Can you remove nasal tip cartilage after primary rhinoplasty? (photos)

Question

I'm one year post-op and the cartilage graft placed on my tip is visible and looks unnatural in my opinion. I have thin skin. The upper part of my nose has a slope so the tip appears prominent. My surgeon said he would not take it out in a revision and recommended camouflaging it with fascia. I now am skeptical of revision with him. Is it possible to remove this tip cartilage graft?

Nima Shemirani, MD · Answer

Hi @80smama. I would recommend a revision rhinoplasty with rib harvesting and removal of the tip graft. Best of luck to you!

Gianfranco Frojo, MD · Answer

This is a very poor rhinoplasty outcome. I am sorry that you are going through this. The nose is totally deviated and the tip is very bulky. I would recommend a complete revision with rib graft or cadaveric cartilage grafting.

Andrew Miller, MD · Answer

Based on your photos, you are a great candidate for revision rhinoplasty. The tip graft can be removed, or most likely refined to fit your nose better. Also it would be good to try to straighten it at the same time. Be sure to see a rhinoplasty expert for consultation.

Gurkan Kayabasoglu, MD · Answer

Hello. In my opinion, the problem with your nose is not only the visibility of the grafts in the tip area. You still have a curved nose, you have asymmetrical nostrils and you have a collapsed middle nasal region on your left side. Therefore, it is not only the problem in the tip area in your revision rhinoplasty. It is necessary to ensure that all these are solved. It is not a difficult thing to get this cartilage out of there, the important thing is to camouflage it so that your thin skin does not cause visibility again while reconstructing.You can get more detailed information about me, ask all questions about your case and sending your photos to my assistants at the number on my profile. You can also book an online consultation and discuss your problems with me. With all respect.

Zoran Potparic, MD · Answer

It would be hard to give you good advise without in person evaluation. Different options are available depending of your needs; trimming of cartilage graft edges, coverage with fascia graft, deprojection of the tip, etc. In person consultation, second opinion, with a board certified plastic surgeon with excellent reputation in rhinoplasty, is recommended. Good luck.

George Bitar, MD · Answer

A big part doing a secondary rhinoplasty is assessing the nose, breathing, thickness of the skin,  availability of septal cartilage after the first rhinoplasty was done, and blood supply.  You are understandably unhappy with your results, but the first thing I tell patients is it is best to go to the surgeon who did the first surgery.  He has assessed you and has a game plan for your revision surgery.  If you are not satisfied with his assessment or plan, then it is best to seek the expertise of a plastic surgeon who is well versed in secondary rhinoplasties.  In situations like yours, the secondary rhinoplasty has to very seriously take into consideration your breathing and make sure that nothing is done to compromise your breathing.  It is difficult to render an honest recommendation without physically examining your nose and feeling the thickness of skin and looking inside the nose to assess your airways and availability of septal cartilage.

Jeffrey Lisiecki, MD · Answer

Generally, yes it is possible to remove a tip graft. You should be seen in person by a rhinoplasty specialist to be examined, and sometimes in the absolute worst cases of thin skin this is not possible. Based on what I see in your photographs, you would then need your tip reconstructed with tip suturing and likely a septal extension graft to maintain projection and rotation, and grafts to support the alae and soft tissue triangles. You still may need some fascia or ADM to soften the tip if your skin is truly very thin. Best of luck!

David M. Kowalczyk, MD, MBA, FACS · Answer

Hi there! It is possible to remove the graft. Examples would be tip grafts made of septal or ear cartilage. In thin skin patients, these can be very challenging to make natural. A camouflage graft such as temporalis fascia is one of my go-to strategies at the time of surgery. This kind of tissue helps to smooth the tip and reduce the likelihood of irregularities. The issue with removing the cartilage entirely without any restructuring of the tip is instability, loss of projection, and change in shape. I hope this helps you!

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