Revision rhinoplasty question - adding cartilage?

I just saw a surgeon and he told me that my bridge is too thin (I agree and I hate it) and my tip is bulbous and it lacks support. He said he will widen my bridge with septum cartilage and add cartilage to my tip for support and make it thinner. Does this sound reasonable? I don't want to regret my choice again. I hate my nose now, I was prettier before surgery and I just want to have my face back! So are these techniques common with less risk?

Doctor Answers (8)

Secondary and tertiary rhinoplasty require technical skill with advanced grafting techniques

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Unfortunately you are in good company.  Most rhinoplasty patients out there are very unhappy with their results in 1-2 years.  The explanation for this is very simple:  Most surgeons performing rhinoplasty do not have advanced training or experience, they perform the rhinoplasty of 50 years ago.  Decades ago thought process of rhinoplasty was to remove cartilage to refine the shape of the nose and perform it through an open approach.  An open approach makes it easy for neophyte surgeons to access visualize and manipulate the structures but also unnecessarily destroys two arteries and veins that are important for nasal vascularity.  The open approach thus ensures that patients have 1-2 years of risidual swelling which hides the final result.  Most rhinoplasties out there I consider cartilage robbing thus when the swlling resolves there is inadequate structure to provide aesthetic appearance and fight the cicatriacial forces or the continued scarring that results from the lowered oxygen tension and fibrosis of tissues.  One additional problem it that most rhinoplasty surgeons out there inadvertently break the connection between the bony nose and the cartilagenous nose.  this can cause irregular narrowing and what we calll "the inverted V deformity" which means the outline of the nasal bone becomes visible through the skin particularly in flash photography under certain lighting conditions.

In my opinion, an expert level rhinoplasty is always performed in a closed technique and ALWAYS involves grafting to add to the structural integrity of the nose.  The act of opening the nose even under the closed technique causes healing and some contraction, thus for a long term beautiful result the nose must be left more structurally sound than it was found.  This is missed upon most rhinoplasty surgeons. 

In secondary cases such as yours it is even more crucial that sound grafting techniques are used.  It sounds like at a minimum you will need bilateral spreader grafts and a columellar strut but a complete L-strut should be considered and harvesting a small bit of rib cartilage may be necessary depending on your findings.  Is sounds like your surgeon is on the right track.  Definitely do not consider any rhinoplasty procedure that does not include grafting preferably by an experienced Plastic and reconstructive training with ddition fellowship level craniofacial and aesthetic training.  Of course this is my bias because it is my training but I think this level of training is very necessary for success in secondary and tertiary rhinoplasty because there is delicate nuance involved and every patient requires different maneuvers.  I hope this helps!

All the best,

Rian A. Maercks M.D.


Miami Plastic Surgeon
5.0 out of 5 stars 32 reviews

Rhinoplasty - adding cartilage

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It is possible and has been done that surgeons have used septal cartilage to improve areas of the nose, what your surgeon said he would do on you is doable and can have good results. For me personally I would not be able to know if that would be the technique I would use I would have to previously evaluate you, but I can assure that ultimately the technique that would be chosen for you would be the best for you, for you to be content and satisfied with your outcome.

Luis Suarez, MD
Mexico Plastic Surgeon
5.0 out of 5 stars 17 reviews

Revision rhinoplasty question - adding cartilage?

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Utilizing the cartilage from your nose  in other parts of your nose is the ideal way to revise and refine it.  I am in favor of using your own cartilage instead of implants.  It sound like the techniques you present are in line with safe and accepted techniques.

Garrett A. Wirth, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 5 reviews

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Nose refinement

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Yes septal cartilage is a good choice for spreader grafts to widen the nose...used between the upper lateral cartilages and the dorsal septum. This is the technique of choice to widen the nose. Ear cartilage and/or septal cartilge depending on the need are good choices for work in the tip. Septal cartilage is best for the columella and ear cartilage is best for the medial and lateral crural cartilage areas. Sounds like your surgeon has the right idea in mind. If he has talent and experience you are set.

Richard Galitz, MD, FACS
Miami Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

Revision rhinoplasty and cartilage grafts

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Cartilage grafts are usually taken from the nose and are performed for structural  or cosmetic purposes.  Adding septal cartilage grafts to the bridge will widen the bridge line, not make it thinner. The bulbous tip is addressed with a combination of suture techniques to the lower lateral cartilages and a conservative cartilage removal when necessary.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 58 reviews

Surgery With Cartilage Is One Option, And Nonsurgical Rhinoplasty Is Another

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Dear Germangirl1990; It appears from your photograph that your bridge is too thin, but that, of course, is relative to your bulbous tip.Now, I cannot tell how much support is lacking in the tip of your nose.Support is a function of the size and strength of the cartilage.In any event, the suggestion to widen the bridge with septal cartilage sounds reasonable, and whether or not you need cartilage for tip support and to help make it thinner does not sound unreasonable, based on what you tell me.It would be nice to see a profile view, but in any event, I think the upside for you in having a rhinoplasty is significant.You have very fine facial features otherwise, and obviously, the disconnect between the narrow bridge and a bulbous tip, unfortunately, impacts negatively on your appearance. I would suggest you discuss all options with your surgeon.There is some value for some patients in the non-injection rhinoplasty as an adjunct to the standard surgical rhinoplasty.Some people need such tweaking with fillers, and that occurs several months after the surgical procedure.There is nothing wrong with using multiple avenues to achieve the best result. Best wishes, Robert Kotler, MD, FACS
Over 4,000 nasal procedures performed
Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON
Author, THE ESSENTIAL COSMETIC SURGERY COMPANION

Robert Kotler, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 56 reviews

Revision rhinoplasty question - adding cartilage?

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Cartilage grafting to increase width is reasonable.  The bulbous tip can be remedied by any number of maneuvers, depending upon intrinsic support and surgeon preference.

Find a board certified plastic surgeon who performs hundreds of rhinoplasties and rhinoplasty revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD

Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 209 reviews

Cartilage Grafts in the Nose

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Cartilage grafts are the building blocks of revision rhinoplasty. They can be used for both structural or cosmetic purposes. When performed correctly and for the right reasons, cartilage of either nasal, ear or rib origin is usually the best material. I would be very skeptical of surgeons using artificial materials in the nose, as it can lead to infection and extrusion (rejection).

Ira D. Papel, MD
Baltimore Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

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.