What started as wanting to straighten my crooked nose for functional and cosmetic reasons has led me to be even more unhappy. I would trade back to my crooked nose in a heartbeat. I am left with a host of problems. I have had two operations with a revision two years ago. The grafts are very uncomfortable and pushing on my skin, they show through and my nasal skin is very red. No fascia was used. My question is how difficult is it to remove the grafts and what method can be used to give smoother contours.
Visible Graft Showing Through Thin Skin? (photo)
Doctor Answers (6)
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Graft Visibility After Rhinoplasty
Thank you for your question and photos. Graft visibility after rhinoplasty is a potential complication. If it is not painful or threatening the skin, it can be shaved with a needle in some cases or camouflaged with fillers. The use of fascia or dermis at the time of surgery helps to camouflage cartilage in thin skinned patients. In your case it sounds like the graft is causing pain and threatening the skin. In this situation, removal of the graft through an open rhinoplasty approach would be the best option. This would allow for correciton of any further contour irregularity. Hope this helps. Best wishes.
Revision Rhinoplasty for visible graft edges
First, see a surgeon who is experienced in this type of surgery - in fact, see more than one. However, even in the best of hands, results cannot be guaranteed - but there is a higher likelihood of success. The existing grafts can be modified, reshaped an replaced and other tissues may be used to soften the results, such as fascia. For the depression along the left side of the bridge a non-surgical option would be the placement of a small amount of dermal filler, such as Juvederm of Radiesse. Although temporary, it is a minimally invasive and relatively predictable treatment. Best of Luck Dr Harrell
The grafts can be removed or shaved down and camouflaged with fascia or alloderm. Best to be seen in person.
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Visible Cartilage Grafts Under Nasal Skin
The grafts can be removed and replaced with fascia or the thickness can be reduced, eliminating the sharp edges which you can see. Consult with a surgeon who specializes in revision rhinoplasty.
Revision rhinoplasty to improve contour of visible grafts
Through an endonasal approach ("closed" where all the incisions are inside your nose) it is possible to remove the offending graft. As you touched on in your question, fascia works wonderfully as a camouflage graft to smooth contour irregularities in areas of thinned skin. An alternative is cadaveric dermis, such as Alloderm or hMatrix which also provide a soft, pliable layer of camouflage which becomes fully integrated into your nose.
Visible Graft Showing Through Thin Skin?
The grafts can be pulverized, thinned, camouflaged, or removed. My usual sequence is to remove them first and determine the status of the underlying cartilage and bone. From there, this can usually be altered to avoid the use of grafts. Kenneth Hughes, MD Los Angeles, CA
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.