Rib Graft Bridge and Tip... Crooked, What Are my Options?

I am 1.5 months post ops and it's very obvious that my rib graft is crooked from the Start of my bridge to the tip... Much to the left. Is the only option to have another surgery or can this be corrected some other ways? I am certain it's not from swelling as I can feeling the graft and see it very clearly that it's more left ..... Even wearing my glasses, I had the get adjusted because it doesn't fit right since the nose piece needs to be adjusted more to the left. 3 docs all agreed.

Doctor Answers (9)

Revision rhinoplasty may be necessary, but you need to wait a bit.

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Dear Sammie125;

It is only 1-1/2 months since surgery and, while you claim that, “My rib graft is crooked from the start of my bridge to the tip,” wisdom suggests that you still wait a bit.  Unless this looks absolutely grotesque and terrible, time may cause some improvement.  In any event, it will also be a technically easier operation for your surgeon to do after some time has passed. 

Occasionally, some people are lucky to have a situation whereby a little filler can restore some symmetry.  I would not know whether that is possible without seeing you, but it is certainly something that ought to be considered before signing up for the revision rhinoplasty

If already three doctors have agreed that you are going to need revision surgery, then most likely you will, but did any of them think you would be helped by a filler?  You can do a “filler test” to see if there is a significant improvement.  Ask about it.

Robert Kotler, MD, FACS
Facial Plastic Surgeon
Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON
Author, THE ESSENTIAL COSMETIC SURGERY COMPANION


Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 52 reviews

Crooked rib graft

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Your graft may be crooked or it may be warped. You'll need to have it surgically adjusted. I doubt you will be happy with filler.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Rib Graft Bridge and Tip... Crooked, What Are my Options?

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 Sadly, no if after the initial post Rhinoplasty swelling subsides (within several months) and the rib grfat is truly crooked...a Revision Rhinoplasty would be required to modify the graft.  IMHO, rib cartilage/bone as well as banked cartilage/bone all have the habit of dissolving unevenly over the years and for that reason I do not use this material for building up the nasal bridge.  I would remove the rib graft and replace it with a straight silastic dorsal graft that's more reliable, IMO.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

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 A crooked graft usually has to be removed and replaced or repositioned.  You can camouflage it sometimes with fille material.

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Revision Rhinoplasty

+1

If the rib graft is crocked, then you will need another surgery. If the rib graft is salvegable, by removing it and burring it to be straight, that is good, otherwise you may need another graft, Rib cartillage or synthetic (Rib cartilage is more biologic)

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Sometimes a crooked graft on your nasal bridge can look better after an Injectable Filler procedure.

+1

I read your concern. You may want to re-post your question with a photo for the RealSelf community of experts to comment on:

I have personally placed an ePTFE graft for dorsal nasal augmentation that ended up looking a bit crooked after swelling resolved. In my patient, the asymmetry was most prominent at the top of the bridge at the radix. Rather than removing the graft, I used an injectable filler to restore symmetry. This could make your nose look wider, so without a photo, I could not know whether this option could be right for you.

Hope this helps.

Dr. Joseph

Eric M. Joseph, MD
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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.