If in theory, a rib graft was to calcify in a diced cartilage fascia graft, what would be the result of the graft?

Without seeing photos, I would recommend the autologous cartilage grafts. The complication rate will be less than the rib graft.
There are secondary procedures to add the the dorsum. Think about doing it in stages. 

Hello,
This and the other questions you've asked are not relevant to your education about rhinoplasty, those are more important to the practitioners who provide rhinoplasty.  If you are interested in having a rhinoplasty, you should interview a few ABPS certified/ASAPS member surgeons (or AAFPRS equivalent) who specialize in rhinoplasty. Find out about the relevant aspects of the surgery that will help you decide if rhinoplasty is for you, and gain trust in your surgeon that you pick. Don't worry about details like perichondrium on the graft (which doesn't aid in it's survival) or calcification of DCF grafts (they don't), that's for the surgeon you trust to know about, and provide the best services for you. Best of luck!

     Dear amyknows in Beverly Hills, California:
          You have not mentioned how many surgeries you have had but you refer to “my last revision.”  Have you had one or more revisions following the primary rhinoplasty?  In any event, the more surgery you have had the more challenging it is to add in grafted tissue in regard to the source.  This is not simple surgery.  It is complex, although often very successful, of course.  If the main issue is to raise your bridge, have you considered temporary or permanent filler?  This may be a practical, although not ideal, answer.  You want to have a reasonable prospect of success.  Each surgical rhinoplasty, particularly with grafting, has a certain percentage of cases that are not ideal and then the next logical question is, “Do I keep having surgeries, particularly when I think about what some celebrities have endured without a satisfactory outcome.”

          I think you should have consultation with the emphasis on evaluation for either temporary or permanent filler, the non-surgical rhinoplasty is becoming popular because it makes sense.  If you can accomplish what you would like with an office treatment instead of another trip to the operating room, it seems that should be very carefully considered.  You need to consult with someone who has the experience and expertise in using temporary or permanent fillers. 

You want to do your homework before consultation.  Prepare well for your consultation.  When you search, look for rhinoplasty super-specialists.  These are surgeons whose practice is the majority or entirely devoted to rhinoplasty, septoplasty, and related procedures.  This would include both primary and revision rhinoplasty surgery.  Why not have the most specialized talent in your service?  Consider how much experience the surgeon has doing the procedure you are considering. We all get better at what we do with time and so those surgeons who have a long run of experience are the ones who have learned the most from experience. Residency and fellowship are where the learning begins, but for all of us, time and experience is where the education continues.

Part of your preparation for consultation should be preparing a list of questions beforehand.  Bring a notepad or ipad or laptop with you and take notes as the surgeon answers the question you are asking.  You should spend more time with the surgeon than with the office administrative staff, because you need to get a sense of whether you are comfortable with the doctor.  You should not feel rushed that you are on a consultation conveyer belt.  If the presentation by the office staff seems a bit to “salesie” that is a bit of a yellow or red light.  Take a friend or relative along since two heads are better than one in gaining information and understanding.  In the end, the purpose of the consultation is for you to be educated and be comfortable, not to be “ sold”.  Ask yourself two key questions: “Is this surgeon teaching me or selling?” And secondly, “Can I put my life and my face into this particular surgeon’s hands? Can I trust him/her?”

There are excellent books out there that you can read and use to study up. It is worth the homework time you put in up front so that you make the right decision with respect to choosing a surgeon who has the talent, experience, and degree of super-specialization that you certainly want to have. 

When you visit doctor’s websites, the most important feature on the site is the before and after gallery.  If there are just a few examples of rhinoplasty or revision rhinoplasty, you wonder how much experience the surgeon has performing such surgeries.  There need to be dozens and dozens of examples.  The more examples there are, the more likely you will see one or more that demonstrate situations similar to yours.  Look closely at the photos for natural results.  That is what you want.  Nobody wants to carry a sign saying “I have had a rhinoplasty.”

     Reviews on review sites, particularly RealSelf are very important and should be carefully digested. The larger the number of reviews the most accurate the picture of the practice and particularly the doctor. A consensus is generally correct.

   A consultation without computer imaging is, in my opinion, of much less value.  Why shouldn’t you see the predicted result of the procedure the doctor is proposing?  At consultation, photos are taken of you and loaded into a computer system that morphs your present appearance into the anticipated “after” based on the nasal surgeons input.  Imaging is an incomparable learning tool because it provides a forum for doctor and patient agreement on what would satisfy the patient and what is, in the doctor’s opinion, achievable.  After all, cosmetic surgery is 100% visual.  It is about appearance, so without a visual evidence of what is planned, how can you make a decision as to whether or not you might be satisfied.  Talking about it is worthless.  To anticipate a successful outcome, there must be a meeting of the minds between surgeon and patient.

     Best wishes,

 

Robert Kotler, MD, FACS

Over 4,500 nasal procedures performed