • Early cast removal:
     Some patients are curious to see the outcome of their nose and remove the cast at home earlier than instructed which causes deviation or prolonged swelling.
   • Early alar wedge sutures removal:
     May cause nares widening or asymmetry.
   • Ignoring postoperative antibiotics.
   • Exposure to sun which may cause swelling and redness.
   • Early wearing of glasses which causes depressions or deviation of the dorsum.
   • Sleeping on the nose which may cause deviation.
   • Children hitting the nose in particular when the cast is still on.
   • Early practising of sports:
     Patient should be instructed not to practise heavy sports for at least six weeks.
2. Psychological problems:
   Patients usually have good results but are still unsatisfied.
   • Early psychic depression: 
     This is common in patients over the age of thirty who have become used to the shape of their original nose. In the clinic when the cast is removed, the patient sees the new shape and may suddenly get vasovagal attack. Afterwards they might frequently visit the clinic continually wanting to discuss the new shape. Two months later, such a patient may return to apologize and thank the surgeon for such a good operation.
   • Late psychic depression: 
     These patients, in spite of satisfactory results do not accept the new shape of the nose and request a revision surgery to return the nose to the original shape.
   • Monomania: 
     The word was used by Weir, 1892, in his article “On Restoring Sunken Noses”. He identified the patient who is never satisfied with results and demands operation after operation in the hope of achieving a perpetually elusive state of perfection.
3. Social problems:
   These problems are not uncommon in our practice and this may be met frequently by surgeons practising in our communities.
   • Friends phenomena: 
     The comments of the patient’s friends may severely upset the patient. The friends usually have no idea about the operation and postoperative effects such as swelling and oedema. Their comments in the first two months may result in very bad psychological effects on the patient.
   • Mother-in-law phenomena:
     Our community has very close social relations. The mother-in-law plays an important role in the husband-wife relationship. The mother-in-law may comment on her daughter-in-law’s nose which may initially push the daughter to have her rhinoplasty done. Then after the operation the motherin-law makes derogative comments because she has changed her face!!!
   • Husband phenomena:
     It is common in our community for the husband to comment on his wife’s nose. Then when the wife decides to go for rhinoplasty the husband refuses the idea in order to avoid the financial burden. The wife usually sells her jewelry or borrows money for the operation, after which the husband may still be unsatisfied and uses this as an excuse for a second marriage. It is common to discover the mother-in-law or the husband phenomena when you find a patient with quite satisfactory results continuously to returning to the clinic with unfounded complaints.

Timing of revision

As previously mentioned, revision of the author’s cases is usually done under local anaesthesia, for correction of minor problems such as mild notching, pinching or deviation. It is preferable that minor correction is carried out eight to ten weeks postoperatively. 

In patients who are referred from another practice, requesting major revision, it is better to wait for at least eight months.