I had rhinoplasty a year ago. I have "notched cartilage" on the right side of my tip where my tip was narrowed. The "notch" basically looks like the cartilage is protruding instead of laying flat like it should. My doctor wants to repair this by going in and cutting the protrusion out. I told my doctor that I had heard that the way to repair it was through a cartilage graft that would essentially pull the cartilage back into place. What is your experience with repairing notched cartilage?
Revision Rhinoplasty- Repairing Notched Cartilage? (photo)
Doctor Answers (8)
Revision Rhinoplasty issues
The irregular appearance of nasal tip is typically caused by some deformity of underlying cartilage. This could have occurred at the time of surgery, or possible due to some scarring tissue forces over the last year. Each tip deformity requires different approach, depending on the cause. In my practice most revision Rhinoplasty surgeries are done by closed approach with highly predictable results. Revision Rhinoplasty is a very demanding procedure, with only a few plastic surgeons that are comfortable and competent correcting this. It might behoove you to see a few revision Rhinoplasty experts to make sure that your revision surgery gives you the desired result.
Revision tip rhinoplasty
It's not clear what type of rhinoplasty that you had one year ago. Did you had implant placed on the dorsum? Was this an open or closed rhinoplasty. How was the tip shaped? Was tip graft used? If the knuckling was caused by suturing then it's best to go back in and adjust the shape. If you had tip graft and graft was malpositioned, you may be able to revise it without opening it. Your operating surgeon has all the details of your surgery. If you are going for second opinion, make sure you have as much information on your original surgery as possible.
Stewart Wang, MD FACS, Wang Plastic Surgery
Revision of "knuckled" alar cartilage requires re-operation.
The medial portion (dome) of the lateral crus of your right alar cartilage is indeed "knuckled" (not notched), probably from scar tissue constricting the cartilage. This likely occurred over time, and was probably not visible initially when your nasal splint was removed. But even if it was this way immediately (then it might have been caused by the way the tip was narrowed or suture secured), you rightly waited a year to allow things to settle so re-operation is safe and less likely to fail again.
Revision surgery is now necessary, and your surgeon know best what to recommend--he was there before. I too would consider scoring and possible partial removal of the excess cartilage with suture repair rather than graft. Grafting is also an option, especially if there is a depression behind the protrusion that needs to be filled for better contour. But not without excision/correction/improvement of the abnormal/asymmetric protrusion.
BTW, this should not be considered an "easy" or "quick fix" operation--it will take another 6-12 months to fully soften, settle, and return to sensation. But the revision is pretty straightforward and all experienced rhinoplasty surgeons have seen and dealt with this problem. Best wishes! Dr. Tholen
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Repairing notched cartilage of the nasal tip
Repairing that tip has several options. In many cases less is better. Without examining you, I would probably favor a procedure under local anesthesia with softening of the cartilage by scoring it gently and perhaps resecting a small fragment. There are many ways to skin this cat.
Talmage Raine MD FACS
Nasal tip irregularity following rhinoplasty.
Irregularities of the nasal tip do occur following rhinoplasty. They are the direct result of an uneven and irregular contour in the underlying lower lateral cartilage and are more pronounced and readily seen if there is a thin overlying skin envelope. An open revision rhinoplasty to recreate a uniform, smooth and symmetric cartilage framework through the nasal tip region is necessary. This may or may not involve cartilage grafts. If the skin is abnormally thin, it may be useful to layer a fascial graft over the cartilage framework.
Mario J. Imola, MD, DDS, FRCSC.
Revision Rhinoplasty- Repairing Notched Cartilage?
In my opinion based upon the posted photos you need excisional revision of some excess lower lateral alar cartilage.
I would suggest a few second opinions with revision rhinoplasty specialists. I perform a lot of revision rhinoplasty from other surgeons and it is a highly specialized skill and a procedure that needs to be done with expertise. I would suggest an open rhinoplasty approach to achieve the best desired results. I would be happy to see you for a complimentary consultation and direct examination to give a further expert opinion. Best regards, Michael V. Elm, M.D.
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