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Table of Contents
CASE REPORT
Year : 2018  |  Volume : 26  |  Issue : 1  |  Page : 32-33

Rhinoplasty in a blind patient


So-ep Aesthetic and Plastic Surgery Clinic, Kayseri, Turkey

Date of Web Publication20-Mar-2018

Correspondence Address:
Dr. Safvet Ors
So-ep Aesthetic and Plastic Surgery Clinic, Kayseri
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjps.tjps_12_18

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  Abstract 


Retinitis pigmentosa is an inherited, degenerative eye disease that causes severe vision impairment due to progressive degeneration of the rod photoreceptor cells in the retina. Nasal deformities are known to attract attention, result in stigmatization, and negatively affect a person's self-perception. Cosmetic surgical management of blind patients is a broad undertaking, requiring the involvement of both a plastic surgeon and a psychologist. While plastic surgeons have performed various reconstructive surgeries on blind patients, including mammoplasty and abdominoplasty, rhinoplasty for a blind patient has not been reported to date. The results of this study point to the positive psychosocial outcomes in a 33-year-old blind patient following rhinoplasty.

Keywords: Cosmetic surgery in blind patients, retinitis pigmentosa, rhinoplasty


How to cite this article:
Ors S. Rhinoplasty in a blind patient. Turk J Plast Surg 2018;26:32-3

How to cite this URL:
Ors S. Rhinoplasty in a blind patient. Turk J Plast Surg [serial online] 2018 [cited 2019 Dec 13];26:32-3. Available from: http://www.turkjplastsurg.org/text.asp?2018/26/1/32/228004




  Introduction Top


Retinitis pigmentosa (RP) is an inherited, degenerative eye disease that causes severe vision impairment due to progressive degeneration of the rod photoreceptor cells in the retina.[1],[2] This form of retinal dystrophy displays its initial symptoms independent of age; thus, its diagnosis can occur at any point from early infancy to late adulthood.[3]

A variety of reconstructive surgeries, including face transplants, are performed on blind patients; however, it is not common for blind patients to undergo surgeries solely for esthetic reasons.[4],[5],[6],[7] Rhinoplasty is currently a popular surgery around the world because nasal deformities are known to attract attention, result in stigmatization, and negatively affect a person's self-perception. Everyone, including blind people, wants to look beautiful. Cosmetic surgical management of blind patients is a broad undertaking, requiring the involvement of both a plastic surgeon and a psychologist. While previous cases of hand transplants, face transplants, and various other reconstructive surgeries on blind patients are reported, rhinoplasty is not reported.


  Case Report Top


A 33-year-old man was referred to our clinic with a nasal deformity [Figure 1]. The patient was unmarried, worked in a factory, and lived with his parents. His RP diagnosis was made in early infancy, and the disease resulted in total loss of vision. On physical examination, the patient's nose was determined to have a wide and low tip, large hump, deviated septum, and double-barrel nostril. Psychopathology was not observed in either the patient or his family; their attitudes were all quite positive. It was not obvious upon observation that the patient was blind, and he did not have strabismus. The patient was evaluated to be a suitable candidate to undergo rhinoplasty. Utilizing the open surgical approach, the following procedures were performed under general anesthesia: Hump resection, lateral osteotomy, nasal tip plasty, and septoplasty. Concha radiofrequency, L-strut grafts, and spreader grafts were also applied. When the patient's splint was removed 10 days after the surgery, his family was pleased with the result. The patient, examining his nose with his hands, stated that the result was good. Eighteen months on after the procedure, the patient had no complaints and was quite happy [Figure 2]. A mental status examination indicated that the patient's general appearance, speech, emotional expression, thinking-perception, and cognitive functions were normal.
Figure 1:(a) Preoperative images of a 33-year-old blind male patient, (b) frontal images of 1-year postoperative results

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Figure 2:(a) Preoperative lateral images of the patient, (b) postoperative lateral image of the patient

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  Results Top


The results of this study point to the positive psychosocial outcomes in a blind patient following rhinoplasty.


  Discussion Top


There has not been enough research related to the sociopsychiatric consequences of esthetic interventions in blind patients. While face transplants, hand transplants, breast surgeries, and other reconstructive surgical procedures in blind patients are reported in the literature, rhinoplasty is not reported.[4],[5],[6],[7] It is the author's view that rhinoplasty is more interesting than other reconstructive operations in blind patients since it is strictly esthetic, whereas the other surgeries are associated with essential functions that impact a patient's quality of life. Due to the psychological aspects of the procedures, which require very long-term follow-up and ongoing evaluations of the treatment, possible risks must be thoroughly explained to face and hand transplant patients.[7] In comparison, rhinoplasty is simpler, with lower complication rates and higher patient satisfaction results.

Cases of blindness have been reported in large numbers in the literature following rhinoplasty and cosmetic filler procedures.[8],[9] Reversely, blind patients receiving esthetic surgical procedures are extremely rare. The patient in this study indicated that he wanted smoother facial features before getting married, which seemed reasonable to me. It was not obvious upon observation that the patient was blind. I agreed to perform the surgery because the patient expressed a desire to have a smoother nose, hence an unblemished appearance. In rhinoplasty, which is a complicated surgery, patient satisfaction can sometimes be low. Since rhinoplasty patients are often affected by positive or negative feedback from their friends, family, and others around them, it is a difficult operation for plastic surgeons. Sometimes, patients are warned not to pay attention to comments they hear because not every comment is true. Understandably, however, blind patients usually ask others about the success of their surgery, so the results must be impeccable. Because our patient and his family were cooperative, we did not have any trouble. It should be noted that even though rhinoplasty is not as complicated as face or hand transplants, it is necessary to be careful with a blind person's esthetics. Since it appears that there will be an increase in cosmetic surgeries on blind patients in the future, it is necessary to develop a good postoperative follow-up plan.


  Conclusion Top


The results of this study point to the positive psychosocial outcomes in a blind patient after rhinoplasty.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Tucker BA, Mullins RF, Stone EM. Stem cells for investigation and treatment of inherited retinal disease. Hum Mol Genet 2014;23:R9-16.  Back to cited text no. 1
[PUBMED]    
2.
Hartong DT, Berson EL, Dryja TP. Retinitis pigmentosa. Lancet 2006;368:1795-809.  Back to cited text no. 2
    
3.
den Hollander AI, Black A, Bennett J, Cremers FP. Lighting a candle in the dark: Advances in genetics and gene therapy of recessive retinal dystrophies. J Clin Invest 2010;120:3042-53.  Back to cited text no. 3
    
4.
Carty MJ, Bueno E, Lehmann LS, Pomahac B. A position paper in support of hand transplantation in the blind. Plast Reconstr Surg 2011;128:510e-5e.  Back to cited text no. 4
    
5.
Carty MJ, Bueno EM, Lehmann LS, Pomahac B. A position paper in support of face transplantation in the blind. Plast Reconstr Surg 2012;130:319-24.  Back to cited text no. 5
    
6.
Burd A. Plastic surgery, body image and the blind. J Plast Reconstr Aesthet Surg 2007;60:1273-6.  Back to cited text no. 6
    
7.
Lemmens GM, Poppe C, Hendrickx H, Roche NA, Peeters PC, Vermeersch HF, et al. Facial transplantation in a blind patient: Psychologic, marital, and family outcomes at 15 months follow-up. Psychosomatics 2015;56:362-70.  Back to cited text no. 7
    
8.
Kim EG, Eom TK, Kang SJ. Severe visual loss and cerebral infarction after injection of hyaluronic acid gel. J Craniofac Surg 2014;25:684-6.  Back to cited text no. 8
    
9.
Lee KM, Han SC, Ho SY, Kim JT, Kim YH. Blindness resulting from orbital cellulitis following rhinoplasty. J Plast Reconstr Aesthet Surg 2013;66:e129-32.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2]



 

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Introduction
Case Report
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