Is It Possible to Have Augmentation in Rhinoplasty?

Question

Is it possible to augment in a Revision Rhinoplasty? My surgeon cut too much off of the bridge. Would the average amount of septal cartilage be enough for the augmentation goal (in yellow) assuming it wasn't used in primary surgery? Also, how complex would augmentation of this type be? Should I seek a revision specialist?  Also, I'm just looking for something completly natural. I'm wondering if the angle would be considered acceptable with the bridge and the tip or would the tip need to be more protruding to create a natural look?

Andrew Turk, MD, FACS · Answer

It is very common to augment a previous rhinoplasty. Using your own tissue is the best choice. This would include cartilage from the nasal septum, ear cartilage used as a saddle augmentation or rib cartilage.
A full exam would be needed to determine the extent of an augmentation.  You also have to take into account any nasal airway obstruction.  You may need additional cartilage grafts to improve breathing if that is the case.

Ronald J. Edelson, MD · Answer

I actually think your nasal bridge looks nice.  Trying to build up your bridge runs the risk of leaving irregularities along the bridge which may appear as the swelling goes down.  In your case, I would not advise having this done based on your photo.

Steven J. Pearlman, MD, FACS · Answer

Augmenting or adding to the nasal dorsum is frequently performed for both primary and revision rhinoplasty. The complexity depends on the underlying structure and strength of your nose. We can use natural substances such as cartilage from your own septum, ear or in extreme circumstances rib. Foreign, yet compatible substances can also be used in many patients.
I agree that your should seek out a revision rhinoplasty specialist. What may seem like a simple procedure may actually be more complex than one thinks. Revision specialists are used to addressing the many challenges that this procedure can provide and hopefully help you avoid needing more than one more operation.
As for nasal balance, discuss that with your potential surgeon. I like to use computer imaging to help decide together what else might help create a better balanced nose.

Michael A. Persky, MD · Answer

Hi Xy,
It is possible to augment your nasal dorsum with either your septal or ear cartilage.  It is always wise to seek a rhinoplasty surgeon who is expert in revision surgery.  To maintain or restore a natural look it is important to have a "supra-tip" break, a slight depression between your tip and the upper 2/3 of your nose.
Do choose your revision surgeon carefully (that is if you are not returning to your orginal surgeon).
Good luck and be well.
Dr. P

William Portuese, MD · Answer

Augmentation rhinoplasty with the patient’s natural septal cartilage is the best alternative to replacing and building up the bridge.  Hopefully, the cartilage from the inside of the nose has not been removed from prior surgery.  Other alternatives for augmentation include ear cartilage, rib cartilage, and synthetic implants such as Silastic.  Revision rhinoplasty is a difficult operation and made more difficult if there is no cartilage left inside the nose.  It is a good idea to seek someone who has performed thousands of rhinoplasty surgeries including primary and revisions to understand the nuances of the difficult rhinoplasty procedure.

Nina S. Naidu, MD, FACS · Answer

It looks as if you need only a modest amount of augmentation to the nasal dorsum. Depending upon your goals, there are many options for augmentation material, including septum (if it is available), ear cartilage, rib, silastic (synthetic), and fillers. I personally would recommend septum if it is available. This is a fairly common procedure, so you could see any surgeon comfortable with this surgery. Although your preoperative photos are not available, your nose actually looks fairly natural in the above photo. If you can obtain your preoperative photos for your consultation, that will be helpful in assessing your goals and planning your next surgery if it is needed. Good luck, /nsn.

Steven Wallach, MD · Answer

Secondary rhinoplasty is always tougher. It would be nice to see photos of you before your first surgery. Nasal augmentation can be performed with autologous cartilage. This can be taken from your septum if not used befor, or better yet the rib.

Michael A. Bogdan, MD, MBA, FACS · Answer

Dear XY,
It is fairly common to perform dorsal augmentation in revision rhinoplasty surgery.  The septum is the ideal donor site, but ear cartilage or rib can also be utilized.  If your septum was untouched during the initial surgery, you might have enough to achieve your goal.  (It is difficult to make that kind of assessment from one picture.)  If you do not have enough cartilage from the septum, then ear could be used as a secondary source.  I do not think you would need rib - rib graft reconstruction is mostly used if your nose has been severely over-resected or destabilized.  I would recommend that you see a rhinoplasty specialist who is known for revisions - in New York I'd recommend one of my mentors - Nicolas Tabbal. 
Best regards,
Dr.B

Mark P. Solomon, MD · Answer

You have many options for revision rhinoplasty. The first choice may be to use a filler. This is a relatively inexpensive way to go. Fillers used for this purpose may last a long time. If a filler is satisfactory, you may avoid surgery. If you choose surgery, there are several options including cartilage graft from your nose, your rib, or an implant. You should ask any surgeon which of these will work for you. Without an exam, it is difficult to say much more about your situation.

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.  The answer is yes and augmentation of the dorsum is possible.  Nasal septal cartilage is the preferred source but ear cartilage can also be used.,

Is It Possible to Have Augmentation in Rhinoplasty?

Answers (11)