Rhinoplasty graft is extremely crooked and flat again, will a cartilage graft (from my own body) solve the problem? (Photos)

Dear aprime,It's tough to see exactly where your nose is crooked from the pictures you postedBone grafts can shift, and not commonly performed as much as they used toIf it was to build up your bridge, then we have other options like a diced cartilage graft The crooked nose may also be due to a high septal deviation that is unrecognized (usually the lower third of the nose is crooked in this scenario)Please see 2-3 revision rhinoplasty specialists to get an idea of what needs to be done. These are not simple surgeries and require special attentionBestDr Nima

Third revision rhinoplasty?  A determination and not be made from the photos submitted. You need a full examination and a copy of the previous operative report to determine how successful they revision would be. See  several very experienced revision rhinoplasty surgeons who can show you  his results in many patients with noses like yours that he has done. . 

All grafts can change with time but bone grafts in particular resort with time.  Cartilage grafts can warp but rarely resort.  The chances are excellent you would get a long term fix with a revision using your own cartilage.

Thank you for your question. I suggest that you move forward and consult with a board certified facial plastic surgeon regarding your healing process, and achieving your desired aesthetic result.
Best wishes,

Revision rhinoplasty is a complex procedure as you have come to experience. It's hard to say for sure based on these photos what the best solution is. It's best to consult a rhinoplasty specialist to discuss the details and pros and cons of everything. 

You have to be very careful in looking into yet another revision rhinoplasty. I'm assuming your area of concern is just above your tip. At least, with the photos you have provided, there seems to be a sharp angle at the supratip causing a scooped look. It's very hard to tell if the graft is shifted from left to right. We know that bone or rib grafts may sometimes resorb and lead to loss of volume where they are placed. I would suggest being very cautious about another rhinoplasty. Instead, you may want to try some restylane (liquid rhinoplasty) to address the areas of contour irregularity. But I will echo what others have said, you need a thorough in-office consultation. Nothing less will do.

 A full set of facial photographs from all angles and usually an in-person examination are going to be required to make a determination about how best to proceed with a very complicated procedure. Since this will be your fourth rhinoplasty, the predictability of the healing process is less than your primary rhinoplasty. Best to obtain operative reports of what was accomplished in three previous procedures so that your next surgeon may have some understanding of what was accomplished previously. It's also important to know how much cartilage is left over on the inside of the nose for potential grafting purposes.

A couple of clarifications needed for a response to your question. First, you need to send a straight shot view of your face and nose to appreciate how and where your graft may have migrated or curved. Second, we don't use bone grafts ! Do you have a rib cartilage (costal) graft? Today, we use costal cartilage that is diced and placed in a wrap which does not migrate or warp ! This graft can actually be purchased for little money thus saving the need to take your rib . 

Dear Aprime, The angles that your attached photographs are taken make it difficult to see your concerns. I would suggest requesting your operative reports and original photographs from your surgeon. Seek consultations with some expert revision rhinoplasty surgeons to determine what the best course of action is. Best regards, Michael V. Elam, M.D.