Revision rhinoplasty question - adding cartilage?

it is a common practice to add cartilage to both support and widen the thin parts. I would recommend having at least 2 consults.

Most patients who have revision surgery need it for one of 4 reasons. In order of common to less common:1) because too much supporting cartilage material was removed in the primary procedure and the nose looks skeletonized2) due to unrecognized or unrepaired nasal deviation3) had a partial procedure and the nose is out of balance now4) had poor work, a healing complication, or a different post-surgical issue affecting the outcomeCartilage replacement is often required in cases 1,2, and 4 and occasionally in reason 3. Structural integrity is critical for long term results and your structure should be relatively similar before and after a nose procedure. There is a reason your nose has the material inside that makes it have a shape; to breathe and support itself. A skilled Rhinoplasty surgeon should be able to reshape the nose without removing a lot of cartilage. In the end, most Rhinoplasty procedures are not simple and should not be simple. Even ones you think are going to be simple can end up complicated and vice versa.For revision, your surgeon needs to have a lot of experience with both primary and revision cases, in order to be able to problem solve during the operation, giving you the best outcome possible.

The most important thing for you to do is seek out a board certified plastic surgeon with EXPERTISE in revision rhinoplasty.  This is a difficult procedure and it is imperative to have a qualified surgeon.  Regarding the cartilage graft, yes, the operative plan sounds reasonable and in the hands of the right surgeon, poses minimal risk.  Your nose can be widened with the grafts as well as your tip refined.  Ask to view the surgeon's portfolio of revision rhinoplasty patients and make sure he/she meets the qualifications for performing revision rhinoplasty.

Thank you for your question. It is imperative to find a qualified board-certified facial plastic surgeon for this procedure, as a revision rhinoplasty is considered one of the most difficult procedures in cosmetic surgery. From what you described, the revision your surgeon has proposed sounds reasonable. However, it is difficult to assess your the status of your nose without pictures or an in-person consultation. My suggestion would be to conduct additional research about your surgeon’s revision rhinoplasty ratings prior to committing to the procedure. Consulting additional board-certified facial plastic surgeons is also a useful option for you to explore. Good luck!

Thank you for your question. The techniques of adding cartilage to the tip and the bridge are well described in the rhinoplasty literature. Revision rhinoplasty procedures are challenging, particularly if patients have had a difficult experience in the past. It is very important to clearly discuss your expectations with your surgeon and be reasonable with your own. Best of luck!RegardsDr Guy Watts

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.

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.

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

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).

Yes.  What you have described are common techniques for the issues you mentioned.  Cartilage can be taken from the septum with little risk.  Strips can be use to "spread" the bridge out if too narrow and this sometimes helps breathing as well.  Additional cartilage graft is then placed to augment the tip projection.  If the tip is also bulbous then some time cartilage can be thinned and removed to narrow the appearance.  Remember though, revision rhinoplasty can be very difficult and a surgeon that has experience in that procedure should be sought out.