3rd Rhinoplasty: What Should I Do? (photo)
- Asked by Lena1983
- 1 year ago
overly reduced,crooked nose,with nostril collapse,poor breathing,excess skin + a clown's tip.Out of 10 doctors,the top 2 on my list said: 1st:not enough ear grafts.Against rib grafts.fascia grafts r pointless (for the bridge)-they will get absorbed through time.So ONLY tip correction/reduction + MAYBE nostrils 2nd:same about ear grafts,more confident to fix nostrils too.Option of rib grafts-nose stiff forever(chances of infection, warping) what do i do? any advice would help a lot. Thank u!
Graft Used in Revision Rhinoplasty
I agree that the ear cartilage graft may resorb over time. There may be enough from both ears but such thickness may not be viable over time. A better option than rib graft would be cranial bone graft, which has better functionality in a situation like yours. Nostrils should be reduced. Tip will be difficult to completely mold after three surgeries but may not need remodeling after bone graft improves dorsum.
Triple revision rhinoplasty and grafting material
I agree that your nose is overly short secondary to the dorsum being reduced too much. This has left you with a nasal tip that appears too big and projected for the rest of the nose. This is a difficult problem to fix because you do need grafting material for the dorsum to build it up. Rib, irradiated cadaveric rib and ear cartilage (wrapped in temporalis fascia) are all good material for this. There are pros and cons to each one however (stiffness and resorption being two). Irradiated cartilage has been shown to be good if it is not required for support purposes such as in a caudal extension graft. Your tip needs some definition and although it might sound counterintuitive a shield graft can help to provide some refinement through the scar and thick skin you possess. I hope this helps. Consultation with a surgeon well versed in revision rhinoplasty will help answer your concerns.
Every grafting material has pros and cons. I think you need to find someone that focuses his/her practice on rhinoplasty/revision rhinoplasty, and has years of experience performing this surgery to maximize your chances of a good outcome.
Once you find the right, experienced doctor, he should tell you what material he feels comfortable using. Each surgeon will have a preference.
Personally. I have used irradiated rib cartilage with a high success rate.
Best of luck,
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I'm sorry you have had unfortunate experiences with your previous rhinoplasty surgeries.As you have said you do have a crooked nose with an overly reduced dorsum and a bulbous tip. If your ears are intact I respectfully disagree that there is not enough cartilage to augment the bridge. I have done this many times over the past 35 years in noses like yours. The nose can be straightened and the tip refined. It will be impossible to get a natural result if you just reduce the tip.
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