Revision rhinoplasty possible without the use of grafts? (Photo)

Question

Hello. I had a rhinoplasty done about 9 years ago. One thing I am unhappy with is the tip. I feel like it's just a little to round and my nostrils are just a little to retracted up. I was wondering if lifting the columella, bringing back the infratip lobule ( I think that's what it's called) and shaving down the supratip lobule a bit will help fix this and possibly without the use of grafts? Thank you!

Ronald J. Edelson, MD · Answer

What you describe is exactly what needs to be done. You have two of the most common issues seen in revision rhinoplasty. A hump that was not lowered enough and a hanging  columella. Both can be corrected without the use of cartilage grafts

Scott Trimas, MD · Answer

It may or may not be possible to correct your concerns. That being said it depends upon whether or not the underlying tissue is strong enough or stable enough to make the changes you desires. The cartilage inside your nose is a very good source of graft material and is very durable over time should your surgeon need to use that to improve the areas of concern.

Jason Altman, MD · Answer

It is very common to use grafts in revision (and primary) rhinoplasty.  These grafts allow the surgeon to augment and support the existing cartilage structure of the nose.  They can add stability, strength and definition to the various areas of the nose.  Your own cartilage, often from the nasal septum, is the preferred material for these grafts. To achieve the look you desire, based on the images provided, it looks like you would need some work on the supratip region as well as alar rim grafts.  It is best to seek out a rhinoplasty expert and allow them to use their expertise to plan your surgery.  You do not want to limit what they can do by avoiding the use of grafts if they are necessary.   Cartilage grafts are safe and effective when used properly

John Layke, DO, FACS · Answer

Although you are thinking about the potential negatives regarding the use of grafts, cartilage grafts during a revision rhinoplasty are not only useful, but often necessary.  You have to imagine that a revision rhinoplasty is difficult for many reasons, but one of the most challenging issues is the formation of scar tissue.  Scarring forces can pull the cartilage framework of the nose in one direction or another, causing cartilage to warp and twist.  Therefore, placing cartilage grafts to augment the framework.  It's very similar to creating the A-frame in building a house.  The beams are correctly placed in order to create a very stable structure.  This is similar with the infrastructure to the nose.

Thomas Trevisani, MD · Answer

Without the benefit of in person exam and more detailed photos- it is impossible to give the best answer. However, based on the very limited profile picture- improvement -can -in my opinion be achieved -through the internal/closed technique. The decision for grafting must be reserved for following the physical exam, and the opinion of the experienced Board Certified PS

Harry V. Wright, MD · Answer

Your goals are achievable but why limit your surgeon by taking grafts off of the table? Structural and aesthetic grafting is a powerful technique employed by most, if not all, rhinoplasty and (especially) revision rhinoplasty specialists. Seek out consultations with 2-3 board-certified revision rhinoplasty specialists to see what your options are, and you should see examples of revision rhinoplasties performed with grafting that looks and functions naturally.Best wishes!  Harry V. Wright MD, Sarasota, Florida

Kailash Narasimhan, MD · Answer

I believe a revision rhinoplasty would be necessary to achieve the desired  changes.  If there is a lack of support in this region, especially in the columella and tip then some grafts may be needed.  Often the cartilage is borrowed from the septum, but also other areas.  Often proper support was not placed into these regions and structure is needed.  I think these changes are achievable but an in-person consultation would be necessary to discuss the procedure, recovery, and examine all aspects of the nose. Trust someone that has consist results with their rhinoplasty procedures.  Good luck!Sincerely,Kailash Narasimhan, MD

William Portuese, MD · Answer

Yes, in many instances a revision rhinoplasty involves further reduction in the size of the nose and does not require any grafting. Some patients who have had too much cartilage removed in the past, will require cartilage grafting. The nose is a three-dimensional structure, therefore a full set of photographs are going to be required in addition to an in-person examination, due to the fact that revision rhinoplasty is a very difficult procedure. From the one limited side profile photograph, it appears that there is the bulbous tip present and hanging columella which can be reduced.

Oleh Slupchynskyj, MD, FACS (retired) · Answer

Hi,If I understand the sequence of photos, it looks like you have an over-projected tip, slight pollybeak deformity and collumelar show. All of these issues can be corrected with a revision rhinoplasty. I would suggest an open approach to visualize all the tip cartilages directly. Best,Dr.S.

Revision rhinoplasty possible without the use of grafts? (Photo)

Answers (9)

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