Bump Under Rhinoplasty Skin Graft. Do I Need a Revision?

Question

A Graft from my Scalp Was Laid over my Nose After the Rhinoplasty.  A Section over my Bridge is Bumpy and Has Not Resorbed. The bump over my bridge is visible, and I can feel the edges of the graft with my fingers. I can shift the graft from side to side. The bump was prominent at 1 week post surgery. The surgeon used the needle method to break up the bump at 5 months post surgery. It has been 11 months since surgery, and the bump is still prominent. Do I need a revision?

Paul S. Nassif, MD · Answer

Hello,

	It would be best to speak with your surgeon regarding your options at this time. He/she knows the extent of your initial surgery and exactly what was performed. If after speaking with him/her you are still not satisfied, it would be a good idea to seek a consultation with a board certified revision rhinoplasty specialist, as he/she will be able to provide you with excellent advice. Thank you, and I hope this helps.

	Dr. Nassif

Sam Naficy, MD, FACS · Answer

It is extremely difficult to answer your questions without seeing your photos or examining you – it would be very helpful to post images showing your areas of concern - any issue(s) that are present at 11 months are not likely to resolve.

Philip Young, MD · Answer

11 months is a good amount of time for reabsorption to occur. But there is still healing left. Rhinoplasty can change years later but the  change is much less than compared to the first year. I think you would be a candidate for reshaping this part of your nose to decrease the bump in this area.

	Thanks for reading, Dr Youn

Vincent P. Marin, MD, FACS · Answer

Grafts are common in revision rhinoplasty and occasionally used to elevate a low bridge when there is a congenitally low dorsum. The risks associated with grafts is that they can resorb, warp or migrate. Most of these are palpable (can be felt) through the skin. It is unclear as to what type of graft that you have, but the most reliable type is your own cartilage. Bone or irradiated cartilage from a donor tend to have less consistent takes. Discuss this with your surgeon to determine the need. If the graft can only be felt and not seen, sometimes it is better to not risk another operation and leave well enough alone. Most revisions are only done until 1 year from the original surgery.

Best of luck

Vincent Marin, MD

San Diego Plastic Surgeon

Best of luck

Vincent Marin, MD

San Diego Plastic Surgeon

Richard W. Fleming, MD (retired) · Answer

I'm sorry, it is not clear exactly what was done at the time of your original rhinoplasty, but it sounds like a temporalis fascia graft was placed. I frequently use fascia because survival of this graft is excellent. You have been patient, waiting for 11 months - a revision to trim this excess will probably be necessary. It is a relatively simple procedure which can be done under local anesthesia.

Francis R. Palmer, III, MD (retired) · Answer

It sounds like the fascia graft is lumpy and bumpy as the internal scar process is changing its shape and position along the bridge of the nose.  For this reason, I do not use fascia or other tissue grafts and prefer silicone straight implants when the bridge requires additional height.  You have three options at this point, IMHO.

	
		Do nothing and of course nothing may change from this point.
	
		Wait and see if the fascia graft completely dissolves although it's probably best that you don't manipulate it, move or twist it as this may cause an inflammation or infection in the nasal tissues.
	
		Have a Revision Rhinoplasty and remove the partially dissolved fascia grfat and replace it, if needed, with a stable secured graft material.

Bump Under Rhinoplasty Skin Graft. Do I Need a Revision?

Answers (6)

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