Dorsal Augmentation: My surgeon hacked off my bridge.

Question

Please let me know which grafting material would be best to restore my preoperative height. Please look at my before and after and provide feedback. Thanks.

Alejandro Nogueira, MD · Answer

The dorsal shave was not an atrocity but I undersand your unhappiness; the amount of missing dorsum is not massive and is mainly concentrated on the radix, in a decrease to the tip.
The best plan is:
-dorsal onlay graft en bloc to cover the full length of the dorsum + a mini island of graft underneath the former at its upper end to match the radix location, so that the graft fills up with accuracy the shaven dorsum: a lot at the radiz and moderately the rest of the dorsal length
-in light of your very thin skin I strongly recommend assurance of invisibility by means of temporal (superficial, with the collagen in millefeuille layers) fascia graftIf you wish other restoration the tip could be derotated and, if total reversal is wished a gentle doral hump could be built.

P. Daniel Ward, MD · Answer

There are a variety of options available to augment the radix. Septal cartilage is preferable if it is available.  However, since you had previous rhinoplasty, you may not have any septal cartilage left.  In that case, rib cartilage or ear cartilage are options. For most of the revision rhinoplasties that I perform, I prefer rib cartilage, because it is more plentiful and you can also use the perichondrium of the rib to help obscure any rough edges.

Sergio Pasquale Maggi, MD, FACS · Answer

Hello,Thank you for your question, and images.  It appears from your picture that the contour is acceptable, not excessive. However with a full set of full face images I could better tell.  As far as correction, this is commonly done with the placement of a graft.  The type of graft used is best left for your surgeon to address; much depending on the amount of correction to obtain, as well as his/her experience.Best,Sergio Maggi, MD, FACSdrmaggi.com

Myriam Loyo, MD · Answer

Hi there, I am having a hard time telling the exact shape of the bridge in the after photo. It looks to me like there is a slight depression where the bones end and the cartilage starts, am I correct? If it is, I do think it is possible to augment the depressed spot and give you a straight bridge. If the bridge is currently straight, and you want to get the small bump back I think that would very hard. Making the exact shape of the bump is likely not possible.As far as which material to use, it really depends on what was done and what cartilage is available. On first glance, I would hope remaining septal cartilage and possible auricular cartilage would be enough. If the available cartilage is not sufficient rib cartilage is a good option. Sometimes I recommend using temporalis fascia to cover the bridge and prevent irregularities from showing from under the skin.Hope this helps. Good luck

David Alessi, MD - Account Suspended · Answer

There are various options.  Much of this depends on what your surgeon is most comfortable with and your in-office exam.  I suspect a combination of cartilage from the septum or ear with fascia from behind the ear will suffice.  I doubt that a rib graft will be needed.  Best wishes.

Richard W. Fleming, MD (retired) · Answer

You will get a variety of response to your question but I have used diced cartilage from the septum or ear with a fascia wrap for many years to augment a bridge like yours. Survival is excellent and rough edges from a cartilage strip graft is avoided.

Dorsal Augmentation: My surgeon hacked off my bridge.

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