I had a Rhinoplasty which involved augmentation as a previous doctor "took too much out" in the first surgery.
Doctor Answers 4
Rib graft the best long-term choice
Using your own rib is the best long-term choice for structural grafting of the nose. Implants may need to come out sooner or later and ear cartilage typically lacks structural support.
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Unfortunately, Medpor is not a permanent soluton for rhinoplasty
Some surgeons use artificial materials because they are easier and do not involve harvesting rib or some other graft. Patients who have had unsuccessful results have already gone through pain and expense and want a simple solution. I am sympathetic.
Unfortunately, implants are not the solution. In a scarred nose, if your surgeon is going to take rib, why not re-do the Medpor and place your own cartilage? That is what is most likely to give you a lifetime solution.
As for the strut, normal tip projection does not come from a strut, but from the strength of the tip cartilages. Hard as it is to read the advice, you may be best off finding a surgeon who can replace your Medpor and create good projection with tip grafts. Make sure you see good results and that you like the doctor--no surgeon gets great results all the time!
Rib Graft for Columellar Strut
I'm sorry your unsatisfied with your previous rhinoplasty results. A rib graft can be used to support the tip and increase or maintain tip projection. The strut can be placed despite the presence of a Medpor graft.
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Revision rhinoplasty to improve tip projection
Rib cartilage is an excellent grafting material for revision rhinoplasty. It is strong enough to provide significant tip support. Using specific surgical techniques a durable increased tip projection can also be attained.
Medpore could be replaced at the same time as rib cartilage should provide enough cartilage for this as well.