I am in need of a complex revision. my nose has no structure and need rib cartilage. Unfortunately I have a large septal perforation although Dr. Toriumi says its too large to fix however he feels he can aesthetically improve my nose. I know he will build it up which is my fear. I am middle eastern and have thick skin. I have had several surgeries and with time, it changes, and just looks amorphous. Most surgeons I seen advise going to Toriumi.