We will summarize the most fundamental parts for normal skin:
– Immediate phase. It is the most immediate postoperative period, which usually lasts around a month and is characterized by the presence of inflammation. Think of inflammation as a sponge that has been soaked in water. The sponge is our tissue, and the water inside is the inflammation that will make our sponge “swell.”
– Intermediate phase. The medium-term postoperative period usually lasts about 6 months, during which the greatest inflammation (60-80%) occurs.
– Late phase. Between 6 and 18 months, the nose is finally deflated, especially the most superficial layers of the skin. The scars will gradually end their maturation and lose volume.
What is fibrosis?
We must consider scars as normal structures as a consequence of tissue repair when they are attacked. We usually see the external scars from surgeries, but we don’t see all the scarring under the skin. In liposuction, for example, the area of internal healing is huge if we compare it with cutaneous scars that can hardly be 1/2 centimeter. When the healing process involves “special effort” for damaged tissue and deposits larger or poorer amounts of scar, we usually call it fibrosis.
Intraoperative Secondary Rhinoplasty for correction of fibrosis in the nose
After a Rhinoplasty this phenomenon is usually especially frequent, among many other cases, in:
– Patients who have thick skin. Thicker dermis (the support layer under our skin) tend to heal more exuberantly.
– Patients who have a natural tendency to heal improperly.
– Smoking patients. Smoking patients tend to have poorer quality healing than nonsmokers.
– It is also our body’s way of “filling” empty holes under the skin or “compacting” an inflammation that is excessive or that lasts too long. If, for example, the nasal skin is not properly attached to the cartilage after Rhinoplasty, the remaining hole will be filled by fibrosis. Also, excessive or too long-lasting inflammation can “peel off” the cartilage skin long enough for fibrosis to build up.
Fibrosis is usually, therefore, scarring that is greater than normal or of worse quality. On the nose, this greater accumulation of scar will thicken the skin and make us lose the aesthetic details that we had planned. Fibrosis is a process that develops slowly over months, usually during the first 6. It is not something that comes out suddenly and therefore, it is possible to take measures, as we will see later, to avoid its appearance or, at least, decrease its importance.