I Am Needing 4th Revision Rhinoplasty for a Retracted Columella and a Anterior Septal Extension Graft? (photo)

As the Other 3 Reabsorb? My last revision rhinoplasty in 2007 I was 44 at the time. The doctor told me I was too old to use my own Rib cartilage ? My anterior septum and the columella has reabsorbed and retracted, they used irridaited cartilage all three times. I was given the option of Medpor? I hear that's risky I was given the option of my own Rib, which I think is good Which is better. My columella has retracted, is thin and so is the front part of my septum about 1 cm in length can this be fixed?

Doctor Answers 3

4th Revision Rhinoplasty questions.

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I have performed Revision Rhinoplasty for 25 years and IMHO, after 4 Rhinoplasties or perhaps it's five including the primary case, you are looking at diminishing aesthetic returns with further Revision Rhinoplasty.  As you stated, irradiated or banked cartilage does dissolve as does your own rib cartilage and/or bone IMO.  Blood supply is a matter of examination in person combined with the degree of warmth (an indication of blood supply) of the nasal skin.  Ear cartilage (assuming there's no further septal cartilage to be harvested at this point) would be the longest lasting, most stable grafting material at this point.  Hope this helps.

Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Rib Cartilage Graft??

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 You are absolutely correct. Rib cartilage will most likely give you the best opportunity for a long term fix. Anticipate, the donor site will be  bit uncomfortable for while but, if it corrects your concern then, it is a win. Best,


Gary R Culbertson, MD, FACS

Gary R. Culbertson, MD
Columbia Plastic Surgeon

Septal extension graft to correct retracted columella

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Your age certainly does not make you too old to be an excellent candidate for revision with rib cartilage harvest.  Rib cartilage harvest tends to be a bit more challenging in older individuals, but still straightforward for surgeons experienced in rib cartilage harvest.

Revision with a septal extension graft fashioned from harvested rib cartilage, and possibly PDS plate, should provide you with a durable result.  


Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 64 reviews

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