Can Lateral Crural & Columellar Struts Ever Be Removed?

Dear patient,

You need to visit an expert revision rhinoplasty surgeon in your area to assess your nose. An experienced rhinoplasty surgeon will not find it difficult to remove previously placed nasal grafts and deal with complex noses like yours. Five years has pasted since your primary surgery and you’re not still happy with the results, therefore a revision rhinoplasty is indicated. If you need name of an exert rhinoplasty surgeon in your area, please let me know. I would be happy to recommend you one.

Good luck. Dr. Kevin Sadati

Your previously placed grafts can be removed though whether this will fix the problems you describe is hard to say without seeing your nose. Asymmetry and alar retraction can occur after rhinoplasty and can be related to many different causes. Revision rhinoplasty can address these concerns, though it is important to maintain your nasal support afterward.

Columella struts can simply be removed by exploring the tip, undoing any sutures that may be present, and removing the implant.  We have used several grafts during revision rhinoplasty surgeries.  Lateral crural grafts can also be removed when needed.

A seasoned revision rhinoplasty surgeon is rarely scared of previous graft placement; almost any graft can be removed, but with caution and meticulous dissection so as not to cause injury to other structures. Most grafts do not feel uncomfortable, but may look too full or visible. Alar retraction is rarely caused by the placement of a graft, but is more likely due to too much resection of the cephalic margin of the lower lateral cartilages or the vestibular skin underneath them, or by filling out the columella so much that the alae look retracted. Your tip asymmetry could be secondary to many possibilities, such as healing contraction, a migrated graft, or bossa formation. Most columellar struts go between the medial crura and should not be causing a kissing problem unless they shift. Sounds like your personal conclusions might be best analyzed by a visit or two to specialists in revision rhinoplasty; it may be that removal of the grafts alone will not solve your concerns. 

Experienced surgeons are not 'scared' of the columellar and lateral crural struts. However, be careful to select a good revision surgeon. If you do have weak cartilages you could have some nasal collapse if you remove all the support provided by the cartilage grafts. Your surgeon will need to determine if your cartilages are weak, and if the grafts need to be reduced or repositioned to correct the tip asymmetry, alar retraction, and the stiff columella.

 I have performed Rhinoplasty and Revision Rhinoplasty for over 20 years and IMHO, yes these grafts can be removed and the nasal tip made more symmetric but exactly how thata's going to be done will be determined by photos showing the current state of your nose.  Views from the front, both sides and base views are the best.  Alar retraction, IMHO, it best addressed as a separate local procedure (typically done at 6-9 months post Revision Rhinoplasty) using a composite skin and cartilage ear graft to lower one or both nostrils.  You really should have consultations with experienced Revision Rhinoplasty surgeons before having another Rhinoplasty, IMO.

Invariably secondary rhinoplasty involves modification of the supporting structures. Modification ranges from removal to repositioning to a combination of the above.