Derotate nose with very little scar tissue : can I do this without grafts?

Question

I would like to derotate my nose. Scar tissue in the tip is nearly absent based on scans. Therefore, the skin is not tethered and quite flexible. Can I derotate my tip and restore the infratip lobule just by releasing sutures? Can instead of rigid SEGs or columellar struts, the derotation graft be used which leads to a more flexible tip, if grafts are really necessary? I'd rather have a droopy tip than grafts in my tip.

Philip Wasicek, MD · Answer

Hello, 
Your best option would be to seek an in person consultation with a board certified plastic surgeon who specializes in rhinoplasty, and who frequently performs revision rhinoplasty. 
It is difficult to say exactly in your situation without evaluating pictures or knowing what was done in your first surgery. 
However, in general, the answer is typically yes, usually multiple grafts are required to derotate a nose in revision rhinoplasty. That can sometimes mean cartilage (including rib cartilage), and soft tissue grafts. There are multiple techniques to do this but they require grafts. The healing and scar tissue forces at play in revision rhinoplasty can be significant--so support to combat these forces and ensure a good long term result requires structural support (cartilage). 
Best of luck.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Grafts are absolutely needed for tip derotation. Also, no scan will ever show anything reliable about scar tissue. This should be determiner by a clinical evaluation by an expert. Make sure you are going to a surgeon with hundreds of long-term before and after pictures on their website with standardized lighting and standardized backgrounds. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Milan Doshi, MS, MCh · Answer

Hi Forceful487232Suture release alone is rarely enough to reliably derotate a nasal tip, especially if the nose has already healed. Even if scans suggest minimal scar tissue and the skin feels flexible, the tip position is controlled by cartilage shape, prior surgical changes, skin envelope, and structural support &mdash; not just sutures.
If derotation and infratip lobule restoration are needed, some form of controlled structural support is usually required. A derotation graft may be considered in selected cases, but it must still maintain stability. Avoiding rigid grafts completely can increase the risk of tip droop, poor definition, or relapse.
The goal should not be an overly stiff tip, but a balanced, stable, and natural tip position with enough support to hold the result.
This is a great question. I would recommend consulting with a board-certified plastic surgeon to further discuss your goals and evaluate you in person.

Derotate nose with very little scar tissue : can I do this without grafts?

Answers (3)

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