Can cartilage grafts be trimmed back or removed in Revision Rhinoplasty?

Question

I have seen numerous mixed responses from doctors on this site relating to the question on whether cartilage grafts placed from prior rhinoplasty can be removed. Some surgeons respond yes and that graft removal is quite easy whereas others indicate that it cannot be done as it will adversely impact breathing and/or lead to poor aesthetic results. What is the true answer for grafts harvested from septum in primary rhinoplasty and placed adjacent to nasal bone causing wider more unattractive nose?

Andrew Miller, MD · Answer

Cartilage grafts that are simple onlay grafts can easily be removed during revision rhinoplasty. A graft that has been placed as an integral structure of the nose during the first surgery can be much more difficult to deal with. Be sure to see a surgeon that specializes in revision rhinoplasty for consultation, but if the cartilage is just sitting next to a nasal bone, it can usually be removed.

Tanveer Janjua, MD · Answer

Cartilage grafts usually survive a 100% and are not absorbed by the body. In that case they can be removed. However, if the body has absorbed the grafts then it becomes part of the scar tissue and cannot be removed. It is hard to determine this till you open the nose. RegardsDr J

Giancarlo Zuliani, MD · Answer

Hello and thanks for the question. All grafts can be removed during rhinoplasty and if these grafts have warped or moved, they should be removed and repositioned. This occurs during nearly every revision I perform. Not all grafts are structural or functional. Some are meant as camouflage and are meant to improve cosmesis. Structural grafts in rhinoplasty are akin to the framework of your house. You need certain sturdy beams and buttresses to keep the nose in the correct position and to provide strength in the areas which tend to collapse and cause functional disturbance after surgery. All in all, make sure you understand what needs to be done and make sure your doctor has performed enough revisions to know what problems can arise and how to correct these issues at the time of revision.

Michelle R. Yagoda, MD · Answer

Dear Pepper123,Technically, cartilage grafts can be removed.  But, they may be necessary for normal nasal function.  Removal of grafts may lead to nasal airway obstruction.  Replacement grafts may be placed that are sized and shaped differently, but a graft may ultimately be necessary for functionality of the nose.  Photos would be helpful!All the best,Dr. Michelle Yagoda

William Portuese, MD · Answer

Cartilage grafts can be removed at the time of secondary rhinoplasty, but there has to be a very good reason to remove them. Scar tissue and the contraction process can alter the healing process after the removal. Spreader grafts are not easy to remove, and may cause more damage during the removal process and can cause the upper lateral cartilages will collapse inward again.

Steven Wallach, MD · Answer

Some grafts can be removed without the sequela you describe, and some can not. Spreader grafts placed for function probably should not be removed because removal may cause breathing issues.

Ciro Adamo, PhD, MD · Answer

Cartilage grafts can be removed or trimmed, depending on the circumstances. Some grafts are placed for purely cosmetic reasons, others also have a functional, structural role. The grafts you are describing should be spreader grafts. Removing a spreader graft is normally not recommended, as it may create breathing and cosmetic problems.

Richard Mark Winters, MD · Answer

Revision rhinoplasty, particularly as it pertains to cases where multiple previous structural grafts have been place rivals severely destructive rhinoplasties as some of the most challenging cases in all of rhinoplasty and even plastic surgery for that matter... given careful dissection, previous grafts can usually be exposed, removed, modified, replaced or substituted altogetherwith extensive experience, proper judgment and meticulous surgical technique almost anything can be done in revision rhinoplasty... perhaps the only situation i can imagine not remediable by conventional means is the true 'rhinoplasty cripple' where the nose is irreversibly damaged to include insufficient skin cover.... this would require replacement of soft tissue from distant donor sites as part of a true reconstructive rhinoplastyyou need a thorough evaluation and a well thought out plan....you will need to gain the confidence that your surgeon has the skills and aesthetic judgment to fix your problem....do your homework and be sure that your revision rhinoplasty surgeon has:1. many years of rhinoplasty practice experience2. judgment and techniques that have evolved over time3. a practice focused on rhinoplasty 4. a willingness to do difficult, secondary and reconstructive cases5. an interest in teaching others how to evaluate and do rhinoplasty properly6. a willingness to share rhinoplasty resume, photos and patient experiences with prospective patientsgood luck...

David Reinstadler, MD · Answer

All cartilage grafts 'can' be removed with a revision surgery. I think the confusion lies in 'should the graft be removed' and 'would removing the graft impact the look and function of the nose'. Those are questions that will depend on each individual case. I would recommend visiting with some revision rhinoplasty surgeons and they can go over your case in more detail. Best of luck

Dennis Barek, MD (retired) · Answer

In general, the answer is yes, cartilage grafts can be modified or removed.Your description of a graft "placed adjacent to nasal bone causing wider....nose" is not precise enough to know if your are describing a spreader graft or an onlay graft. We also don't know if it is bilateral or not.Spreader grafts are mostly functional and onlays are cosmetic, to correct a depression.The operating surgeon would be the best source of what should or could be done.

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