Hi. I had a nose surgery 6months ago. Immediately after surgery the nose was unstraight and the bride overly narrowed. I went to see my surgeon last week who says he needs to a revision with spreader graft. Do you think by looking at the pictures that's enough to do? Should he place uni or bilateral spreader graft? I also think the bone is unstraight? Also there is a "dip" in profile just beneath the bone. What can be done to fix that? Overall I'm very disappointed. Hope you can answer. Tx
Answer: Revision surgery--inverted V It appears from the photos you have what is called an inverted V deformity after primary rhinoplasty. This likely due from the cartilages along the sides of your nose (upper lateral cartilages) falling in. In these revision cases, ideally one would use septal cartilage to help re-support and suspend the upper lateral cartilages onto the septum. If septal cartilage is not sufficient then ear cartilage can be used. These are recommendations based on the photos you have submitted but it is best to see your surgeon or a surgeon in your area that specializes in revision rhinoplasty.
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Answer: Revision surgery--inverted V It appears from the photos you have what is called an inverted V deformity after primary rhinoplasty. This likely due from the cartilages along the sides of your nose (upper lateral cartilages) falling in. In these revision cases, ideally one would use septal cartilage to help re-support and suspend the upper lateral cartilages onto the septum. If septal cartilage is not sufficient then ear cartilage can be used. These are recommendations based on the photos you have submitted but it is best to see your surgeon or a surgeon in your area that specializes in revision rhinoplasty.
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Answer: Middle Nasal Vault Collapse It appears to me that you have an "inverted V deformity" with middle nasal vault collapse. This means that the cartilages in the middle third of your nose are collapsing off of the bridge and nasal bones downward into your nose. I do believe that cartilage grafting with spreader grafts is the mainstay of therapy for this problem. It's not just the actual grafting of the cartilage, but the act of resuspending the collapsed cartilages (along with the new spreader grafts) upward and outward back to the nasal dorsum. I agree that you also suffer from a "pollybeak" deformity from over-resection of the nasal bones and/or under-resection of the dorsal cartilages. You may need more cartilage placed onto the upper third of the nose, a bit more taken down from the middle third, or a combination of both (likely in your case). While full healing isn't reached until at least a year after your initial surgery, 6 months is a reasonable amount of time to begin considering the revision since the defects are obvious. I would be leery of injections into the nose since it is a temporary fix, the nasal skin may be very thin, and since this is a revision and the blood supply is compromised which could lead to an adverse outcome.
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Answer: Middle Nasal Vault Collapse It appears to me that you have an "inverted V deformity" with middle nasal vault collapse. This means that the cartilages in the middle third of your nose are collapsing off of the bridge and nasal bones downward into your nose. I do believe that cartilage grafting with spreader grafts is the mainstay of therapy for this problem. It's not just the actual grafting of the cartilage, but the act of resuspending the collapsed cartilages (along with the new spreader grafts) upward and outward back to the nasal dorsum. I agree that you also suffer from a "pollybeak" deformity from over-resection of the nasal bones and/or under-resection of the dorsal cartilages. You may need more cartilage placed onto the upper third of the nose, a bit more taken down from the middle third, or a combination of both (likely in your case). While full healing isn't reached until at least a year after your initial surgery, 6 months is a reasonable amount of time to begin considering the revision since the defects are obvious. I would be leery of injections into the nose since it is a temporary fix, the nasal skin may be very thin, and since this is a revision and the blood supply is compromised which could lead to an adverse outcome.
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January 21, 2015
Answer: Revision rhinoplasty for collapsed nose. You need to wait another three months for a revision of your collapsed nose. At that time you will need soft tissue and cartilage graft placed in the mid nose as well as spreader graphs possible removal of cartilage in the supratip. In addition you may need alarbatten graphs and further excision of cartilage in the tip which I will know when i examine your nose. You can look at various websites under revision rhinoplasty and choose a very experienced revision rhinoplasty surgeon who does natural looking noses. Meet with patients who had a revision and is like yours to determine who should do your nose. You will not need rib cartilage.
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January 21, 2015
Answer: Revision rhinoplasty for collapsed nose. You need to wait another three months for a revision of your collapsed nose. At that time you will need soft tissue and cartilage graft placed in the mid nose as well as spreader graphs possible removal of cartilage in the supratip. In addition you may need alarbatten graphs and further excision of cartilage in the tip which I will know when i examine your nose. You can look at various websites under revision rhinoplasty and choose a very experienced revision rhinoplasty surgeon who does natural looking noses. Meet with patients who had a revision and is like yours to determine who should do your nose. You will not need rib cartilage.
Helpful
January 21, 2015
Answer: Nasal Collapse and Revision Rhinoplasty In reviewing your pictures, you appear to have some issues with you nose. The middle part of the nose appears to be narrow and may has some collapse. From the profile, you have some concerns about a dip. It is difficult to give you specifics about what you need without clear communication of your goals and concerns and I would need to review the following:1) You preoperative pictures2) Your operative report--The document describing the techniques your surgeon used. 3) Detail physical exam of your nose to feel it strength and review the 3D structure of your noseGenerally speaking, you need to re-support the middle area of the nose where you have collapse. This is commonly resupported with spreader grafts. My gut would think you are going to need spreader grafts on both sides of your nose. The timing of a revision rhinoplasty is important. Before
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January 21, 2015
Answer: Nasal Collapse and Revision Rhinoplasty In reviewing your pictures, you appear to have some issues with you nose. The middle part of the nose appears to be narrow and may has some collapse. From the profile, you have some concerns about a dip. It is difficult to give you specifics about what you need without clear communication of your goals and concerns and I would need to review the following:1) You preoperative pictures2) Your operative report--The document describing the techniques your surgeon used. 3) Detail physical exam of your nose to feel it strength and review the 3D structure of your noseGenerally speaking, you need to re-support the middle area of the nose where you have collapse. This is commonly resupported with spreader grafts. My gut would think you are going to need spreader grafts on both sides of your nose. The timing of a revision rhinoplasty is important. Before
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January 20, 2015
Answer: I think spreader grafts will be necessary! Hello Lina85,Thanks for your question.When you are ready for your revision surgery, I think that spreader grafts will be necessary. You have an inverted V deformity indicating middle vault collapse and narrowing. Additionally it seems as if your tip has rotated up a bit to much, shortening your nose projection. In these situations, I am a big fan of bilateral extended spreader grafts. They help widen and support the narrowed middle vault, and they can help rotate the tip back down into a better position. As far as bone asymmetries are concerned, most people have them before surgery because of craniofacial asymmetries around the nose. Asymmetric osteotomies can be used to help get the symmetry closer but not perfect.I would recommend that you speak with a revision rhinoplasty specialist in your area to get a second opinion about maneuvers that would be useful in your situation.Good luck,Dr. Shah
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January 20, 2015
Answer: I think spreader grafts will be necessary! Hello Lina85,Thanks for your question.When you are ready for your revision surgery, I think that spreader grafts will be necessary. You have an inverted V deformity indicating middle vault collapse and narrowing. Additionally it seems as if your tip has rotated up a bit to much, shortening your nose projection. In these situations, I am a big fan of bilateral extended spreader grafts. They help widen and support the narrowed middle vault, and they can help rotate the tip back down into a better position. As far as bone asymmetries are concerned, most people have them before surgery because of craniofacial asymmetries around the nose. Asymmetric osteotomies can be used to help get the symmetry closer but not perfect.I would recommend that you speak with a revision rhinoplasty specialist in your area to get a second opinion about maneuvers that would be useful in your situation.Good luck,Dr. Shah
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