Nous allons entamer là une série d’articles sur la rhinoplastie secondaire, qui représente pour moi le gros problème actuel en rhinoplastie. A ma connaissance il n’y a pas de statistiques, mais il ne me semble pas que les progrès de la chirurgie esthétique du nez aient entraîné une diminution notable des reprises chirurgicales.
Il convient d’admettre également que le développement des connaissances du public (merci Internet…) rend certainement les patients plus exigeants. Ceci n’est certainement pas un mal, puisque cela ne peut tendre que vers une amélioration des résultats.
Il convient tout d’abord de définir les termes de rhinoplastie secondaire. A mon sens, on parle de simple retouche, quand en général le même chirurgien reprend de manière limitée, une rhinoplastie relativement réussie, pour en améliorer le résultat esthétique ou fonctionnel. Ces retouches sont très fréquentes, si on veut un résultat parfait ou presque.
A l’inverse, mais il ne s’agit encore que de mon avis, on parle de rhinoplastie secondaire quand il est nécessaire de reprendre l’ensemble de l’intervention, car le résultat est mauvais, ou très mauvais voire parfois épouvantable. Ces cas sont évidement plus rares, heureusement et sont les plus souvent pratiqués par un autre chirurgien (logique !! car il y a perte de confiance et donc changement d’opérateur).
Une réelle deuxième rhinoplastie est nécessaire et elle est souvent beaucoup plus difficile que la première. Actuellement, on utilise préférentiellement la voie externe qui permet de faire un état des lieux, et donc de savoir ce qui a été « mal fait ». On a recourt à divers greffons osseux ou cartilagineux. En fait il s’agit là de véritables rhinoplasties réparatrices, tout à fait comparable aux rhinoplasties post-traumatiques après accidents ou agressions.
Photos avant/après rhinoplastie et après une legère retouche pour bosse résiduelle…
N’hésitez pas à regarder les photos Avant-Après de rhinoplasties.
Sandro Botticelli : Portrait de Simonetta Vespucci
Effectuez-vous des opérations reparatrices de perforations de la cloison nasale large (3cm)
Une telle opération est-elle possible?
En vous remerciant de votre attention
les perforations importantes de la cloison (3cm ) sont extrêmement difficile a fermer, surtout celle qui sont iatrogènes (cad causées par une intervention). Néanmoins seules les perforations antérieures sont symptomatiques et donc gênantes , les postérieures sont le plus souvent ignorées . Aussi il m’est arrivé d’avoir d’excellent résultats fonctionnels en fermant la partie antérieure de la perforation souvent avec une greffe de cartilage.
les autres perforations , notamment celle causées par l’abus de cocaïne sont beaucoup plus facile à fermer dans mon expérience .
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