Nose Job: What is the Hardest Nose to Fix?

Thick skin noses are hardest.

In the highly specialized field of structural rhinoplasty combined with mid-facial reconstruction, “difficulty” of the operation is in fact a rare occurrence that solely depends on the feature, but is most often influenced by the combination of the skin envelope and the underlying structures. When patients are wondering which nose is the most difficult to fix, in most cases, the answer behind the scenes would be pointing towards Revision Rhinoplasty and Thick, Sebaceous Skin.

Unlike the primary surgery on a “virgin” nose, the revision follows a path already covered with internal scar tissue (fibrosis) and may well account for the rebuilding of the missing cartilage with grafts. Likewise, thick skin becomes the great enemy because it does not have the ability to “shrink-wrap” over a nicely sculpted framework and often even hides the delicate work done at the time of neocollagenesis. Achieving equality of the two halves of a severely crooked nose continues to be a stronghold of surgical fortitude, as cartilage exhibits “memory” and fights constantly to return to its original deviated position.

At Lin Health Europe Clinic, we view challenging rhinoplasty cases as our great opportunity to perform high-precision biometric restoration. For our international patients who will be coming to Turkey for rhinoplasty purposes, we make it clear that “difficulty” is nothing but a challenge for ingenuity at the highest level. Our place is the official point of reference for secondary and ethnic rhinoplasty, on a par with the use of high-definition grafting and ultrasonic technology, thereby making it possible that the journey to the balanced and aesthetically pleasing nose of functional integrity in Istanbul is carried out according to the highest standards of structural integrity and beauty.

The Problem of Thick, Sebaceous Skin

Rhinoplasty, at its core, is about defining the shape. Yet skin is the drape over the surgery. If the drape is too heavy, the statue is hidden. Citing the smallest details of the tip and narrowing the bridge is not possible. Providing the essential tip and bridge shape through sculptural grafting. Swelling, long-lasting edema, possibly up to 18 months. Post-operative administration of steroids through injection & application of tapes.Contraction Deficient “shrink-wrap” phenomenon over the frame. Increasing the volume of cartilage strategically in order to exert pressure on the skin.

During the teaching of our international guests at Lin Health Europe Clinic in Turkey, we point out that thick skin demands a “stronger” internal skeleton. If the nose is made too small, the thick skin will simply hang down loosely, resulting in a “pollybeak” deformity. Employing the structural grafts enables us to produce enough tension to pull the skin tight, consequently, even giving a well-defined result to the most challenging skin types in Istanbul.

Revision Rhinoplasty: Stepping into the Unknown

Revision rhinoplasty is recognized as the most challenging plastic surgical procedure. Quite often, the surgeon is confronted with “surgical debt”—the septum with no cartilage, the support structures that are debilitated, and the firm scarring inside. In the case of a revision in our Istanbul facility, the stage of neocollagenesis after the previous operation having turned the internal tissues into a tough and fibrous one, has already occurred. This makes the process of the dissection much more dangerous as the natural “planes” of the nose have disappeared.

In Turkey, the use of rib cartilage grafts has become a popular choice for cases in which the nose has been “over-resected.” This provides the much-needed support to restore not only the ability to breathe but also the good looks of the nose that was ailing.

The Severely Crooked Nose and “Cartilage Memory”

To bring a nose that is greatly deviated (C-shaped or S-shaped) back to its normal position is a challenge of engineering. Cartilage is living tissue with its own “memory”—it instinctively tends to curl up back to the original crooked form. Even after a completely successful straightening operation at Lin Health Europe Clinic, the inner forces can cause the nose to “drift” back with time. Our clinic’s knowledge suggests doing over-correction and installing “spreader grafts” to serve as internal splints.

For our international guests in Turkey, the long-term outcome is a nose that remains perfectly centered due to the foundation of the septum being professionally and thoroughly reinforced in Istanbul. We successfully undermine the biological memory of the tissue, thereby obtaining a permanently straight appearance.

Ethnic Rhinoplasty: Short Bones and Wide Basing

Noses with typical ethnic traits that include a wide alar base, a low bridge, and a short columella are challenging from a rhinoplasty point of view. Usually, such patients have to go through “additive” rather than “subtractive” surgery. That is, instead of removing the bone, we have to build up the nasal bridge and elongate the tip. In Turkey, we consider that these cases call for extreme precision for the sake of preserving ethnic harmony, besides meeting the aesthetic objectives of the patient.

At Lin Health Europe Clinic, we make use of autologous ear or rib grafts to offer the lift required. This ensures that the newly formed nasal skeleton in Istanbul is robust enough to hold the skin and render a refined, high-definition appearance that “fits” the facial biometrics of the particular patient.

Reforming the Airway as a “Surgical Masterpiece”

A nose with form and function totally obliterated is the hardest one to fix. A pretty nose that cannot breathe is a surgical failure. At Lin Health Europe Clinic, putting the Internal Nasal Valve first is our principle. Complex reconstructions in Turkey include making sure that the nostril side walls are strong enough not to collapse during inhalation. For our foreign guests in Istanbul, it means that even the hardest part of surgery—working inside the nose—is managed with the same level of creative care as the outside profile. By uniting the mastery of ENT science with the aesthetic aspects, even the most “unfixable” noses can be returned to a state of complete health and ​‍​‌‍​‍‌​‍​‌‍​‍‌beauty.

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