Can cartilage shift back after a rhinoplasty? (photo)

Question

I was looking into getting rhinoplasty for a crooked nose due to a trauma case caused years back . I came across online that the memory of the nose cartilage can tend to shift back after rhinoplasty. If this does occur will my nose look crooked like it did before the procedure was done ? Or will it be slightly more crooked then the nose I came out of procedure with ?

Paul Durand, MD · Answer

Cartilage does have memory but if treated properly the effects of this should be minimal. That said, no nose will be perfectly straight because of our own inherent facial asymmetries (that everyone has) but it can definitely be straighter. Your surgeon should go over these details with you in your consultation. Hope this helps!
Paul Durand, MDRhinoplasty ExpertMiami, Florida

John Michael Thomassen, MD · Answer

Cartilage used for the nose is usually from the septum.  This cartilage has very low incidence of warping and this should not be a concern.  Rib cartilage can warp and therefore additional maneuvers are needed when using whole rib.

Andrew Miller, MD · Answer

If your nose used to be perfectly straight and trauma made it crooked, then you have a great chance of getting it straight again. If the nose grew crooked, it is more difficult to get it perfectly straight, but a well performed procedure will always look better than what you started with. Be sure to see a rhinoplasty expert for consultation.

Manish H. Shah, MD, FACS · Answer

Hi, 
Thanks for your question. The information you are speaking about is related to septoplasty surgery for deviated septum correction. There are lots of reasons to have a septal deviation. There are also normal asymmetries of the face and facial bones. Both of these things are the most common reasons a person notices a crooked nose.
A skill rhinoplasty surgery will create a straighter nose that is structured to withstand recurving over time by supporting the cartilage and repositioning the bony framework to create a straighter, solid construct that you see as a straighter nose. 
However, just performing septoplasty surgery alone leaves you with a greater risk of recurving. 
I hope this helps.
Dr. Shah

Gary M. Horndeski, MD · Answer

Your nose has 2 components: bone and cartilage. The bone will have to be corrected as well as the cartilage. Cartilage can have a memory but usually cartilage is treated in such a way that is will not go back to the original position.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Eric M. Joseph, MD · Answer

You are correct the cartilage has memory, however, when we are straightening a crooked nose, this typically involves both bony osteotomy work, and cartilage grafting, usually with spreader grafts. When performed properly, crooked nasal appearances should not recur. Thank you for this excellent question! Sincerely, Dr Joseph

Zoran Potparic, MD · Answer

Yes, there is a tendency for cartilage to take previous shape. A surgeon should make an effort to prevent that using different technique to keep cartilage in desired shape, but shape may change in time. If that creates a significant change in nose appearance a new procedure may be required to correct  it. You should not be worried about it too much now. Good luck.

Lucian Ion, FRCS · Answer

Thank you for your question and for sharing your photograph.

Adjustment of the direction of the nasal bridge involves addressing deviations in both the bony structures of the nose and the cartilaginous structures. While persistent deviation is often attributed to cartilage memory, it may also stem from incomplete correction of the bony nasal septum, which plays a significant role in alignment.

It’s important to note that recurrence of the deviation is not systematic; in many cases, adjustments to the nasal alignment achieve a permanent result. However, factors such as facial asymmetry and imperfect symmetry in facial muscle movement can also influence the perception of nasal deviation and should be considered in the evaluation and correction process.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Straightening a crooked nose can be a challenging maneuver in rhinoplasty.  I would recommend carefully observing your surgeon’s before and after gallery on their website to make sure that have lots of longterm pictures of this specific type of rhinoplasty.

I highly recommend that my patients focus much more on real longterm before and after photographs rather than 3D imaging.   I encounter so many patients in my practice who see me for revision rhinoplasty who previously had surgery elsewhere who feel like they were mislead into surgery by surgeons who relied heavily on 3D imaging without adequate real before and after pictures to back it up.  Photoshop is easy but real surgery is very different.

I always recommend that you carefully evaluate your surgeon’s online before and after gallery on their website for both quality and quantity of results. Make sure that there are hundreds of real before and after pictures which demonstrate long-term follow up results. If your surgeon is posting mostly on table results without real long-term follow up results, that is usually a major red flag.  If a surgeon is posting mostly just splint removal day videos without longterm follow-up pictures, that can also be a red flag.   Long-term results are much more meaningful than on table results or 1 week post-op results.

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

Bruce B. Kadz, MD, FACS · Answer

It's hard to predict what a cartilage graft would do long term. Warping is definitely a possibility not probability. Hard to predict the final outcome.