My nose is crooked due to the rib cartilage warping in my columella; what do I do? (Photos)
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Doctor Answers 3
Crooked nose possibly due to cartilage warping
While side view photos are not enough for proper evaluation, generally, we also have to confirm that your existing anatomy is not abnormal or that your nasal septum is not deviated to begin with, before we conclude that it is the rib cartilage that warped and caused the crookedness. Should the latter be the case however, it can be adjusted, or other cartilage from your ears or the septum itself, can be used.
My nose is crooked due to the rib cartilage warping in my columella; what do I do?
Thank you for your question and images. Your profile view looks pleasing and I do not see any significant distortion. Like all things in life their are pros and cons. Rib cartilage is one of the mainstays for rhinoplasty, often in the revisionary setting but occasionally in primary rhinoplasty. Adding support to the nasal tip will usually mean harvesting cartilage from another source wither the septum or if large pieces are needed the crib cartilage. Any increase in tip projection will usually be associated with stiffness of the nose and I discuss this with all my patients prior to surgery. They go hand in hand, if you want increase projection you need a strong support. Although there are alternatives, such as medpore, they are implants have have their own risks and benefits. I would suggest you discuss your concerns with your original surgeon.
Dr Guy Watts
Rib Graft Rhinoplasty Revision
Any material placed into the tip of the nose when used a columellar strut to provide significant projection is going to feel firm. That is why it works long-term to resist soft tissue push back. While there are a host of different biomaterials to use I would be hesitant to place a synthetic material in the columella/tip of the nose due to infection/extrusion risks. You would be better served by re-working the rib graft columellar strut by straightening it through cuts, suturing to a restorable PDS columellar plate and re-inserting it. It should then heal without bending.
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