Planning on 3rd Revision Rhinoplasty, In Your Opinion How Much Risk Involved with Cartilage Graft (photo)?

I'm planning on getting a third revision rhinoplasty but I want to make sure it is my last. My nostrils are a bit pinched and using cartilage from my rib to fill in the tip and cover the pinched nostril crevices has been a suggestion. I'm not real comfortable with the extensiveness of these kinds of techniques. In your opinions, how much risk is involved with cartilage grafts? What can and what is the likelihood of things going wrong? I don't want make yet another mistake. Thanks.

Doctor Answers 7

Tertiary Rhinoplasties & Cartilage Grafts

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A tertiary rhinoplasty is a complicated operation which should be done by one who has experience and expertise in secondary and tertiary rhinoplasty. Cartilage grafts are often used. If they are done they have to be camouflaged and the cartilage has to be shaped so there is no sharp edges as over time they can become palpable or visible.

Dallas Plastic Surgeon

Rhinoplasty revision

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Based on a limited photo of only the tip and not knowing specifically what was done at the previous 2 operations it is impossible to say what should be done now or if the proposed surgery is reasonable. Your concerns are valid but if each operation was/will be performed by a different surgeon without a perusal of previous operative reports you are bound to dig yourself deeper into a hole with each surgery. If you are not comfortable with a procedure or a surgeon you should not proceed until you are comfortable. With each additional surgery your body creates more scar tissue that makes it more difficult for the skin to wrap around a cartilage/bone framework whether it is native or grafted cartilage/bone. Proceed with extreme caution.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Third revision rhinoplasty and use of cartilage grafts

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With a third revision rhinoplasty there is going to be extensive scar tissue discovered at the time of the procedure.  Cartilage grafting is an acceptable from of treatment and it is always best to use nose cartilage first, then ear cartilage and then rib cartilage if the above two have been used already.  There is risk involved with using cartilage grafts, however, rib cartilage does tend to want to warp over time and can be problematic.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Planning on 3rd Revision Rhinoplasty, In Your Opinion How Much Risk Involved with Cartilage Graft

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 IMHO, your intuition serves you well.  Revision Rhinoplasty should not be aggressive or extensive, especially when previous Rhinoplasties have removed significant amounts of cartilage and bone.  A targeted approach is what I recommend keeping in mind the goal of all Rhinoplasty, which IMO, is to make the nose more naturally attractive.  I don't use or recommend rib grafts as they can absorb unevenly over the years and could require another Rhinoplasty to correct the resulting nasal deformities.  

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Rib cartilage in revision rhinoplasty

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I understand your concern, and it is good that you are proceeding with caution. The nasal septum is a great source of cartilage for reconstructing the nose, but your septum was probably already used if you had 2 prior rhinoplasty surgeries. Ear and rib cartilage are other sources of cartilage, and based on your photo I would recommend the use of rib cartilage. It is an excellent source of grafts, and sturdy enough to counteract the scarring forces present from your prior surgeries. One piece of rib cartilage can be carved into numerous grafts, as well as diced for use in a diced-cartilage-fascia graft if needed. The ear cartilage is good but it is softer, there is less of it available, and it may not provide the structure you need in your reconstruction. Each revision rhinoplasty surgeon has his or her own preferred techniques, and there is not one operation that should be applied to all patients. The most experiences surgeons are comfortable using a variety of techniques and choose the one that is best for you (not always using rib, or always using ear). There is no way to guarantee this will be your last operation, but I do think that reconstruction with rib cartilage will make that more likely than if ear is used. Do your research on your surgeon- check credentials (he or she should be a board certified Plastic Surgeon or Facial Plastic Surgeon), experienced with revision rhinoplasty, makes safety a priority (done in accredited center, and if using rib it’s recommended to stay in an aftercare facility one night), and before and after photos (make sure you like the after photos!). If you have any reservations,  consult with more than one surgeon rather than rushing into surgery.

Anita Patel, MD, FACS
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 12 reviews

Revision rhinoplasty for the overdone nose.

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In over 35 years of revision rhinoplasty, I have not had to use rib grafts. I use cartilage and soft tissue from your ears as well as your septum to do all you need.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Risk with Cartilage Grafts in Rhinoplasty Surgery

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I understand your apprehension about another surgery but your nose is very difficult even in the hands of an experienced revision specialist because your operation will be reconstructive. It will be necessary to do the grafts to to improve nasal support, function, and appearance. Unfortunately "extensive" techniques will be necessary.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.