Hi, I've had a rhinoplasty about 18 months ago. Aside from poor breathing, a constant runny nose, a hole in the septum (which I was told is about an inch and to large to fix) there is a little dent on the left side of the tip of my nose. The nose is also does straight. I have had a couple of consultations and am strongly considering revision with rib cartilage. Should I do this? Unfotunately, the dent is not greatly clear from these pics. Your resposes are greatly appreciated. Thank you
Should I Get a Revision Rhinoplasty W/ Rib Cartilage?
Doctor Answers 10
Rib Cartilage for Nasal Dent
Personally I would stay away from rib cartilage if you can. Rib can warp and there can be risks from harvesting. Most dents can be correct using ear cartilage and/or artificial fillers or implant material. I think rib cartilage should be used as a last resort.
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Revision for a small dent
I agree with others that a rib graft would be overkill for what you have - try a short term filler first and if you like the results you can do an ear cartilage graft.
Best method to correct nasal tip dent
From the photos you posted you may be able to have ear cartilage used as a graft to improve the dent you're concerned about.
There may be more dynamic collapse of the area that is hard to appreciate in still photos, however. It may be that your surgeon wanted to strengthen the cartilage in that area as well, which would require cartilage stronger (and straighter) than ear cartilage.
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Rib cartilage use in revision rhinoplasty
From your pictures, it appears that you will not need rib cartilage graft. Rib cartilage is used when there is a very low dorsum such as in over-resected dorsum or collapsed dorsum. Your dorsum seems adequate on these pictures. Minor deformities can be corrected with minor surgery or fillers.
Revision rhinoplasty with rib cartilage
Before undergoing a rhinoplasty with rib cartilage, the patients must ask themselves what the rib will be used for. If only a very small cartilage graft is needed, ear cartilage would be the first option rather than embarking on harvesting from a rib. The risks associated with a rib harvest can be a pneumothorax. One must be willing to harvest and use the entire rib cartilage in the nose for multiple grafting purposes. The rib cartilage is much stiffer than nose cartilage and subsequently the nose will be stiffer. Septal perforations are usually closed with a silastic septal button. Once the septal button is in place, laminar airflow can take place rather than cross ventilation through the perforation, which should help with a runny and crusty nose.
Revision with rib cartilage
I don ot think that your revision will need rib cartilage unless you are considering building up the dorsal height. The small indentation on the side wall can be corrected possibly as easy as placing a small amount of filler in it or using a cartilage graft.
Revision Rhinoplasty and Rib Cartilage
I have reviewed your pics and concerns. Although I am a firm believer in the effectiveness of rib cartilage in revision rhinoplasty, and have seen much success, I do not beleive your issues require such an undertaking. Regarding the indentation on the left nasal tip, this can be easily corrected with crushed cartilage grafts or a small temporalis fascia graft to add volume to the indentation. Regarding your breathing issues, the cause is difficult to discuss without first performing a detailed nasal exam. I will speculate that you have a degree of internal nasal valve collapse which can be repaired with "spreader grafts" fashioned from ear cartilage, since I am sure there is not much septal cartilage remaining given the large perforation. Lasty, with a nasal perforation of the size you describe, it will be quite difficult to completely close. I would suggest constant nasal irrigation and application of ointments to prevent drying, crusting, and bleeding. Good Luck....Dr. Corrado
The indentation in your nose may be improved by a well-performed non-surgical rhinoplasty procedure.
I read your concern and reviewed your photos:
Some patients experience "runny nose after rhinoplasty", and frankly, it's not well described in the literature. Your runny nose may improve with a topical antihistamine nasal-spray, so see a reputable ENT for evaluation.
Large nasal-septal perforations are not easily repaired with surgery. You can use OTC nasal saline gel for relief of dryness and crusting that may be associated with nasal-septal perforations. Nasal saline washes are also helpful for symptoms associated with septal perforations.
In my practice, the indentation above the tip of your nose on your left could be improved with an Injectable Filler treatment. In my view, revision rhinoplasty surgery would be excessive and unnecessary: you have a nice result.
All the best from NJ.
I looked hard at the pictures you posted and wondered what are you trying to improve?
If there is a dent at the nose tip then there are other sources of cartilage to correct that. or it may be corrected without a graft.
The rib cartilage graft main uses are
1: To build a collpsed bridge, or non exixtant bridge as in some ethnic noses.
2: Use rib cartilage graft for SPREADER graft, it gives straight and long enough graft.
In your case with the breathing problem the internal valve may need support with a spreader graft. But with a one inch septal perforation, the spreader graft may not be suitable because it needs a pocket between the septum and the upper lateral cartilage.
What is the cause of the hole in the septum ? some causes may also compromise the vascularity of the nasal and septal mucosa.
Concentrate on correcting your fistula and breathing problems.
Revision rhinoplasty with rib graft
The amount of improvement to be achieved is relatively modest and, in my opinion, does not warrant the risk of an additional surgery, particularly with a rib graft. Given your septal fistula, the circulation to your nose is already compromised and any additional surgery would further interfere with the remaining vascular supply.