Can I have a cadaver cartilage graft shaved down without a full revision surgery again? (Photos)

Question

I had my 2nd revision rhinoplasty (3rd surgery) done in October ‘24. The cadaver cartilage on one side is extremely prominent and shows through the skin. Is this something that will even out and blend in? Can I have it shaved down without a full surgery again? I cannot stomach thinking about having to go for a fourth rhinoplasty surgery after 3 prior doctors have failed me. Help!

Steven M. Denenberg, MD · Answer

It certainly does look like a couple of noticeable bumps. When you feel it, is it hard, like cartilage, or soft and squishy? Soft would indicate scar tissue, but it would be unusual for there to be such an isolated lump of scar this long after your operation. If it is cartilage, then yeah, it should be possible to design an operation to go evaluate what's there and carve it down to something that doesn't draw attention and doesn't bug you. But the surgeon would have to *feel* your nose to figure that out. Some problems can mostly be diagnosed with photos; yours required fingers on the nose.
But anyway, if it is an over-enthusiastic implantation of cartilage that was too big and left lumps, carving it down is indeed another operation. No other way to do it that I know of.

Alejandro Nogueira, MD · Answer

It is a very bad idea going for cadaver rib grafting, the complications, risks and failures are not rewarding if compared with harvesting a tiny piece of your own rib cartilage; ah yes, I know, if the surgeon is not meticulous there can be a pleural puncture and bla bla, I am aware of that... that's my work and my responsiblity, so far... knock on wood... never had that problem out of so many harvestings executed in my career.

The lumps, because I see more than one, you have now are likely due to rejection, intolerance or just cyst formation around what has no condrocytes (they've been killed by the radiation).

Unfortunately, a minimally invasive shaving of the lumps is no option, you need a full revision from scratch, a comprehensive examination, disassembling and cleasing of all the nasal areas; then and only then start from zero... but this time with a surgeon solidly experienced in complex revision.

Yes it is your fourth attempt, I have received tenths and further ones.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for revision rhinoplasty. Maneuvers for your surgery would include improvement in tip symmetry, tip refinement, nasal tip deprojection, among other maneuvers.  This appears much more complicated than just simply removing a graft.   With good surgical technique, you could have an outstanding result. 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

Can I have a cadaver cartilage graft shaved down without a full revision surgery again? (Photos)

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Can I have a cadaver cartilage graft shaved down without a full revision surgery again? (Photos)

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Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.