Do I need a graft for thick skin rhinoplasty? (Photos)

Do give up isotretinoine (Accutane) 1 month prior and 1 month after surgery, it is very toxic and interferes healing and anesthesia, this is of utmost importance, do-not-ta-ke-it.

You can choose to philosophies of rhinoplasty for your nose:
1. Classical, traditional or aka reduction rhinoplasty: this has been the first rhinoplasty applied in medical history and still stands at a good role for a small percentage of noses in which there is not an absolute requirement for modern rhinoplasty maneouvers (see next point) and the patient has very basic goals of improvement. This allows you to remove the hump, narrow the nose and reduce the tip, littler more. However, many issues in your nose would remain untouched: the boxy tip, the alar retraction, the columellar show, the lack of tip definition, etc.
2. Modern or structure rhinoplasty: This encompasses a large series of maneuvers, types of grafting (cartilage, fascia, etc), plications with sutures, augmentations, reductions, reshapings, etc, you can practically create a custom nose.

Needless to say, if the surgeon is reluctant to offer you a modern rhinoplasty this means he is acting within his frame of confidence and skills capacity; seek better opinions so that you can choose between both modalities of rhinoplasty.

RetinA cannot be utilized preoperatively and in the postoperative healing. After any surgery. Based on your photos, you appear to have medium thick skin, with a droopy nasal tip appearance, and a dorsal hump. Well performed rhinoplasty surgery may be considered for addressing these issues, and the decision to place a tip graft for support and additional tip definition is usually one that is made on the operating room table, when there is medium thick skin like yours. If your skin were thicker than it is, I would think that you would require a tip graft. I hope this is helpful! Sincerely, Dr Joseph

The cartilage graft is used to provide more tip definition. This is usually harvested by taking a portion of your septum.

Best Wishes,

Gary Horndeski, M.D.

Great questions and thank you for providing photos!
I think the question you are asking is whether you need a rib graft for your rhinoplasty. This is sometimes necessary to project the nasal tip in order to provide more definition to the tip itself, especially in patients with thicker skin. However, if you have enough native cartilage from your septum (ie no previous nasal surgery), this is sometimes enough to accomplish the same thing.
Regarding accutane before surgery, this is often based on surgeon's preference, but there is alot of evidence that this can help decrease skin thickness before surgery and can sometimes help achieve more definition. But again, this is not always 100% necessary.
Hope this helps and best of luck! Kyle Kimura, MD

Grafts are not necessary for the rhinoplasty unless we are trying to augment it like big change or very high tip etc. The cartilage that is removed from the tip will help and can be also used for any grafts that might be needed. Accutane should be discussed with your dermatologist before you decide.
Regards
Dr. Janjua

Hello and thank you for your question. Based on your photographs, you are a great candidate for rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. Cartilage grafts are extremely important for structural support and a good longterm result. 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