forgot to ask this to my other Question. I have scar tissue, irridiated cartilage now totally reasborbed from Caudal extension graft in 2007 I'm 50 Will my own rib last? Am I too Old? some say yes, some say no? also blood supply, worried because it's thin, can my lining be helped? Someone said use skin from my top of my head to re-vascularize the area? is this needed? My nose at the columella and anterior septum feels weak and thin, is this normal due to retraction and reabsorption
4th Revision? (photo)
Doctor Answers (3)
Columellar retraction and revision rhinoplasty.
In all likelihood, the main issue at present is the lack of healthy soft tissue and the presence of poorly vascularized scar tissue through the caudal septum area and columella. Any cartilage grafting at this point will be severely compromised due to this poor recipient soft tissue bed. Returning a vascularized soft tissue bed to this region poses a challenging problem but is critical prior to attempting further cartilage grafting. Options include local flaps from either the cheek skin or oral mucosa based on the facial artery. These options may or may not be worth it in your particular scenario. Consult with an experienced reconstructive facial plastic surgeon.
Mario J. Imola, MD, DDS, FRCSC.
I have performed Revision Rhinoplasty for 25 years and IMHO, after 4 Rhinoplasties or perhaps it's five including the primary case, you are looking at diminishing aesthetic returns with further Revision Rhinoplasty. As you stated, irradiated or banked cartilage does dissolve as does your own rib cartilage and/or bone IMO. Blood supply is a matter of examination in person combined with the degree of warmth (an indication of blood supply) of the nasal skin. Ear cartilage (assuming there's no further septal cartilage to be harvested at this point) would be the longest lasting, most stable grafting material at this point. Hope this helps.
4 times is a lot for rhinoplasty. Hard to say from your photo. You may have rib cartilage that is OK, as we get older the cartilage calcifies and it is diffficult to carve. Sometimes an x-ray or sono of the area can be helpful. Yes, alloderm or temporal fascia can help cover the graft material. Good luck.