I went to a doctor for rhinoplasty- he told me he was just going to refine it a little and take very little off.He said no one would even notice. I did not know he was going to scoop out my bridge and take my tip off my nose- now I have an upturned- scooped out- short nose-small nose- with nostrils showing,crooked-and does not look like it fits my face. Doctors that I have seen want to use different grafts and I am confused-I hear good and bad about these different graft materials -Please help,Thank you
Which is Best for Bridge: Goretex Implant Vs. Rib Graft Vs. Ear Graft?
Doctor Answers (14)
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Here are your options
Unfortunately I see patients like you every week in my office. Patients who have had over aggressive reductive rhinoplasty by irresponsible plastic surgeons who do not understand the nose or the limits of their own skills. Its a shame!
Safe options for implant material are:
Septal cartilage, ear cartilage, your own rib cartilage, frozen or irradiated rib cartilage, temporalis fascia, and alloderm. A combination of cartilage and fascia may be needed for the best results.
Stay away from implants such as Gortex as they are quick fixes but many times get infected down the line or have other issues. Good luck and do lots of homework before going through another surgery.
Implant and graft options for nasal bridge
I am sorry to hear you had such a difficult time with your first rhinoplasty. It is important to go to a rhinoplasty surgeon who is well versed with revision rhinoplasty.
There are several different grafts available for reconstructing the nose. Stay away from Gortex implants in the nose since they have a propensity to get infected and we have seen many problems from those implants.
The best option is a septal cartilage graft provided there is septal cartilage still left inside your nose.
The next best graft source would be cartilage from the ear, which can build up the nasal bridge height. The cartilage may also be diced and placed in the temporalis fascia pocket to augment a large area.
Rib grafts also are acceptable, however, they tend to warp and bend in the postoperative healing phase.
A small silastic implant can be used if you do not wish to use any grafts.
Nasal Implants for Nasal Augmentation
There are different implants for different types of augmentation. There is no one best augmentation material. It all depends on how much needs to be augmented and how much experience the surgeon has with that particular material. Don't get caught up with what type of material is used, rather find a surgeon you think can do the job and go with the material he suggests. All of the augmentation material have pros and cons. Keep doing your research and you will find a surgeon that you trust.
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Graft Materials for Revision Rhinoplasty
I have used Gortex during the past 35 years of rhinoplasty surgery. However, in revision surgery I use the patient's own tissue;in order of preference the septum, ear, or rib cartilage . The choice really depends on the quantity needed.
What graft to use depends
Your situation is difficult. Without seeing photos of you it is hard to guess how much work is involved in correcting your problem. Usually in cases like yours there is a significant loss of supporting cartilage, that is why the tip turns up. In that case you will need cartilage to repair and rebuild the bridge of your nose.
Gortex has no strength so it is not a good choice for a structural rebuild. Ear cartilage is fairly short and doesn't have the stiffness needed to push the tip back down. My number one choice in a case like yours is rib cartilage. I use it rebuild what is missing and try to restore a natural shape. Septal cartilage could be used in a similar fashion if you have any left.
The most important thing for you is find a skilled and experience rhinoplasty surgeon who can handle a case like yours without making it worse. I hope this helps.
Dorsal grafts in rhinoplasty revision.
I feel that any of the materials you mention can work well. I do not like using gortex or any foreign material in revision noses. In 35 years of revision rhinoplasty, I have used septal and ear cartilage. It is your own material and does not have the pain associated with rib grafts.
Grafts in rhinoplasty
Every surgeon has his or her own preference for graft material in the nose, so you'll probably read some different opinions on this. I personally like to use septum if it is available and will provide enough volume. In Asian patients, a Goretex or silastic implant is often necessary. I do not like to use synthetic grafts in Caucasian patients given their relatively thin skin. I reserve rib cartilage for patients who need a large amount on their dorsum, but who are not good candidates for a synthetic graft. Ear cartilage is not as strong as the other options, so I rarely use it. I hope this helps, good luck, /nsn.
Revison Rhinoplasty, Grafts, Computer Imaging
Sorry to hear about your rhinoplasty unsatisfactory results. It is so very important that patients and rhinoplasty surgeons communicate in an exact manner before surgery. Many times computer imaging is an excellent tool to clear up any miscommunication about the degree of profile reduction or augmentation. At this point you should consult with a few rhinoplasty revision experts (as well as your original surgeon if you still have faith in his/her work). The type of graft is not as important as the rhinoplasty surgeon who will be constructing the graft and placing it. Your revision will likely be complicated so choose your rhinoplasty surgeon most carefully. Good luck and be well.
Goretex is my choice
If over 6 months has passed since your rhinoplasty, I would suggest you consider a graft made of Goretex if your problem is as you describe. This material is easy to obtain and to shape and if is easy to remove if not satisfactory. There are many other dorsal nasal implants materials, but I have had my best results with Goretex.
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