In reconstructive rhinoplasty, the defects and deformities that the plastic surgeon encounters, and must restore to normal function, form, and appearance include broken and displaced nasal bones; disrupted and displaced nasal cartilages; a collapsed bridge of the nose; congenital defect, trauma (blunt, penetrating, blast), autoimmune disorder, cancer, intranasal drug-abuse damages, and failed primary rhinoplasty outcomes.
Rhinoplasty reduces bony lumps, and re-aligns the nasal bones after they are cut (dissected, resected). When cartilage is disrupted,suturing for re-suspension (structural support), or the use of cartilage grafts to camouflage a depression allow the re-establishment of the normal nasal contour of the nose for the patient.
When the bridge of the nose is collapsed, rib-cartilage, ear-cartilage, or cranial-bone grafts can be used to restore its anatomic integrity, and thus the aesthetic continuity of the nose. For augmenting the nasal dorsum, autologous cartilage and bone grafts are preferred to (artificial) prostheses, because of the reduced incidence of histologic rejection and medical complications.
Reconstruction rhinoplasty for the correction of defects and deformities caused by:
- Skin cancer. The most common cause (etiology) for a nasal reconstruction is skin cancer, especially the lesions to the nose of melanoma and basal-cell carcinoma. This oncologic epidemiology occurs more readily among the aged and people who reside in very sunny geographic areas; although every type of skin is susceptible to skin cancer, white-skin is most epidemiologically prone to developing skin cancer. Furthermore, regarding plastic surgical scars, the age of the patient is a notable factor in the timely, post-surgical healing of a skin cancer defect (lesion); in terms of scarification, the very elastic skin of young people has a greater regenerative propensity for producing scars that are thicker (stronger) and more noticeable. Therefore, in young patients, the strategic placement (hiding) of the rhinoplasty scars is a greater aesthetic consideration than in elderly patients; whose less elastic skin produces scars that are narrower and less noticeable.
- Traumatic nasal defect. Although trauma is a less common rhinoplasty occurrence, a nasal defect or deformity caused by blunt trauma (impact), penetrating trauma (piercing), and blast trauma (blunt and penetrating) requires a surgical reconstruction that abides the conservation principles of plastic surgery, as in the corrections of cancerous lesions.
- Congenital deformities. The unique plastic properties of the bone, cartilage, and skin of patients’ afflicted with congenital defects, and associated anomalies, are considered separately.