Is it possible to have an open revision rhinoplasty done? Does this increase my risk of necrosis? (photo)

Question

Hello everyone I had an open rhinoplasty 11 years ago and I have an L shape Silicon , I would like to change my implant to Gore tex and ear cartilage for the tip of my nose . My question is is it ok to undergo open rhinoplasty again for revision ? I’m scared that I’m going to have a necrosis if I will do have open surgery again . Thank you for your time and answer .

Donald B. Yoo, MD, FACS · Answer

DCF (Diced cartilage fascia) provides permanent results without the risk of warping or resorption compared to en bloc rib cartilage/ cadaver rib cartilage, and with a much lower rate of migration, infection, or extrusion than synthetic grafts (i.e. Goretex, silicone). With a rhinoplasty surgeon experienced in this open rhinoplasty technique, diced cartilage wrapped in fascia is a consistent, reliable, long-lasting technique for creating dorsal augmentation with excellent results. While there are a variety of approaches and techniques employed by various surgeons, it is up to you to do your due diligence to find a rhinoplasty specialist in order to achieve the results that you described. Good luck! @drdonyoo

Eric M. Joseph, MD · Answer

We use nearly exclusively an open approach for revision rhinoplasty, unless there is no tip work to be performed. I suspect your surgeon will choose an open approach for the best precision reconstructing your tip and bridge. Good luck! Dr Joseph

Barry M. Weintraub, MD, FACS · Answer

The answer depends on the level of skill of your surgeon. No question that having had a prior rhinoplasty with a silicone implant can make matters a bit tricky, but because the blood supply to the nose is robust, you are likely to do well with a revision if your surgeon is experienced. The choice of materials for revision surgery has improved in recent years:  instead of Gortex (which is synthetic and can extrude) and/or ear cartilage, I have found that deantigenized cartilage allows for custom carving, and therefore allows for sculpting it to produce a more favorable appearance. When a patient's septum is absent, as I believe it probably is in your case, deantigenized cartilage allows for surgeons like myself to give you a most precise and untampered-with result. Deantigenized cartilage is now state-of-the-art in revision rhinoplasty when autologous septum is no longer available. The goal of any rhinoplasty surgery -- whether revision or primary -- is longevity. In other words, a stellar result that continues to look good for decades, and a result that exhibits a keen eye towards natural, understated beauty.

David M. Kowalczyk, MD, MBA, FACS · Answer

Good Afternoon! The risk of necrosis with revision rhinoplasty comes with any compromise to the nasal skin - typically, at the tip. When too much tension is placed by an implant, for example, it may decrease the blood supply and make future procedures more risky. There are ways to combat this if there is question regarding the blood supply such as hyperbaric oxygen, nanofat injections, and camouflage grafts over the tip with temporalis fascia. These techniques help to make the skin more robust. Removal of the silicone may be a good idea, but GoreTex can cause problems as well. Maybe consider using your own rib as the results can be long-lasting and natural. Best of luck!

Is it possible to have an open revision rhinoplasty done? Does this increase my risk of necrosis? (photo)

Answers (4)

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