Follow-up question: Permanent solution to camouflage visible dorsal rib graft?

Question

I posted a question about my visible rib graft earlier but I would like some opinions on permanent solutions. I had my rhinoplasty many years ago and have been happy with the results however the rib graft has started to become visible. Are there any permanent ways to hide the graft? Could a layer of fascia be added to the side of the bridge? Or could fat be injected into the nose?

Lucian Ion, FRCS · Answer

The surgical solution would depend on whether you would like the bridge to appear wider more or less the same size.
Adding materials like fascia or biological implants to the sides of the nose could potentially be carried out as a small intervention. The approach would widen slightly the bridge and carries some risks of irregularities in positioning the onlay grafts on the side walls.

An alternative would be to use a full exposure of the nasal bridge and add an onlay of fascia covering the dorsum and the sides. Without narrowing slightly the graft, the contours would be a little wider. In addition, the fascia placed on top of the bridge which raise slightly the projection and may need to be positioned in continuity with the tip to maintain the contour of the profile.

Fat transfer procedures have variable longevity and are probably the less reliable alternative. Similarly, injection of diced cartilage has been tried but under thin skin is likely to show irregularities.

Samuel Mattine, MBChB, MRCS, FRCS · Answer

I would personally advise you against filler injections as they are temporary and you will need a relatively larger volume to cover those edges. Consider fat grafting as an alternative or more appropriately in my opinion a simple revision to augment the dorsum with fascia or small fractionated cartilage particles wrapped in a fascia.

Bradford A. Bader, MD · Answer

This is essentially a volume mismatch between your dorsum and the nasal sidewalls. It can be improved by either reducing volume of the dorsum (ie, shaving down the edges of the graft) or by adding volume to the sidewalls (ie, fillers, fat, fascia). Visit with your original surgeon if possible to see about some solutions.

Follow-up question: Permanent solution to camouflage visible dorsal rib graft?

Answers (3)

More Revision Rhinoplasty Questions

Can an alar-base reduction be reversed or improved (0.4 inches nostril reduction)? Unhappy with cosmetic and functional outcome.

Can a fascia lata graft be used instead for rhinoplasty revision?

Is there a limit to how much nasal bones can narrow a nose?

What can be done with these deep lines on one side of my nose. It is very upsetting to me and my nose is bumpy looking (Photo)

My doctor has completely ruined my nose, what can I do to fix this? It's short, fat pig like and the tip is turned up. (photos)

WE SEND PRETTY
EMAILS