Will Gore-Tex removal leave my nose flat? (Photo)

Question

i had rhinoplasty 6 months ago. i have uneven bridge and doctor said he broke my bridge and inserted goretex when it was not necessary. i want it out. will it leave my nose flat since he said he broke it? i also had tip plasty using septal and ear catillage. i now have a big and bulbous nose instead of narrow tip. i can wait for the tip for swelling to go down but i am concerned with the bridge.

Aaron Stone, MD · Answer

It sounds like your current complaints are an uneven bridge and a wide tip. Alar base reduction can narrow the tip and it does not look like that was done at your first surgery. I think bridge augmentation was indicated and doing so improved the appearance. Your posted after photos do not clearly show the uneven bridge which could be due to bunching or folding of the goretex or an inappropriately shaped implant. The nose breaking you describe is the infracture which virtually every surgeon would have performed and I think was also indicated.
	
	That leaves what should you do to improve things and when should you do it/them. The closer to a year that you wait for revision surgery the better off you will be. The what could be implant replacement, alar base reduction and/or nostril rim thinning, colummellar strut etc.. The what depends on what look you want. You also need to discuss things in greater depth with your surgeon because some of what you feel was not necessary in the first surgery (infracture, bridge augmentation) is what most surgeons would have done in the same case scenario.
	
	I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.
	
	My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Anita Patel, MD, FACS · Answer

It is possible to remove the Goretex from your nose. To maintain the dorsal height or bridge, I would recommend replacing it with your own tissue in the form of a DCF (diced cartilage and fascia) graft. This can be done using septal or ear or rib cartilage. During a revision rhinoplasty sometimes the existing grafts can be re-purposed to make new grafts, but you may need rib cartilage if you don't have septum or ear cartilage left to work with. You can also use grafts carved from rib cartilage to support the tip and provide framework to give a more defined tip. If you have thick sebaceous skin at the tip, you cannot always see the fine detail of the structure below. (Another way to think of this is - imagine thin skin as a bedsheet, and thick skin as a down comforter. No matter what you put underneath, the structure will be more evident under the sheet than the down comforter.) So you can make the structure beautifully, and the extent to which you can see this depends on your skin once it has healed. Also, sometimes Goretex can get imbedded into the skin, and damage it, so taking it out can be tricky. The DCF graft can help make this look better too. Only seek out board certified plastic or facial plastic surgeons with experience doing revision rhinoplasty for this type of procedure. I think it is possible to remove your Goretex and get a nice result, but only in the right hands, so do your research.

Toby Mayer, MD · Answer

Gore-Tex can be removed at any time but you will probably have a depression where the cortex has been removed. This can be replaced with your own cartilage from the septum or the ear the tip needs to be revised after six months more.

Stewart Wang, MD, FACS · Answer

I am sorry to hear about your experiences. It looks like you had a complicated surgical experience. Since you are about 6 months postop, it's reasonable to discuss your result with your surgeon. If your nasal bone was broken and currently supported with Goretex graft, removal of the Goretex graft may unmask a more depressed bridge. I can't make specific recommendation without a face to face evaluation. If you are not sure about your original surgeon then seek a reputable surgeon for second opinion.

	Best Wishes,

Jeffrey Zwiren, MD · Answer

If gortex was used to augment your dorsum then you will see a drop in your dorsal nasal profile.  It is unlikely that the gortex is causing any widening of the nasal tip.  You do have a wide alar base with a nostril flare.  This can be improved with a resection of the flare.

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