My wife wants a rhinoplasty revision for a pinched tip; how is it possible to add back what was once taken away? Where does the extra cartilage come from?
Where does the cartilage come from for a rhinoplasty revision for a pinched tip?
Doctor Answers (16)
Extra cartilage to rebuild nose during revision rhinoplasty
It's a good question, and it's one rhinoplasty surgeons address every day. Even a couple of decades ago "reduction" rhinoplasties to shorten, narrow and sharpen the nose were in vogue. As you mentioned, cartilage and bone were liberally "taken away". The results looked terrific, at least for a few years, but with time the lack of appropriate structural integrity left pinched, collapsed noses as they continued to heal.
The extra cartilage to rebuild the nose comes most commonly from three areas: nasal septum, ear or rib. Depending on the amount and type of cartilage that is necessary, the surgeon will determine which is best for a particular patient.
The Pinched Secondary Rhinoplasty Look
Having a pinched nasal tip is very common especially in patients who have rhinoplasty done in the 70’s and 80’s and still some done in some parts of the world where cartilage is excessively moved or transected. The optimal management for this is to find a highly experienced rhinoplasty surgeon that can reconstruct using your own tissue either from your own septum or ear cartilage. Using your own tissue is the best and in most cases this will require reconstruction of the nasal framework and tip. Choose your rhinoplasty surgeon wisely especially for secondary revisional rhinoplasty.
Revision of rhinoplasty complications often requires additional cartilage from the nose, possibly the ear or rib cartilage
Revision of rhinoplasty complications often requires additional cartilage from the nose, possibly the ear or rib cartilage. Most often, if enough cartilge is left in the nasal septum, that will be used. The second most common source would be cartilage from the "bowl" of the ear. A small incision is hidden on the back of the ear and this does not change the appearance of your ear. If alot of cartilage is required or the previous two sources do not provide enough cartilage, then a portion of the front part of a rib is removed and used for structural grafts. This is done via a small incision in the breast crease. It hides very nicely in women but is typically not objectionable in men either.
Stephen Weber MD, FACS
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Usually from the ear but may require rib cartilage if issue is significant
Yes, i call it "reverse rhinoplasty" we usually use ear cartilage but may require rib cartilage if the issue is significant.
Rhinoplasty revision donor cartilage.
Revision for pinched tip
The pinched tip look is a tell-tale of a poorly performed rhinoplasty. Supporting the tip in this case requires grafting and the best material is autologous cartilage. Possible harvest sites include the nasal septum, the ear, or the rib. I generally use ear cartilage, but rib may be necessary if the nose is very tight and needs the sturdiest support. Make sure your surgeon has experience with tertiary rhinoplasty.
Where does cartilage come from
If not totally depleted from the first surgery the "new" cartilage to be added usually comes from the nasal septum. If there is not enough available from the septum I will usually go to the ear as my "spare parts box" for the nose. If unusually large amounts or major support is needed or the ears have already been used then I would go to the patients rib. Another option is donor irradiated rib but it would be my last choice.
Where do cartilage grafts come from for revision rhinoplasty surgery?
The cartilage to rebuild a pinched tip comes from either the nasal septum (the dividing wall inside the nasal cavity) -- if there is some available -- or from ear or rib cartilage. Ear cartilage is taken from what is called the conchal bowl via an incision behind the ear. The skin of the ear is left in place (so there's no hole in the ear) and the ear typically heals very nicely with no visible change to its shape. If more support is needed rib cartilage is a great option.
Visiting with a revision rhinoplasty specialist will allow to get a better idea of what type of grafting may be needed.
Cartilage Graft For a Secondary Rhinoplasty
The cartilage used for grafting in a secondary rhinoplasty is either taken from excess cartilage remaining in the nose itself or else it is taken from the ear. It is done through an incision behind the ear, which is very well concealed.
Where the Cartilage used in Rhinoplast comes from
The cartilage used for grafting during a rhinoplasty comes from the septum, ear or rib cage. If possible the cartilage will come from the septum as no additional scars are necessary.
The septum is the wal that divides the right and left nostril. The lining over the cartilage is lifted off, the needed cartilage is taken and then the linings are sewn back together. If the septum doesn't have enough cartilage, then the cartilage is taken from the bowl of the ear or the ribs right next to the sternum (the ribs are cartilage there).
Hope this helps. Good luck!