I had a really straight nose but my nostrils were wide and my tip droopy. 1st surgeon really did a number on me. So I had a revision done 2 months ago and right after the surgery my nose was really straight. But as inflammation has resolved, I hump is begun to reveal itself. My surgeon suggested that because of skin being stretched from the botched nose job I had, that the rib cartilage is bowing. He also advised that the bowing will resolve as the skin tightens around the rib graft. is that true?
Will Rib Cartilage Bowing Resolves on Its Own or Does It Mean a Revision Will Be in Order? (photo)
Doctor Answers 6
Revision rhinoplasty with rib cartilage
It is difficult to say from the two photos provided whether the hump you are seeing is from the graft warping, the graft placement being off or from post operative swelling. At two months there is certain to be some swelling still present and it may resolve unevenly, resulting in temporary asymmetries. If the problem is due to graft malposition, poor shaping, or warping a revision will be necessary. I generally wait at least 12 months after a revision procedure to insure swelling is resolved.
The problem is that the rib cartilage was shaped wrong and not inserted in the correct plane nor secured. This is why it moves. Cartilage can also warp making matters worse. The best material is custom carved silicone implants. I have used them for the last 15 years without any problems. Its not the implant material so much as how its shaped and placed in your nose. See links below.
warping can happen with rib cartilage. Sometimes this needs to be revised. Hard to say without looking at all the before and afters. You would have to wait abour year fo things to settle.
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Rib cartilage warping
It's hard to say from your photos without examining you. If the problem responds to taping then you have a good chance that it will continue to do so over time. Warping is a risk of rib grafts and if it does occur then surgical correction is needed.
Rib Cartilage Bowing
Looking at the photos, I would agree that your rib graft is likely changing shape with time, which certainly happens in some cases. Do you need to have the rib graft reshaped? I don't know without examining you in detail and reviewing your history. It is unlikely the skin shrink wrapping down is going to resolve the bowing issue.
Rib Cartilage Bowing After Revision
What was done during the first rhinoplasty? If you have a rib graft, there may be some warping that will change over time. Hard to say without an exam and without knowing exactly what was done during the first rhinoplasty and the revision. Kenneth Hughes, MD Los Angeles, CA
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