Visible cartilage - can this be filed down without open surgery? (Photo)

Question

I’ve had two procedures to fix deviated septum I’ve had since childhood and that was made worse by injury. First was closed procedure but didn’t fix septum or breathing. For revision, Dr used ear cartilage. NSeptum is still deviated, breathing still bad & over time, the cartilage has become very visible & painful, especially since I wear glasses. It’s become very stressful. If septum can’t be corrected, can cartilage be filed down to smooth it out without open surgery?

Eric M. Joseph, MD · Answer

Many patients benefit from microdroplet Silikon-1000 injections to camouflage visible pieces of native cartilage or grafted cartilage after previous rhinoplasty surgery. Examination would be necessary to determine somebody's candidacy. I hope this helps. Sincerely, Dr Joseph

Jeffrey H. Spiegel, MD · Answer

It is possible that we can smooth that cartilage out right in the office. Additional photos will be very helpful for a more accurate determination.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. I don’t recommend having rasping performed under local anesthesia. This will usually make the nose look better for 1-2 months and then it will actually get much worse long-term afterwards, with contour irregularities developing. This is because the skin of the dorsum is extremely thin. A much better approach is to do a formal revision with rasping and placement of a dorsal onlay fascial graft to help smooth the dorsum.   Here is some general advice when considering a surgeon.

I highly recommend that my patients focus much more on real longterm before and after photographs rather than 3D imaging.   I encounter so many patients in my practice who see me for revision rhinoplasty who previously had surgery elsewhere who feel like they were mislead into surgery by surgeons who relied heavily on 3D imaging without adequate real before and after pictures to back it up.  Photoshop is easy but real surgery is very different.

I always recommend that you carefully evaluate your surgeon’s online before and after gallery on their website for both quality and quantity of results. Make sure that there are hundreds of real before and after pictures which demonstrate long-term follow up results. If your surgeon is posting mostly on table results without real long-term follow up results, that is usually a major red flag.  If a surgeon is posting mostly just splint removal day videos without longterm follow-up pictures, or all patient selfie’s without real longterm in-office formal pictures that can also be a red flag.   Long-term results are much more meaningful than on table results or 1 week post-op results. Selfie’s can also be fun to look at, but these can often have a filter and do not represent true longterm results because of this and are not as valuable as real longterm in-office before and after photographs on your surgeon’s website.

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

William Portuese, MD · Answer

A closed rhinoplasty approach can accomplish filing this area down with all the incisions placed on the inside of the nose. Much more information is going to be needed, such as a full set of facial and nasal photographs from all angles, and a copy of the operative report, since revision run plat is one of the most difficult procedures to perform correctly in the entire field of cosmetic surgery.

Visible cartilage - can this be filed down without open surgery? (Photo)

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