Revision Rhinoplasty: Q&A
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Shaving Rib Cartilage Graft on Bridge For Revision Possible?
Hello, 6 months ago, I had rib grafts put into my bridge and tip (strut) of my nose. Now i think the bridge is too high (2.5mm) and the tip is upturned, stiff, and overprojected. I want to shave the bridge to 1-1.5mm and remove the collumellar strut from my tip. So my question is, is it possible to carve down the bridge rib graft to 1mm? Also, can the tip be sharpened/defined without a strut (i don't like a really stiff nose) or a graft?
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9 Doctor Answers |
Asked by
NateL
in SF
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Shaving Rib Cartilage Graft on Bridge For Revision Possible?
I have performed Rhinoplasty for over 20 years and IMHO, it would be unrealistic to think the rib graft could be shaved exactly 1mm. The strut can certainly be removed and if you're already having a revision Rhinoplasty to do that, it does make sense to try and decrease the rib cartilage graft by shaving. I'm just not sure it can be as exact as you're asking.
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Shaving rib cartilage graft
It certainly is possible to refine the dorsal rib graft, though I would suggest waiting until at least 1 year after surgery. If you proceed too soon you may shave down too much cartilage as there may still be swelling causing some fullness.
It's hard to say how your tip should be addressed. Just removing a columellar strut may destabilize the tip which could lead to a droopy tip down the road. There are ways of addressing how upturned the tip is with revision rhinoplasty manuevers....
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Shaving Rib Graft on Bridge
The rib graft on your bridge can be trimmed and the columellar strut revised. However, I suggest you wait another 6 months before considering additional surgery, especially if the past operation was a revision of previous work.
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Revision of nasal rib grafts
After this type of graft procedure a revision is somewhat complex due to scarring and blood supply issues. Make sure that your surgeon has a lot of experience with revision work after grafting.
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Rhinoplasty Surgery
The answer to your question is yes, the rib graft can be modified with a revision surgery. I would recommend that you wait at least one year before considering revision surgery. With time, your tip may drop somewhat and soft up. These changes may make you more happy with your surgical result and help you to avoid revision surgery.
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Nasal revision
It is possible to revise the cartilage graft. Having said that it is still a bit early to be able to determine what is swelling and what may be extra cartilage.
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Adjusting rib cartilage grafts to nose
The short anskwe to your question is probably yes. However, it is best wait at least one year for your nose to heal after your rhinoplasty and the skin and soft tissue to settle down. Also, the tip will continue to soften over time and may only need minimal adjustments if any at that time as well so I would wait perhaps a little longer there as well.
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Rib Graft and Strut
Hi,
You can certainly have the rib cartilage shaved down to bring down the bridge. The tip definition is typically created with cartilage grafts so the stiffness that you feel will usually get better with time. You can also have temporalis fascia placed in the tip to soften it.
Good luck,
Dr.S.
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Graft adjustments
Without knowing exactly what was done and what your original pre-op photos looked like, it would be difficult to comment on the columella strut. Certailny the dorsal graft may be able to be shaved down a bit if it is aproblem for you. However, the columella strut may be providing support.
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