If my upper lateral cartilage is caved in from my primary rhino and septoplasty, what options can correct that in revision?

Question

Is the only way to correct a caved-in upper lateral cartilage with cartilage grafting from rib?

Steven J. Pearlman, MD, FACS · Answer

The two primary procedures used to elevate the upper lateral cartilages in revision or primary rhinoplasty are spreader grafts or a butterfly graft. The specific procedure depends on your specific anatomic needs. You should see an expert in revision rhinoplasty for a personal exam and definitive opinion.

Thomas A. Mustoe, MD, FACS · Answer

Usually this can be corrected using a spreader graft harvested from the remaining cartilage but does require formal revision.  Usually this can be done through a closed approach which would minimize postoperative swelling of the tip

William Portuese, MD · Answer

A full set of facial photographs, the previous operative reports and an in-person examination going to be required to make a determination about how best to proceed. Revision rhinoplasty is much more difficult than a primary rhinoplasty due to the fact that there's been radius alterations to the normal anatomy and scar tissue present. It's important to know how much cartilage is left over on the inside of the nose for potential grafting purposes. Nasal cartilage is the primary source of cartilage grafting. If there is a cartilage depleted nose, then consider ear cartilage. A spreader graft is typically used to support the caved in upper lateral cartilage. For many examples and diagrams what  spreader grafts can accomplish, please see the link and the video below

Jeffrey Jumaily, MD · Answer

Depends on the exact cause of the depression of the cartilage. Often if you have a caved upper lateral cartilage, you get an inverted V deformity. The repair is usually done spreader grafts, bone contouring etc. The grafts are made from cartilage. The source of the cartilage depends on how much septum you have left. Other sources include ear, rib etc. Best wishes

Jennifer Parker Porter, MD, FACS · Answer

Cartilage that has a depression after Rhinoplasty can typically be fixed with cartilage grafting. The source of the graft could be septal cartilage (inside the nose), ear cartilage or rib cartilage.  It really depends on how much structure is needed to fix the problem.

David Alessi, MD - Account Suspended · Answer

It depends on the examination.  Generically, cartilage grafting with spreader and/ or shield grafts will help.  We can obtain them from any remaining septal cartilage or ear cartilage.  We use a lot of rib cartilage for revisions, but typically not with a misplaced upper lateral cartilage (ULC).  Often, we can simply dissect out the ULC and suture it in place with special suture techniques.  Seek out a board-certified revision expert for a consultation.  Best wishes.

Richard W. Fleming, MD (retired) · Answer

Collapse of the upper laterals cartilages after rhinoplasty surgery which can cause both aesthetic and breathing problems is usually corrected with cartilage graft that can be taken from the septum, ears, or ribs. Very, very rarely do I feel it is necessary to use rib grafts.

If my upper lateral cartilage is caved in from my primary rhino and septoplasty, what options can correct that in revision?

Answers (7)

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