Rasti Majid, Rasti Sina, Behshadnia Fatemeh
Plastic Surgeon Private Practice, 21 Mardavij street, Isfahan, Iran.
Isfahan University of Medical Science, 8174673461, Isfahan, Iran.
Aesthetic Plast Surg. 2023 Apr;47(2):738-745. doi: 10.1007/s00266-022-03053-9. Epub 2022 Aug 29.
Excessive nasal edema is among the complications after rhinoplasty translating into Skin-Soft Tissue Envelope (SSTE) thickening and disruption in the nasal framework's definition. Revision rhinoplasties are suspected of causing even more nasal edema. The objective postoperative SSTE thickness between revisionary and primary rhinoplasties is compared in this study.
A study was conducted over a recorded database of eligible candidates who had attended the senior author's private clinic in a 12-month period and underwent primary and revisionary open-approach rhinoplasties. The SSTE thickness was measured by ultrasonography in each nasion, rhinion, supratip, and tip region at months 1, 3, 6, and 12 after each episode of rhinoplasty. Paired T-test was used for pairwise comparisons of the corresponding region-time thicknesses between primary and revisionary rhinoplasties. Repeated measure ANOVA tests were used to assess mean thickness changes over time after each surgery-P < 0.05 indicated significance.
Of the 36 participants analyzed, the SSTE was significantly thicker after revisionary surgery in all the follow-up sessions and nasal regions, except for the 1-month follow-up in the nasion (p = 0.273) and 12-month follow-up in the rhinion (p = 0.050). Mean nasal SSTE thickness showed decreasing trends in each region after either primary or revisionary surgery, with a lower level of resolution in the nasion region after revision rhinoplasty (p < 0.001).
The nasal SSTE had been significantly thicker in most regions after revisionary procedures than primary ones, and the swelling had subsided slightly slower. Surgeons are recommended to consider revisionary rhinoplasties based on these findings cautiously.
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鼻整形术后并发症之一是鼻水肿过度，这会导致皮肤软组织包膜（SSTE）增厚，破坏鼻支架结构的清晰度。二次鼻整形术被怀疑会导致更严重的鼻水肿。本研究比较了二次鼻整形术与初次鼻整形术后目标SSTE厚度。
对在12个月内到资深作者私人诊所就诊并接受初次和二次开放式鼻整形术的符合条件的候选人记录数据库进行研究。在每次鼻整形术后1、3、6和12个月，通过超声测量每个鼻根、鼻背、鼻尖上区和鼻尖区域的SSTE厚度。采用配对t检验对初次和二次鼻整形术相应区域-时间厚度进行两两比较。采用重复测量方差分析评估每次手术后SSTE厚度随时间的变化——P<0.05表示有统计学意义。
在分析的36名参与者中，除鼻根1个月随访（p=0.273）和鼻背12个月随访（p=0.050）外，所有随访期和鼻区二次手术后SSTE均显著增厚。初次或二次手术后，每个区域的平均鼻SSTE厚度均呈下降趋势，二次鼻整形术后鼻根区域的消退水平较低（p<0.001）。
二次手术多数区域的鼻SSTE比初次手术厚，肿胀消退略慢。建议外科医生根据这些发现谨慎考虑二次鼻整形术。
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