I had primary rhinoplasty 1.5 yrs ago mostly tip augmentation work, which the tip is over-rotated. I am now seeking revision rhinoplasty to bring the tip down, probably with the use of rib cartilage. Since the septum had been used previously for the columella strut, I was wondering if it was possible to reuse that same cartilage piece for the new strut, or would a new piece have to be harvested. Just wondering since I'm not sure if there is enough septum left and I heard rib struts can be firm
Possible to Reuse Columella Strut In Revision?
Doctor Answers 7
Reusing grafts in nasal surgery
Certainly a columellar strut can be used for any revisional work in the nose. If only a columellar strut was harvested from the previous rhinoplasty there should be plenty of cartilage left on the internal portion of the septum. We very frequently will reuse grafts in the nose since it is living and viable tissue. Taking down the columellar strut will most likely help with the overrotation of the nasal tip.
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Reusing columellar strut graft
The cartilage graft that was used for the columellar strut can be resued in most cases. The main issue is that the cartilage is straight and strong enough to support the tip after surgery.
With tip de-rotation additional cartilage grafts can be obtained from the rib or ear.
Possible to reuse cartilage in revision Rhinoplasty?
Yes, the septal cartilage could be reused in the Revision Rhinoplasty but I'd suggest doing some omline research before having rib cartliage as this is prone to uneven dissolution over the years. IMHO, a straight silastic dorsal graft is best for the dorsum while conchal ear cartilage works best for the nasal tip.
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Re-Using Collumelar Strut
If the columellar strut is still good and can be removed, then yes. However, I don't think that you need to worry about that or even worry about rib cartilage. De-rotating a tip usually only requires revising the the tip cartilages.
Tip derotation and nasal lengthening may be difficult to achieve with Revision Rhinoplasty Surgery.
I read your concern. If your tip is over-rotated, this may be a difficult task to improve with further nasal surgery. Columella-struts may be reharvested and reused, but this may not be adequate cartilage to achieve your goals.
You should go on several consultations with reputable rhevision rhinoplasty specialists to see what may be feasible in your particular case.
I hope this is helpful for you.
Regards from NJ.
As long as there is minimal resorption, previously placed cartilage grafts can be reused in revision surgery. The grafts can be modified, re contoured and replaced as needed. If there is not enough graft material from the septum or previously placed nasal grafts, both ear cartilage and rib cartilage are other options.
Reuse of Columellar Strut in Revision Rhinoplasty
Your question is a very valid one. Ultimately, the answer will be influenced by several factors but 4 important ones to keep in mind are as follows:
1. The amount of cartilage that remains from your first surgery and the strength of that cartilage
2. The degree of over-rotation you currently have and the degree to which you want it corrected
3. The technique that was performed to rotate your nose in the previous surgery
4. The degree of skin mobility you currently have following surgery.
For ease of understanding, if you consider the analogy of your nose resembling a table cloth drapped over a table, the shape of the table cloth reflects the shape of the underlying table. In the same fashion, the overling skin and soft tissues of the nose reflect the underlying architecture of cartilage and bone.
Following your first surgery, the skin/soft tissue "drape" conformed to the underlying cartilage/bone framework. Bringing your tip "down" will require movement of both the "drape" and the "framework" and so both will need to be considered. In many revision cases, rib cartilage is required to push the tip down in order to offset the scar contracture produced from a prior surgery. Revision rhinoplasty is one you should take seriously. Make sure you feel comfortable with your surgeon and with his/her experience in treating "over-rotated" noses & his/her experience with using rib cartilage for rhinoplasty.
Best of luck!!
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