i am told rib grafft would be good , but has a down side , ie feels hard , 2. was given advice by 2nd surgeon [ ear cartledge ,but might not last ]3rd surgeon, septal catrledge ,but may not be sufficiant amount??? would realy like some advice on the right way to go ...
I Was Thinking About Rhinoplasty , As I Have an Upturned Nose, I Have Had 3 Cosultations
Doctor Answers 9
Rhinoplasty and graft to correct upturned nose
Nasal septal cartilage is the best grafting source for augmenting the nasal bridge. If you have a cartilage-depleted nose the next best source is the ear. Another consideration would be rib cartilage, but it does tend to make the nose quite stiff. A synthetic silastic implant is a good option if you do not wish to undergo the rib cartilage harvesting procedure. Look for a rhinoplasty surgeon who has performed thousands of nasal surgeries since this appears to be a difficult rhinoplasty.
Treatment of "Upturned" Nose
It is rare that there is not enough septal and ear cartilage to lengthen the nose in primary rhinoplasty - rib grafts should not be necessary. After healing is complete, the tip will feel normal.
DeRotating the Nasal Tip
Without photographs it is difficult to give you specific advice. Is your nose turned-up naturally? Did you break your nose? Did you have a prior rhinoplasty. The general technique involves de-rotating tip or lengthening the nose. de-rotating/lengthening is generally more difficult to do that rotating or shortening the nose. As you have learned from your 3 consultations, de-rotating the nasal tip involves adding some type of cartilage. The type of cartilage and technique will usually determine the degree to which the surgeon can de-rotate your tip.
The advantage/disadvantages of each technique include:
1. Rib graft - excellent for lengthening and de-rotating the tip. Rib cartilage can warp. May look unnatural if rib graft too large and yes it will be firm. Harvest site can be painful.
2. Septal Cartilage. Not as much lengthening as rib, but usually very good. Depends on the availability of enough septal cartilage to create a caudal septal extension graft to suppor the lengthen tip.
3. Ear Cartilage. Can be used alone or in combination with above grafts. If used alone, usually minimal legthening, but may be adequate in some cases. Care has to be taken to ensure that these grafts are not visible.
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Cartilage graft of choice for upturned nose job
There is no definitive answer here for the choice of graft material. You most likley require a septal extention graft to lengthen the tip of the nose and make it apprear.
Most patients don't need rib cartilage.
The best graft for an upturned nose
The three alternatives to augment and lengthen an upturned nose are all good alternatives. The septum is by far the easiest and the area where borrowed is invisible. The volume is limited, though without an assessment it is hard to know if this alternative is ruled out. The ear cartilage is great, and remember you do have two ears from which to borrow. The cartilage will not 'go away' and would be my favorite. The rib cartilage is great at the extreme when the nose requires tremendous lift and support. Stiff, yes but if needed again, a good solution. You may have to try one more surgeon to sort things out.
Best of luck,
If you have a very low dorsum and do not have a lot of nasal cartilage, sometimes rib is necessary. However without an exam I could not say.
Rhinoplasty , As I Have an Upturned Nose, I Have Had 3 Cosultations
Very hard to advise without posting some photos. My guess is ear cartilage grafting, but only a guess. Best from MIAMI Dr. Darryl J. Blinski
Dorsal Grafting Material
There is no one perfect material for grafting of the nose. Each has its advantages and disadvantages. As you have seen three surgeons all recommending augmentation, it would seem that you must have a fairly significant correction that needs to be done. There are two aspects that you need to consider: the appearance and the function. If you can't breath through your nose it will not make any difference how it looks, you will be unhappy. Make sure that your surgeon feels that they can give you a good functional result, whatever grafting material is used. Next, consider the donor site. Make sure that you find a scar on your chest acceptable before undergoing a rib graft. Finally, ask about alloplastic (off-the-shelf) products. There are a number of synthetic grafts that can be used and are great choices in the right situations.
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.