Temporial fascia or mastoid to cover tip grafts?

Question

What fascia is better for a revsion needed ro cover grafts in the tip poking out . Temporial fascia or mastoid ? What is the difference and why would one be better than the other? Can you see it under your skin as you heal ? My suregon suggested temporial and anothet mentioned mastoid .

Eric M. Joseph, MD · Answer

Your nasal tip cartilages are visible because you appear to have very thin nasal skin. Since your skin is thin, and since your tip cartilage appears white through the skin. Rather than undergoing another operation, you may wish to consider permanent non-surgical nose job treatments to add soft tissue filler precisely to the areas where your tip cartilage is visible. Silikon-1000 injections are excellent for removing many of the Stigmata associated with previous nasal surgery in those patients with thin nasal skin. I hope this helps! Sincerely, Dr Joseph

Steven M. Denenberg, MD · Answer

I personally don't cover prominent tip grafts with fascia. It makes sense mechanically, but you're putting something into the nose, and it has the opportunity to make the tip too big or too wide, or to bunch up, or to not be effective.
To me, it's better to evaluate the tip for trimming the prominent grafts so they don't stand out. And I'd have to see what the nose looks like, to see whether I thought the tip deserved to move somewhere, too. For example, if the grafts make the tip look too forward-projecting, then trimming the grafts (or who knows, removing them?) might be the thing to do. Also, if your ideal nose were, for example, a shorter nose, with the tip higher, that would affect the decision of what to do with the tip and its grafts.

Mark K. Markarian, MD, MSPH, FACS · Answer

Hello and thank you for your question.  My short answer to your question is mastoid fascia -- the surgical incision is behind your ear, without any significant complication, whereas a temporal fascia harvest (in your temple/side of your head) can sometimes be associated with hair loss/disruption and a potentially visible scar, depending on the haircut/hairstyle...

The long answer involves the following:

First off, it's important to recognize that complications happen to ALL surgeons, and any surgeon that does not have complications or any suboptimal results is either not operating enough or lying.

With that said, although an exam in person is ideal, from your photograph alone, I agree that your tip cartilage is slightly off and prominent creating some asymmetry.  If you are at least 1 year out from your rhinoplasty, the skin has likely healed and is healthy enough to undergo a surgical intervention -- as such, I would recommend a revision tip rhinoplasty to (1) modify your tip cartilage (with trimming, stitching or grafting) and (2) placement of a mastoid fascia tip graft between the reconstructed tip complex and your skin to (a) not just reduce cartilage prominence (tenting up of the nasal tip skin by cartilage), but (b) to also create a feminine tip-defining point (subtle natural upturn).  Since I don't have a profile view, I'm unsure if your ala (nostril rims) are notched, of if your tip is droopy -- other cartilage grafts and tip maneuvers would be necessary if this was the case.

Due to your prior rhinoplasty, the cartilage in your septum was likely harvested and so you will likely require MTF (Musculoskeletal Transplant Foundation) aka cadaver cartilage to perform this revision rhinoplasty.  Also note that if your septum is deviated and you have breathing difficulty, a revision septoplasty may benefit you as well, which can be covered by health insurance.

The next step for you is to pursue the right aesthetic plastic surgeon for your revision rhinoplasty.  In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course.  Also, be sure to see plenty of before-and-after pictures in women who have a similar nose appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome.

After seeking out a board-certified plastic surgeon who specializes in aesthetic plastic surgery, I think the most important component of the consultation is to establish a good connection with your plastic surgeon.  It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For more information on rhinoplasty, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon

Jeffrey H. Spiegel, MD · Answer

Any fascia will work - the source is not the key. More important is to consider reshaping or removing the tip grafts. These grafts were very much the mode for a while but are somewhat less in style now because of results like yours. I'l reshape or remove the graft and consider fascia, but the shaping is more important.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Both mastoid fascia and temporalis fascia can be used as a tip graft during during your revision to help smooth the contour. For my patients, I find mastoid fascia a better option as it does not have the donor site complications of temporal fascia.. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

William Portuese, MD · Answer

Any type of fascia works for this issue, but just know that your tip will be wider when adding fascia to it for camouflage purposes.

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