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septoplasty real or myth
In next part I wanted to focus how it should be done correctly, unfortunately the pictures are not very helpful, I uploaded photos and animations in excellent quality but after upload all photos are so small, all have degraded quality to 400px max and are rasterized or blurred…
Osteotomy is performed in every rhinoplasty, patients probably expect surgeons should know how to perform it, often from surgeons you could hear, osteotomy is easy and It will take few minutes only, that may be true only if everything is symmetric. But patient which go for surgery rarely have everything symmetric.
So I thought about why so many surgeries end so bad, most surgeons do not know how to performs septoplasty, and many of them do not know correctly perform osteotomy, I look at many after surgery photos and most of surgeons reduced alar base, alar base reduction may be needed if bones were moved in the pyriform area, so it is consequence of “low” performed osteotomy, this means, many surgeons do not preserve Webster’s Triangle what causes collapse of internal nasal valve. Internal nasal valve is like a “tent” held by elastic fibers, when surgeon push bone (Webster’s Triangle) closer to septum, elastic fibers become very loose, and that causes “tent collapse” and other problems.
Invisible upper teeth
Another problem I have after surgery is, when I open mouth i have no upper teeth visible, they completely disappeared, this usually happen after anterior nasal spine reduction, but I guess I could be related with pitanguy ligament which surgeon removed, because this ligamets is connected to nasal spine and SMAS area, gives support to medial crura cartilages.
(picture 100)
the blue nasal bones are longest in the area of lateral osteotomy line, therefore even small lateral movement by 5 degree causes serious narrowing at the end in the pyriform area if osteotomy is performed too low. Webster's Triangle is marked red, yellow osteotomy line preserves part of Webster's Triangle and prevents middle vault collapse
(picture 101)
On pictures A,B is real nose anatomy C, D are sketches, many nose sketches are wrong drew it is on of causes why surgeons do so fatal mistakes
Real Webster's Triangle (red) on picture A is much larger than on animation C what may mislead surgeon to perform osteotomy too high, doing osteotomy as on picture A would create visible bone bump.
On picture B part of Webster's Triangle is narrowed while the other part remains intact that will prevent collapse of internal nasal valve and unaesthetic narrowing of lateral crura in the pyriform area
When is mention about nasal bones in some animation are nasal bones marked by same color, but nasal bones are light-blue, dark-blue is ascending process of maxilla, both bones are connected as one piece by nasofrontal suture (line), so for better explanation my left nasal bone is practically destroyed, also if you look at A,B pictures, upper lateral cartilages (ULC) are connected to nasal bones, look at picture D how misleading it is drew, ULC continues to ascending process of maxilla, so if surgeon completely destroys nasal bone in the keystone area ULC will lose any connection to this bone. How much remained from my left nasal bone in the keystone area, about 2-3 mm and as bone continue to radix bone is almost gone... so i wonder what support has my left ULC from nasal bone.
(Picture 103)
On consultation surgeon said "we do not know to close open roof". Who is "we"? Animation shows what happens after osteotomy.
In the first part of animation bones are moved laterally it will leave visible gaps near pyriform area, and significantly narrow nasal cavity what can cause serious breathing problems,
gaps between septum and nasal bones near radix are 2 mm while gaps in the keystone area after hump removal are always wider in this case 4 mm,
Nasal bones must reach septum in the keystone area, to do that with lateral movement only would cause too large gaps in the pyriform area and serious breathing problems.
bones can be rotated around osteotomy line, how much? Until they reach septum in the radix area. This means in most rhinoplasty both types of nasal movement are necessary.
As you can see i did not even use spreader grafts or spreader flaps, so closing open roof is easy, IF SEPTUM IS IN THE MIDDLE, this is answer why many rhinoplasties eds so bad. Surgeons do not know septoplasty, and if they even try to perform septoplasty they do that wrong...
In case if open roof is still not close even after both types of nasal bones movement, there it is possible perform second osteotomy,yellow dashed line, creates bone triangle which is rotated much faster in the radix area that allows rotate nasal bones even more to close open roof, same i did not even need to use spreader grafts or spreader flaps to fill gaps in the keystone area.
Lateral movement of nasal bones:
advantages: narrows nasal bones, aesthetic improvement
disadvantages: gaps between bones, breathing problems (if moved too much)
digital osteotomy, (rotation of nasal bones):
advantages: breathing problems related are minimal
disadvantages: unaesthetic, nose could look too wide in the nasal base like African nose if the nose had already wide nasal base
To avoid disadvantages of both osteotomies, combination of both osteotomies is the key to success, but first prediction of success is septum, if septum is not symmetric nothing will be symmetric, trying to fake surgery will cause even more damage and asymmetries
Of course i is better to not move the green thin triangle, but still better than destroy it, what did this surgeon to me.
On animation C is yellow arrow and white cross around which is bone rotated, at this point bone remains on place while in the radix area it rotates faster, that will balance gaps in the radix and keystone area and also makes bones look more concave.
On animation D is how the piece triangular bone touches septum, so it has support from septum from nasal bones, from splint.
I really doubt surgeons will perform such osteotomy, because the triangle is very thin it could easy break, this is not possible to do that with classic surgery tools, precise tool could do that like ultrasonic tools or micro saws.
(Picture 104)
This is similar animation, but green bone has trapezoid shape, on animation B rotation would leave visible edges, also part of bone remained intact in the keystone area, because to this bone are connected upper lateral cartilages.
Osteotomy is performed in every rhinoplasty, patients probably expect surgeons should know how to perform it, often from surgeons you could hear, osteotomy is easy and It will take few minutes only, that may be true only if everything is symmetric. But patient which go for surgery rarely have everything symmetric.
So I thought about why so many surgeries end so bad, most surgeons do not know how to performs septoplasty, and many of them do not know correctly perform osteotomy, I look at many after surgery photos and most of surgeons reduced alar base, alar base reduction may be needed if bones were moved in the pyriform area, so it is consequence of “low” performed osteotomy, this means, many surgeons do not preserve Webster’s Triangle what causes collapse of internal nasal valve. Internal nasal valve is like a “tent” held by elastic fibers, when surgeon push bone (Webster’s Triangle) closer to septum, elastic fibers become very loose, and that causes “tent collapse” and other problems.
Invisible upper teeth
Another problem I have after surgery is, when I open mouth i have no upper teeth visible, they completely disappeared, this usually happen after anterior nasal spine reduction, but I guess I could be related with pitanguy ligament which surgeon removed, because this ligamets is connected to nasal spine and SMAS area, gives support to medial crura cartilages.
(picture 100)
the blue nasal bones are longest in the area of lateral osteotomy line, therefore even small lateral movement by 5 degree causes serious narrowing at the end in the pyriform area if osteotomy is performed too low. Webster's Triangle is marked red, yellow osteotomy line preserves part of Webster's Triangle and prevents middle vault collapse
(picture 101)
On pictures A,B is real nose anatomy C, D are sketches, many nose sketches are wrong drew it is on of causes why surgeons do so fatal mistakes
Real Webster's Triangle (red) on picture A is much larger than on animation C what may mislead surgeon to perform osteotomy too high, doing osteotomy as on picture A would create visible bone bump.
On picture B part of Webster's Triangle is narrowed while the other part remains intact that will prevent collapse of internal nasal valve and unaesthetic narrowing of lateral crura in the pyriform area
When is mention about nasal bones in some animation are nasal bones marked by same color, but nasal bones are light-blue, dark-blue is ascending process of maxilla, both bones are connected as one piece by nasofrontal suture (line), so for better explanation my left nasal bone is practically destroyed, also if you look at A,B pictures, upper lateral cartilages (ULC) are connected to nasal bones, look at picture D how misleading it is drew, ULC continues to ascending process of maxilla, so if surgeon completely destroys nasal bone in the keystone area ULC will lose any connection to this bone. How much remained from my left nasal bone in the keystone area, about 2-3 mm and as bone continue to radix bone is almost gone... so i wonder what support has my left ULC from nasal bone.
(Picture 103)
On consultation surgeon said "we do not know to close open roof". Who is "we"? Animation shows what happens after osteotomy.
In the first part of animation bones are moved laterally it will leave visible gaps near pyriform area, and significantly narrow nasal cavity what can cause serious breathing problems,
gaps between septum and nasal bones near radix are 2 mm while gaps in the keystone area after hump removal are always wider in this case 4 mm,
Nasal bones must reach septum in the keystone area, to do that with lateral movement only would cause too large gaps in the pyriform area and serious breathing problems.
bones can be rotated around osteotomy line, how much? Until they reach septum in the radix area. This means in most rhinoplasty both types of nasal movement are necessary.
As you can see i did not even use spreader grafts or spreader flaps, so closing open roof is easy, IF SEPTUM IS IN THE MIDDLE, this is answer why many rhinoplasties eds so bad. Surgeons do not know septoplasty, and if they even try to perform septoplasty they do that wrong...
In case if open roof is still not close even after both types of nasal bones movement, there it is possible perform second osteotomy,yellow dashed line, creates bone triangle which is rotated much faster in the radix area that allows rotate nasal bones even more to close open roof, same i did not even need to use spreader grafts or spreader flaps to fill gaps in the keystone area.
Lateral movement of nasal bones:
advantages: narrows nasal bones, aesthetic improvement
disadvantages: gaps between bones, breathing problems (if moved too much)
digital osteotomy, (rotation of nasal bones):
advantages: breathing problems related are minimal
disadvantages: unaesthetic, nose could look too wide in the nasal base like African nose if the nose had already wide nasal base
To avoid disadvantages of both osteotomies, combination of both osteotomies is the key to success, but first prediction of success is septum, if septum is not symmetric nothing will be symmetric, trying to fake surgery will cause even more damage and asymmetries
Of course i is better to not move the green thin triangle, but still better than destroy it, what did this surgeon to me.
On animation C is yellow arrow and white cross around which is bone rotated, at this point bone remains on place while in the radix area it rotates faster, that will balance gaps in the radix and keystone area and also makes bones look more concave.
On animation D is how the piece triangular bone touches septum, so it has support from septum from nasal bones, from splint.
I really doubt surgeons will perform such osteotomy, because the triangle is very thin it could easy break, this is not possible to do that with classic surgery tools, precise tool could do that like ultrasonic tools or micro saws.
(Picture 104)
This is similar animation, but green bone has trapezoid shape, on animation B rotation would leave visible edges, also part of bone remained intact in the keystone area, because to this bone are connected upper lateral cartilages.
The Truth Behind Rhinoplasty
My first surgery went wrong, first surgeon removed 1mm hump only, caused deprojection of right dome of nose tip, something like tip Bossae and left me with open roof my right bone did not grow with septum a gap remained there even after 1,5 years there was about 2mm gap between right nasal bone and septum in keystone area. It was very simple surgery without osteotomy. Nose bridge after surgery became much wider compared to original nose bridge before surgery.
Two years ago I underwent second nose surgery, revision rhinoplasty. Main reason for surgery was open roof causing wide nose bridge, breathing problems on left side, bleeding from left nasal cavity, tip asymmetry, remaining 3 mm hump and also my septum was little shifted to left side.
I absolved consultation about upcoming surgery with dr. Selçuk Inanli. I prepared many questions and animation, to better explain inner structure of nose what was changed, so he could carefully plan what to do. We talked or better say he talked mostly almost 2 hours, despite so long time I did not have time to ask all question I had, I declared simple question and followed long reply about everything else.
I, as a patient, was interested about what he plans to do because I was very scared from surgery, after the first unsuccessful surgery my trust to doctors was significantly weakened. My most important request was closing open roof, this was main reason for surgery, because nose looked very wide from front, second important request was to not put wide spreader grafts between nasal bones and septum as this will cause extreme wide and weird nose and absolutely to not narrow nasal tip, tip was already narrowed during first surgery, further narrowing would cause pinched tip. I asked to make tip widest as possible and achieve nose symmetry. I strongly appealed to precisely smoothing sharp bony edges after hump removal and in areas where is performed osteotomy, create smooth connection to radix (hump removal), and I requested to reduce a little, excessively prominent anterior nasal spine, and lift nose tip a bit to make nose look shorter. Same I asked absolutely to not use cap graft and shield graft because these grafts may be visible in the tip area, rounding off any sharp edges of cartilaginous grafts. I warned surgeon that my left nasal bone was a little bended, it had such convex shape while right nasal bone was straight and had more concave shape. Approx. 2 hours I talked there is gap between septum and right nasal bone, an open roof, I had also pictures, animations of open roof on my website with my photos, finally at the end of consultation when I started to draw nasal bones on paper he noticed that, he looked somehow unfocused all time. Weird is how he understand term open roof, in every literature open roof is defined as wide nose usually because of gaps between septum and nasal bones, but this surgeon understands open roof as damaged mucosa after hump removal, honestly I never heard or read such definition… so I ensured him my mucosa is most likely not damaged, 1st surgeon rasped very small part of hump. I asked him to draw on my face osteotomy lines, how he usually performs osteotomy. He also told me, MAYBE he will need to perform double level osteotomy, that was very surprising for me because, most of surgeons do not do that. As I wrote before, because my trust to surgeons is very low after first surgery, more important than his morph that he drew on PC, was surgery plan, I wanted to make sure, he will not use some crazy surgery technique, his reply was, he will look, he will look what damage caused first surgeon a then he will decide what to do.
In next part we will look what damage caused second surgeon, this doctor.
Week later I had a surgery at Academic Hospital.
In the hospital I paid surgeon the required price to surgeon. In short I repeated all my surgery requests again.
Surgery started around 13:00, I woke up from anesthesia around 16:00 maybe or sooner. Anesthesiologist held my hand and told me I have great nose, my first thought about that was, "what a liar the nose surely looks terrible", and as you can read further, I was truth. He asked me how do I feel, I replied "I feel cold", he said its normal. I felt like after a brutal attack on my face.
Splint
I remember I felt very bad, surgeon came to visit me and told me surgery went well. I told him the splint is very loose. His reply "tight splint is not good it could cause skin necrosis." My reply "but then bone will move" and I could again end with open roof. His reply "bones can move ", … so bones heard him so they really moved. Such useless, completely USELESS splint, wrong trimmed. As you can see on photo (Picture 36) too short splint, part of bone after double level osteotomy on right side held by NOTHING, the thermoplastic splint was a decoration on the nose only. What did I said on consultation, strong splint at least 3 weeks, and what he did, loose splint removed after week, nose was completely unstable and extremely wide. On consultation I asked him if he performs preservation rhinoplasty with use of technique push down, he said he does not do that because it produces very unstable noses, he does structural rhinoplasty only. This is weird because I had consultation with other surgeon which does preservation rhinoplasty mostly and he said, he likes preservation rhinoplasty because noses are very stable. So it seems dr Inanli creates unstable nose with structural rhinoplasty also.
Surgeon itself get shocked from that, what he created, surgeon took few photos called his assistant with camera and asked for my opinion, what should I reply… I said it looks smaller (from profile) but from front is was absolutely massive terrible shapeless potato. Just to make clear, smiling on the photo does not mean patients are happy. Because I decide to stay in Istanbul 3 weeks he taped my nose and ask me to come again week later, photos can be found in gallery.
At hotel I could see badly overnarrowed tip, my first though, I will be unhappy for rest of life. Left nasal passage terribly swollen and much smaller than the right nasal passage, I wondered WHAT HE DID with it, when it is so small. So much crusted blood inside both nasal passages. I cold no breathe through my nose at all. It was second week after surgery, so I came again for control, surgeon took photos. I still could not breath, on right side in the osteotomy area I had visible bump, right half of nose was completely paralyzed, on touch I felt nothing, why? He performed double level osteotomy, he most likely cut blood vessels, despite my requests, he left sharp bony edges on right side after osteotomy, unrasped. He gave me mirror and expected my reaction…, my first impression, I was disgusted, at first I noticed extremely overnarroved pinched and asymmetric tip and massive wide nose bridge. A what surgeon said, "it is good, just wait". What did I say on consultation? NO tip grafts, don’t put wide grafts between nasal bones or tip will look pinched compared to rest of nose, he said "don’t worry it won’t be pinched", and what it will be? Pinched tip. What he expected he put unilateral spreader graft to right side to widen passage and right dome of the tip he narrowed even more than it was before, what other result can be expected, when dorsum is widened even more while tip is narrowed, result pinched tip, it so ugly. My request was make tip widest as possible, the right dome was so badly overnarrowed, it was narrowed to half of size from left dome. During consultation I talked about how to suture tip to make sure, he will not do some madness, this … is unbelievable, he sutured both sides of right dome, top and bottom, asymmetric domes, angle of domal divergence is probably unknown term for him. What did I say on consultation, absolutely not suture bottom part of dome, because it causes tip pinching, but you know when surgeon want to do thing easy and mostly fast, fast, fast. How can one surgeon perform surgery by way, he corrects one tip asymmetry, but instead that he will create 2 new tip asymmetries while the first one remains. Such procedure is good for what? Maybe you ask how can one surgeon overnarrow tip? Does not he see the tip is asymmetric after suturing, does not he know it is bad? Of course he sees and he knows, but he still does that, because when someone is lost, then he does surgery like a lost surgeon, and then he will come to patient and lies … surgery went well. Very poor liar, I knew from beginning it went wrong.
As you can see from photos, asymmetric aesthetic dorsal lines, asymmetric tip in the pyriform area. That’s all new asymmetries a much others I will describe into details further.
Nasal Tip
Instead of widening tip he completely overnarrowed it, wrong sutured dome, on the photo you can see the first third of nose after opening, from left side of tip cephalic part of lateral crura is almost gone a small part remained (green), on right side is unfinished cephalic trim, yellow is trimmed part while rest of cephalic part of lateral crura is still there, surgeon tried to fool me, both cephalic parts are gone, am I blind, I can clearly see remaining cephalic part of right lateral crura on picture, I can also palpate it, that was second lie. He folded remaining part inward, it does not hold there, I don’t know if it sutured, because it partially returned back and mucosa could not reconnect correctly to this cartilage. This was one of steps that caused tip narrowing and loss of tip width. (Picture 84)
Pitanguy’s ligament
He destroyed it, I have static, stiff tip held by caudal septal extension graft. Some surgeons preserve this ligament.
Middle vault area and nasal bones
For reconstruction of middle vault area, he used "spreader flaps" technique, but he also put spreader graft to right nasal passage, that made nose excessively wide compared to overnarrowed right dome of nasal tip.
Before surgery he said "we do not want harm internal nasal valve", and what he did, ou yes he did it, again, HE CUT WEBSTER’S TRIANGLE!!! Result, collapse of internal nasal valve on left side, that caused also collapse of external nasal valve in the pyriform area, I guess this started rhinoplasty domino effect of destructive steps. Now what to do on left side he performed very low osteotomy that caused collapse, so he decided to perform osteotomy on right side little higher so part of Webster’s triangle remained intact, and right side on internal nasal valve did not collapse, but by this step he created asymmetry, each side was different, left side collapsed and right side uncollapsed.
He got himself into trap. He wanted to perform osteotomy very low, on consultation he said "only I do that like that." What is weird on consultation he drew osteotomy lines differently compared to what he did during surgery. I had reason why I asked him to draw osteotomy, I red many times, surgeons ruined nose by wrong performed osteotomy, but mistake is not he did something by an accident, mistake is in his head, he does not know fundamental principles of rhinoplasty. How can one surgeon move Webster’s triangle, this is known more than thirty years, it must stay untouched. Moving Webster’s triangle was one of FATAL mistakes he did. He does not know to perform most basic lateral osteotomy which is performed in every rhinoplasty and he declares he has 30 years of experiences …
On right side he performed lateral osteotomy too high in the eye area and he extended it to radix… What!?... He should not touch radix at all, he narrowed radix from right side, this way he completely destroyed right dorsal aesthetic line, radix, area of nasal bones, keystone area, middle vault area, all same wide, nose looked like a shapeless stick ending with pinched tip. On consultation he said, he wants to create dorsal aesthetic lines, with narrowing radix he ruined them completely. Narrowing radix was another FATAL MISTAKE.
Hump removal
He removed about 3 mm hump and about extra 1 mm, so nasal bones are not smoothly connected to radix roof, there is 1mm stair step between radix roof and nasal bones, this is not so serious mistake but still mistake. On consultation I asked him to create smooth connection to radix, it seems, he does even not know rasp nasal bones properly…
If you are drinking or eating, rather stop for a moment, and carefully sit, while you are reading this…
What he did with left nasal bone?! He removed another triangular piece from nasal bone, so from left nasal bone is missing additional 3mm, my left nasal bone is practically destroyed, is GONE! GONE FOREVER! Instead of bone he put there diced cartilage, and is very well known, diced cartilage will resorb over time, after 6 months I noticed significant changes on left side. He put so much diced cartilage to dorsum also, about 2 mm thick layer. It is completely useless, there is nothing, after 1.5 years everything resorbed. Why?
Cartilages consist approx. from 20% cells and 80% water, as you know water is now very stable especially when cartilage is cut to small pieces. From my own experience, diced cartilage causes terribly oily skin, I never had oily skin, not even after first surgery, but when I said oily, I mean really oily skin, like when you brush your nose with oil. Cleaning nose did not help much, because after hour it was oily again. Nose skin stopped being so oily when the cartilage was fully resorbed, body does not like when something is blocking way to periosteum, nasal bones need to reestablish connections with periosteum. Destroying left nasal bone was third FATAL MISTAKE, he did it intentionally, it is not possible to destroy 3 mm from nasal bone and not know about that, but you know when is someone lost, does surgery like lost surgeon. Surgeons who do this I put to blacklist immediately, this is unfixable!
On touch I can clearly recognize sharp edges of nasal bones and septum, I asked surgeon to smooth any sharp edges. He smoothed sharp bony edges in the key stone area only. Second surgery and again ruined nasal bones this time definitely. Fifteen years I dreamed about nose surgery, but I had no money for it, then I had first surgery which fixed nothing, after 1.5 years I had second surgery performed by this surgeon and everything is lost, whole wrong.
But not everything is only black or only white, maybe if I started with thing which are good It would end with few words.
After first surgery I had big scars after suturing inside my nostrils, as you can see on photos, scars are gone, remaining hump was removed, transcolumellar incision is practically invisible, graft put to radix is removed, all other steps are wrong or partially wrong.
Looking back, I guess, he planned it from beginning. The surgery did not even start, and everything was convicted to failure. On consultation I did not care about morph, drawing profile in the computer will not tell me how the nose will look like from front. I asked surgeon what he plans to do, this means specific steps, but his reply "I shall see, I shall see". I said "I am afraid my nose will look like a shapeless potato", he started to laugh, what he was thinking about? (::how did you know that, that’s exactly how it will look like::)
Why did I choose otolaryngologist? Because otolaryngologists perform only one surgery all time, nose surgery, so they should have more experiences than plastic surgeons which do everything else.
So in case, if I would need to correct septum also, he would be able to do that. But it looks like this surgeon does not even know how to correctly perform lateral osteotomy, so how he could correct septum which is much more difficult.
WARNING: here is how this surgeon corrects deviated septum, instead of breaking bony part of septum he detached cartilaginous part septum from bony septum, little rasped wall of bony septum and sutured it back with few pieces of grafts, another fake surgery… bony part remains unfixed, while nose will most likely look very wide when, look how many grafts he put there.
https://www.semanticscholar.or...
https://www.semanticscholar.or...
If you look on my before photos, my philtrum is shifted to left, my nasal spine is shifted to left, my whole septum this includes bony septum is also shifted to left, and what he did? He moved right nasal bone also to left together with radix, haha should I laugh or cry... he destroyed left nasal bone, he misstaked rhinoplasty with sculpture. Like this he corrects convex nasal bones, instead of osteotomy he rather destroyed it, but when is something easy, and mostly fast, fast, fast.
To right side he put unilateral spreader graft to camouflage deviation to left side, right nasal bone had support nowhere, it floated in the aid, from inside held by unstable spreader graft, no connection between septum and right nasal bone, there was gap, so open roof again. Main reason for surgery was closing open roof, but to do that, he would have to move septum to center.
Just for understanding where is located my bony septum, when I touch dorsum, septum is completely on left side where should be usually left nasal bone, so nasal bone was pushed away to left side, therefore left nasal bone was so badly bended also. Before surgery he told me my septum is not a problem.
Putting unilateral spreader graft is not an alternative to septoplasty, graft will only help to lower asymmetry, but it will not correct breathing problems. Even with this graft my whole nose and tip goes to the left side. It is practically impossible to perform osteotomies and reshape bones if septum is so badly shifted to side.
How much is septum moved to left? I guess it is about 2mm, so moving septum to opposite side this mean to right side is not same as unilateral spreader graft, because correcting septum allows left nasal bone to move back to right, also gaps between septum and nasal bones are equal then, that allows to achieve symmetry, it corrects breathing problems, and also nose bridge is not wide, compared to when is used unilateral spreader graft which makes nose wide only.
This will happen if you will meet faker fake surgeon which performs fake surgeries.
Inside nasal cavity
Week after surgery I could not breath, 2 weeks after rhinoplasty I could not breath, 2 months after rhinoplasty I could not breath, After that I could breathe with right nasal passage only, berthing on left side is very difficult, I hardy can put Q-tip inside, 6 months after surgery I cannot breath with left side properly, 12 months after surgery I still can’t breathe with left side properly, 18 months after surgery I cannot breath with left side properly, 24 months after surgery, breathing difficulty on left side still occurs.
Also surgeon said, he will reduce my turbinates, with "few" radio-fervency shots so these turbinates will shrink. My question was If it causes empty nose syndrome. He said I would have empty nose syndrome only If turbinates will be removed. What he did? He roasted my turbinates. After surgery I have synechia on left side, part of turbinate is adhered to septal mucosa and I suffer often dryness in the nose, empty nose syndrome?
I guess when he performed osteotomy on lefts side, he probably damaged mucosa inside left cavity, there was so much blood, over two years I take crusts from nose.
Daily problems I have all time, my right side is too much shifted to left, I still feel like my right side was badly injured, breathing problems on left side and batten graft he put to collapsed side of internal nasal valve does not even hold there, it still moves and prevents mucosa to heal self to cartilage. I feel weird pressure in radix area after radix narrowing, as if the right nasal bone would like to return from under raised radix roof, the radix area healed so badly, it is so ugly my radix is ruined.
I really did no expect my septum is so badly shifted to left side, I recommend to every patient who goes for surgery do CT scan of nasal cavity even if you not plan septoplasty, because you may need it. And of course you have to find surgeon who knows how to perform septoplasty, true septoplasty not faking. One young women from my country had similar deviated septum but her septum was shifted to right, she had previous septoplasty, but the first surgeon did not fix it, he did not even touch cartilaginous part of septum, practically no change, she visited surgeon in Austria, he told her unfortunately the only way is broken bony septum, she is very happy, I saw her nose, I asked her also after 6 months if she is still happy and if nose is stable she said it is, she paid even less than me 7000€ and she had complete surgery this include also esthetic part septorhinoplasty.
Why, why why I always choose wrong surgeon, who does not even know how to perform osteotomy, who does even not know rasp bones, nooooo! Q_Q
So if I can recommend anyone who plans surgery, leave tip width untouched, because often surgeons cut too much cartilage from tip and then tip will completely lose width, while dorsum is even wider, that will result to massive wide nose with pinched tip. Relationship between parts of nose is very important. If tip is narrowed then radix may look too wide, then surgeon will narrow radix, if he will do it wrong like this surgeon, radix will be same wide like dorsum, same like keystone area, same like middle vault area, and then nose looks like a long weird shapeless stick.
What was ruined:
Left side, collapse of internal nasal valve: FATAL MISTAKE
Left side, wrong performed lateral osteotomy, moved Webster’s triangle on left side: FATAL MISTAKE
Right side, lateral osteotomy performed too high in the area where is medial canthal ligament, double level osteotomy extended to radix, step of deformity: SERIOUS MISTAKE
Sharp edges of septum, nasal bones after hump removal and osteotomy: MISTAKE
Destroyed left nasal bone: FATAL MISTAKE
Narrowed right side of radix: FATAL MISTAKE
Overnarrowed right dome of nasal tip: SERIOUS MISTAKE
Overrasped nasal bones: FATAL MISTAKE
No Cap graft no Shield graft I said: What I have? cap graft and probably shield graft also.
The columellar skin is still so swollen from front it looks like hanging columella.
Poor work with grafts which he put to the tip, grafts are very thick, I wonder if surgeon even bother to thin them, it looks like he put to nasal cavity raw grafts without any modification.
Whole 2 years I search solution, how to correct asymmetries he created, main problem is, my septum is about 2 mm away from center It is too much, unfortunately it can’t be accessed anymore because during second surgery was remove septal cartilage, area where was cartilage before was filled by scar tissue, so both side of septal mucosa are heal together like one tissue, any try to get inside along septum would result to serious damage to this tissue, it would cause septal perforation.
This means only one mega, super, overpowered, precise, best of best septorhinoplasty per life.
Surgeon did not correct septum, septum cannot be corrected anymore because:
99% chance for septal perforation
He destroyed left nasal bone, now the septum pretends to be the left nasal bone
He narrowed radix, moving septum would create asymmetry on opposite side (because my left nasal bone is gone and radix narrowed)
This is rhinoplasty domino of destruction, everything is lost.
For consultation I paid 100€, except this consultation I had consultations with other ORL doctors also in Turkey. All other surgeon offered consultation for free, one said it will be easy as he removed even bigger humps, other surgeon told me I have nice nose and rather not go for surgery, because he knows I will be unhappy after surgery, another surgeon when examined my nose and noticed deviated septum, he encouraged me to go for surgery to Germany rather.
When surgeon will ruin tip: You know tip surgery is difficult.
When surgeon will ruin radix: You know radix surgery is difficult.
When surgeon will ruin osteotomy: You know osteotomy is difficult.
When surgeon will over-rasp nasal bones: You know rasping is difficult.
When surgeon will ruin everything: You know rhinoplasty is difficult. No just you are so terrible surgeon.
Tip ruined, radix ruined, nasal bones ruined, osteotomy messed up, turbinates roasted, nose asymmetric, breathing problems.
If you think I had just bad luck and it cannot happen to you, then read this
https://www.bmc.org/patient-ca...
The bone and cartilage that divides the inside of the nose in half is called the nasal septum. The bone and cartilage are covered by a special skin called a mucous membrane that has many blood vessels in it. Ideally, the left and right nasal passageways are equal in size. However, it is estimated that as many as 80 percent of people have a nasal septum that is off-center. This is called a deviated septum, which may or may not cause certain symptoms.
80% of people have a nasal septum that is off-center. So if surgeon does not know how to perform septoplasty he will ruin, ruin and ruin, so basically 20% chance for success, or less this surgeon messed up osteotomy also...
I strongly suggest this surgeon to not touch noses anymore
Two years ago I underwent second nose surgery, revision rhinoplasty. Main reason for surgery was open roof causing wide nose bridge, breathing problems on left side, bleeding from left nasal cavity, tip asymmetry, remaining 3 mm hump and also my septum was little shifted to left side.
I absolved consultation about upcoming surgery with dr. Selçuk Inanli. I prepared many questions and animation, to better explain inner structure of nose what was changed, so he could carefully plan what to do. We talked or better say he talked mostly almost 2 hours, despite so long time I did not have time to ask all question I had, I declared simple question and followed long reply about everything else.
I, as a patient, was interested about what he plans to do because I was very scared from surgery, after the first unsuccessful surgery my trust to doctors was significantly weakened. My most important request was closing open roof, this was main reason for surgery, because nose looked very wide from front, second important request was to not put wide spreader grafts between nasal bones and septum as this will cause extreme wide and weird nose and absolutely to not narrow nasal tip, tip was already narrowed during first surgery, further narrowing would cause pinched tip. I asked to make tip widest as possible and achieve nose symmetry. I strongly appealed to precisely smoothing sharp bony edges after hump removal and in areas where is performed osteotomy, create smooth connection to radix (hump removal), and I requested to reduce a little, excessively prominent anterior nasal spine, and lift nose tip a bit to make nose look shorter. Same I asked absolutely to not use cap graft and shield graft because these grafts may be visible in the tip area, rounding off any sharp edges of cartilaginous grafts. I warned surgeon that my left nasal bone was a little bended, it had such convex shape while right nasal bone was straight and had more concave shape. Approx. 2 hours I talked there is gap between septum and right nasal bone, an open roof, I had also pictures, animations of open roof on my website with my photos, finally at the end of consultation when I started to draw nasal bones on paper he noticed that, he looked somehow unfocused all time. Weird is how he understand term open roof, in every literature open roof is defined as wide nose usually because of gaps between septum and nasal bones, but this surgeon understands open roof as damaged mucosa after hump removal, honestly I never heard or read such definition… so I ensured him my mucosa is most likely not damaged, 1st surgeon rasped very small part of hump. I asked him to draw on my face osteotomy lines, how he usually performs osteotomy. He also told me, MAYBE he will need to perform double level osteotomy, that was very surprising for me because, most of surgeons do not do that. As I wrote before, because my trust to surgeons is very low after first surgery, more important than his morph that he drew on PC, was surgery plan, I wanted to make sure, he will not use some crazy surgery technique, his reply was, he will look, he will look what damage caused first surgeon a then he will decide what to do.
In next part we will look what damage caused second surgeon, this doctor.
Week later I had a surgery at Academic Hospital.
In the hospital I paid surgeon the required price to surgeon. In short I repeated all my surgery requests again.
Surgery started around 13:00, I woke up from anesthesia around 16:00 maybe or sooner. Anesthesiologist held my hand and told me I have great nose, my first thought about that was, "what a liar the nose surely looks terrible", and as you can read further, I was truth. He asked me how do I feel, I replied "I feel cold", he said its normal. I felt like after a brutal attack on my face.
Splint
I remember I felt very bad, surgeon came to visit me and told me surgery went well. I told him the splint is very loose. His reply "tight splint is not good it could cause skin necrosis." My reply "but then bone will move" and I could again end with open roof. His reply "bones can move ", … so bones heard him so they really moved. Such useless, completely USELESS splint, wrong trimmed. As you can see on photo (Picture 36) too short splint, part of bone after double level osteotomy on right side held by NOTHING, the thermoplastic splint was a decoration on the nose only. What did I said on consultation, strong splint at least 3 weeks, and what he did, loose splint removed after week, nose was completely unstable and extremely wide. On consultation I asked him if he performs preservation rhinoplasty with use of technique push down, he said he does not do that because it produces very unstable noses, he does structural rhinoplasty only. This is weird because I had consultation with other surgeon which does preservation rhinoplasty mostly and he said, he likes preservation rhinoplasty because noses are very stable. So it seems dr Inanli creates unstable nose with structural rhinoplasty also.
Surgeon itself get shocked from that, what he created, surgeon took few photos called his assistant with camera and asked for my opinion, what should I reply… I said it looks smaller (from profile) but from front is was absolutely massive terrible shapeless potato. Just to make clear, smiling on the photo does not mean patients are happy. Because I decide to stay in Istanbul 3 weeks he taped my nose and ask me to come again week later, photos can be found in gallery.
At hotel I could see badly overnarrowed tip, my first though, I will be unhappy for rest of life. Left nasal passage terribly swollen and much smaller than the right nasal passage, I wondered WHAT HE DID with it, when it is so small. So much crusted blood inside both nasal passages. I cold no breathe through my nose at all. It was second week after surgery, so I came again for control, surgeon took photos. I still could not breath, on right side in the osteotomy area I had visible bump, right half of nose was completely paralyzed, on touch I felt nothing, why? He performed double level osteotomy, he most likely cut blood vessels, despite my requests, he left sharp bony edges on right side after osteotomy, unrasped. He gave me mirror and expected my reaction…, my first impression, I was disgusted, at first I noticed extremely overnarroved pinched and asymmetric tip and massive wide nose bridge. A what surgeon said, "it is good, just wait". What did I say on consultation? NO tip grafts, don’t put wide grafts between nasal bones or tip will look pinched compared to rest of nose, he said "don’t worry it won’t be pinched", and what it will be? Pinched tip. What he expected he put unilateral spreader graft to right side to widen passage and right dome of the tip he narrowed even more than it was before, what other result can be expected, when dorsum is widened even more while tip is narrowed, result pinched tip, it so ugly. My request was make tip widest as possible, the right dome was so badly overnarrowed, it was narrowed to half of size from left dome. During consultation I talked about how to suture tip to make sure, he will not do some madness, this … is unbelievable, he sutured both sides of right dome, top and bottom, asymmetric domes, angle of domal divergence is probably unknown term for him. What did I say on consultation, absolutely not suture bottom part of dome, because it causes tip pinching, but you know when surgeon want to do thing easy and mostly fast, fast, fast. How can one surgeon perform surgery by way, he corrects one tip asymmetry, but instead that he will create 2 new tip asymmetries while the first one remains. Such procedure is good for what? Maybe you ask how can one surgeon overnarrow tip? Does not he see the tip is asymmetric after suturing, does not he know it is bad? Of course he sees and he knows, but he still does that, because when someone is lost, then he does surgery like a lost surgeon, and then he will come to patient and lies … surgery went well. Very poor liar, I knew from beginning it went wrong.
As you can see from photos, asymmetric aesthetic dorsal lines, asymmetric tip in the pyriform area. That’s all new asymmetries a much others I will describe into details further.
Nasal Tip
Instead of widening tip he completely overnarrowed it, wrong sutured dome, on the photo you can see the first third of nose after opening, from left side of tip cephalic part of lateral crura is almost gone a small part remained (green), on right side is unfinished cephalic trim, yellow is trimmed part while rest of cephalic part of lateral crura is still there, surgeon tried to fool me, both cephalic parts are gone, am I blind, I can clearly see remaining cephalic part of right lateral crura on picture, I can also palpate it, that was second lie. He folded remaining part inward, it does not hold there, I don’t know if it sutured, because it partially returned back and mucosa could not reconnect correctly to this cartilage. This was one of steps that caused tip narrowing and loss of tip width. (Picture 84)
Pitanguy’s ligament
He destroyed it, I have static, stiff tip held by caudal septal extension graft. Some surgeons preserve this ligament.
Middle vault area and nasal bones
For reconstruction of middle vault area, he used "spreader flaps" technique, but he also put spreader graft to right nasal passage, that made nose excessively wide compared to overnarrowed right dome of nasal tip.
Before surgery he said "we do not want harm internal nasal valve", and what he did, ou yes he did it, again, HE CUT WEBSTER’S TRIANGLE!!! Result, collapse of internal nasal valve on left side, that caused also collapse of external nasal valve in the pyriform area, I guess this started rhinoplasty domino effect of destructive steps. Now what to do on left side he performed very low osteotomy that caused collapse, so he decided to perform osteotomy on right side little higher so part of Webster’s triangle remained intact, and right side on internal nasal valve did not collapse, but by this step he created asymmetry, each side was different, left side collapsed and right side uncollapsed.
He got himself into trap. He wanted to perform osteotomy very low, on consultation he said "only I do that like that." What is weird on consultation he drew osteotomy lines differently compared to what he did during surgery. I had reason why I asked him to draw osteotomy, I red many times, surgeons ruined nose by wrong performed osteotomy, but mistake is not he did something by an accident, mistake is in his head, he does not know fundamental principles of rhinoplasty. How can one surgeon move Webster’s triangle, this is known more than thirty years, it must stay untouched. Moving Webster’s triangle was one of FATAL mistakes he did. He does not know to perform most basic lateral osteotomy which is performed in every rhinoplasty and he declares he has 30 years of experiences …
On right side he performed lateral osteotomy too high in the eye area and he extended it to radix… What!?... He should not touch radix at all, he narrowed radix from right side, this way he completely destroyed right dorsal aesthetic line, radix, area of nasal bones, keystone area, middle vault area, all same wide, nose looked like a shapeless stick ending with pinched tip. On consultation he said, he wants to create dorsal aesthetic lines, with narrowing radix he ruined them completely. Narrowing radix was another FATAL MISTAKE.
Hump removal
He removed about 3 mm hump and about extra 1 mm, so nasal bones are not smoothly connected to radix roof, there is 1mm stair step between radix roof and nasal bones, this is not so serious mistake but still mistake. On consultation I asked him to create smooth connection to radix, it seems, he does even not know rasp nasal bones properly…
If you are drinking or eating, rather stop for a moment, and carefully sit, while you are reading this…
What he did with left nasal bone?! He removed another triangular piece from nasal bone, so from left nasal bone is missing additional 3mm, my left nasal bone is practically destroyed, is GONE! GONE FOREVER! Instead of bone he put there diced cartilage, and is very well known, diced cartilage will resorb over time, after 6 months I noticed significant changes on left side. He put so much diced cartilage to dorsum also, about 2 mm thick layer. It is completely useless, there is nothing, after 1.5 years everything resorbed. Why?
Cartilages consist approx. from 20% cells and 80% water, as you know water is now very stable especially when cartilage is cut to small pieces. From my own experience, diced cartilage causes terribly oily skin, I never had oily skin, not even after first surgery, but when I said oily, I mean really oily skin, like when you brush your nose with oil. Cleaning nose did not help much, because after hour it was oily again. Nose skin stopped being so oily when the cartilage was fully resorbed, body does not like when something is blocking way to periosteum, nasal bones need to reestablish connections with periosteum. Destroying left nasal bone was third FATAL MISTAKE, he did it intentionally, it is not possible to destroy 3 mm from nasal bone and not know about that, but you know when is someone lost, does surgery like lost surgeon. Surgeons who do this I put to blacklist immediately, this is unfixable!
On touch I can clearly recognize sharp edges of nasal bones and septum, I asked surgeon to smooth any sharp edges. He smoothed sharp bony edges in the key stone area only. Second surgery and again ruined nasal bones this time definitely. Fifteen years I dreamed about nose surgery, but I had no money for it, then I had first surgery which fixed nothing, after 1.5 years I had second surgery performed by this surgeon and everything is lost, whole wrong.
But not everything is only black or only white, maybe if I started with thing which are good It would end with few words.
After first surgery I had big scars after suturing inside my nostrils, as you can see on photos, scars are gone, remaining hump was removed, transcolumellar incision is practically invisible, graft put to radix is removed, all other steps are wrong or partially wrong.
Looking back, I guess, he planned it from beginning. The surgery did not even start, and everything was convicted to failure. On consultation I did not care about morph, drawing profile in the computer will not tell me how the nose will look like from front. I asked surgeon what he plans to do, this means specific steps, but his reply "I shall see, I shall see". I said "I am afraid my nose will look like a shapeless potato", he started to laugh, what he was thinking about? (::how did you know that, that’s exactly how it will look like::)
Why did I choose otolaryngologist? Because otolaryngologists perform only one surgery all time, nose surgery, so they should have more experiences than plastic surgeons which do everything else.
So in case, if I would need to correct septum also, he would be able to do that. But it looks like this surgeon does not even know how to correctly perform lateral osteotomy, so how he could correct septum which is much more difficult.
WARNING: here is how this surgeon corrects deviated septum, instead of breaking bony part of septum he detached cartilaginous part septum from bony septum, little rasped wall of bony septum and sutured it back with few pieces of grafts, another fake surgery… bony part remains unfixed, while nose will most likely look very wide when, look how many grafts he put there.
https://www.semanticscholar.or...
https://www.semanticscholar.or...
If you look on my before photos, my philtrum is shifted to left, my nasal spine is shifted to left, my whole septum this includes bony septum is also shifted to left, and what he did? He moved right nasal bone also to left together with radix, haha should I laugh or cry... he destroyed left nasal bone, he misstaked rhinoplasty with sculpture. Like this he corrects convex nasal bones, instead of osteotomy he rather destroyed it, but when is something easy, and mostly fast, fast, fast.
To right side he put unilateral spreader graft to camouflage deviation to left side, right nasal bone had support nowhere, it floated in the aid, from inside held by unstable spreader graft, no connection between septum and right nasal bone, there was gap, so open roof again. Main reason for surgery was closing open roof, but to do that, he would have to move septum to center.
Just for understanding where is located my bony septum, when I touch dorsum, septum is completely on left side where should be usually left nasal bone, so nasal bone was pushed away to left side, therefore left nasal bone was so badly bended also. Before surgery he told me my septum is not a problem.
Putting unilateral spreader graft is not an alternative to septoplasty, graft will only help to lower asymmetry, but it will not correct breathing problems. Even with this graft my whole nose and tip goes to the left side. It is practically impossible to perform osteotomies and reshape bones if septum is so badly shifted to side.
How much is septum moved to left? I guess it is about 2mm, so moving septum to opposite side this mean to right side is not same as unilateral spreader graft, because correcting septum allows left nasal bone to move back to right, also gaps between septum and nasal bones are equal then, that allows to achieve symmetry, it corrects breathing problems, and also nose bridge is not wide, compared to when is used unilateral spreader graft which makes nose wide only.
This will happen if you will meet faker fake surgeon which performs fake surgeries.
Inside nasal cavity
Week after surgery I could not breath, 2 weeks after rhinoplasty I could not breath, 2 months after rhinoplasty I could not breath, After that I could breathe with right nasal passage only, berthing on left side is very difficult, I hardy can put Q-tip inside, 6 months after surgery I cannot breath with left side properly, 12 months after surgery I still can’t breathe with left side properly, 18 months after surgery I cannot breath with left side properly, 24 months after surgery, breathing difficulty on left side still occurs.
Also surgeon said, he will reduce my turbinates, with "few" radio-fervency shots so these turbinates will shrink. My question was If it causes empty nose syndrome. He said I would have empty nose syndrome only If turbinates will be removed. What he did? He roasted my turbinates. After surgery I have synechia on left side, part of turbinate is adhered to septal mucosa and I suffer often dryness in the nose, empty nose syndrome?
I guess when he performed osteotomy on lefts side, he probably damaged mucosa inside left cavity, there was so much blood, over two years I take crusts from nose.
Daily problems I have all time, my right side is too much shifted to left, I still feel like my right side was badly injured, breathing problems on left side and batten graft he put to collapsed side of internal nasal valve does not even hold there, it still moves and prevents mucosa to heal self to cartilage. I feel weird pressure in radix area after radix narrowing, as if the right nasal bone would like to return from under raised radix roof, the radix area healed so badly, it is so ugly my radix is ruined.
I really did no expect my septum is so badly shifted to left side, I recommend to every patient who goes for surgery do CT scan of nasal cavity even if you not plan septoplasty, because you may need it. And of course you have to find surgeon who knows how to perform septoplasty, true septoplasty not faking. One young women from my country had similar deviated septum but her septum was shifted to right, she had previous septoplasty, but the first surgeon did not fix it, he did not even touch cartilaginous part of septum, practically no change, she visited surgeon in Austria, he told her unfortunately the only way is broken bony septum, she is very happy, I saw her nose, I asked her also after 6 months if she is still happy and if nose is stable she said it is, she paid even less than me 7000€ and she had complete surgery this include also esthetic part septorhinoplasty.
Why, why why I always choose wrong surgeon, who does not even know how to perform osteotomy, who does even not know rasp bones, nooooo! Q_Q
So if I can recommend anyone who plans surgery, leave tip width untouched, because often surgeons cut too much cartilage from tip and then tip will completely lose width, while dorsum is even wider, that will result to massive wide nose with pinched tip. Relationship between parts of nose is very important. If tip is narrowed then radix may look too wide, then surgeon will narrow radix, if he will do it wrong like this surgeon, radix will be same wide like dorsum, same like keystone area, same like middle vault area, and then nose looks like a long weird shapeless stick.
What was ruined:
Left side, collapse of internal nasal valve: FATAL MISTAKE
Left side, wrong performed lateral osteotomy, moved Webster’s triangle on left side: FATAL MISTAKE
Right side, lateral osteotomy performed too high in the area where is medial canthal ligament, double level osteotomy extended to radix, step of deformity: SERIOUS MISTAKE
Sharp edges of septum, nasal bones after hump removal and osteotomy: MISTAKE
Destroyed left nasal bone: FATAL MISTAKE
Narrowed right side of radix: FATAL MISTAKE
Overnarrowed right dome of nasal tip: SERIOUS MISTAKE
Overrasped nasal bones: FATAL MISTAKE
No Cap graft no Shield graft I said: What I have? cap graft and probably shield graft also.
The columellar skin is still so swollen from front it looks like hanging columella.
Poor work with grafts which he put to the tip, grafts are very thick, I wonder if surgeon even bother to thin them, it looks like he put to nasal cavity raw grafts without any modification.
Whole 2 years I search solution, how to correct asymmetries he created, main problem is, my septum is about 2 mm away from center It is too much, unfortunately it can’t be accessed anymore because during second surgery was remove septal cartilage, area where was cartilage before was filled by scar tissue, so both side of septal mucosa are heal together like one tissue, any try to get inside along septum would result to serious damage to this tissue, it would cause septal perforation.
This means only one mega, super, overpowered, precise, best of best septorhinoplasty per life.
Surgeon did not correct septum, septum cannot be corrected anymore because:
99% chance for septal perforation
He destroyed left nasal bone, now the septum pretends to be the left nasal bone
He narrowed radix, moving septum would create asymmetry on opposite side (because my left nasal bone is gone and radix narrowed)
This is rhinoplasty domino of destruction, everything is lost.
For consultation I paid 100€, except this consultation I had consultations with other ORL doctors also in Turkey. All other surgeon offered consultation for free, one said it will be easy as he removed even bigger humps, other surgeon told me I have nice nose and rather not go for surgery, because he knows I will be unhappy after surgery, another surgeon when examined my nose and noticed deviated septum, he encouraged me to go for surgery to Germany rather.
When surgeon will ruin tip: You know tip surgery is difficult.
When surgeon will ruin radix: You know radix surgery is difficult.
When surgeon will ruin osteotomy: You know osteotomy is difficult.
When surgeon will over-rasp nasal bones: You know rasping is difficult.
When surgeon will ruin everything: You know rhinoplasty is difficult. No just you are so terrible surgeon.
Tip ruined, radix ruined, nasal bones ruined, osteotomy messed up, turbinates roasted, nose asymmetric, breathing problems.
If you think I had just bad luck and it cannot happen to you, then read this
https://www.bmc.org/patient-ca...
The bone and cartilage that divides the inside of the nose in half is called the nasal septum. The bone and cartilage are covered by a special skin called a mucous membrane that has many blood vessels in it. Ideally, the left and right nasal passageways are equal in size. However, it is estimated that as many as 80 percent of people have a nasal septum that is off-center. This is called a deviated septum, which may or may not cause certain symptoms.
80% of people have a nasal septum that is off-center. So if surgeon does not know how to perform septoplasty he will ruin, ruin and ruin, so basically 20% chance for success, or less this surgeon messed up osteotomy also...
I strongly suggest this surgeon to not touch noses anymore
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