Is it possible to add cartilage to my radix in a revision rhinoplasty? How difficult would this be?

Question

I had 3 previous rhinoplasties. I'm happy with my nose but wish my radix was filled out more to create a slope to my nose. I got filler there a year ago and love the results but I want a permanent solution. Is it possible with my history of 3 previous rhinoplasties to use cartilage to augment my radix? Would this still be a full open rhinoplasty surgery and take the same recovery as my previous surgeries? I was swollen for a couple years after my surgeries. Is it risky given my history? My last doctor said I had a lot of scar tissue in my tip. Would this be too difficult to do or is it fairly easy?

Mark K. Markarian, MD, MSPH, FACS · Answer

Hello and thank you for your question.

Although photographs and an exam in person is ideal, from your story alone, I will tell you that yes, it is a possible to augment the radix for a permanent solution not achieved with fillers.  With that said, oftentimes filler may not dissolve completely and remnants can remain permanently.  My surgical solution to augment the radix involves the careful placement of mastoid fascia and diced cartilage along your dorsum instead of a rigid cartilage graft (or implant) that may be palpable, prominent, and potentially "unnatural" in appearance.

Would this be an open rhinoplasty?  I only perform open rhinoplasties -- this offers me the best exposure to your "osseo-cartilaginous framework" i.e. the bones and cartilages of your nose.

Would this be the same recovery as prior rhinoplasties?  Every rhinoplasty (or surgical intervention) increases scarring and can therefore potentially add to the recovery time.  However, if bones are not broken to narrow the nose, this can reduce the recovery time.  Furthermore, I perform steroid injections frequently during your recovery period which not only speeds up the resolution of your swelling, but also reduces the scarring under your skin -- both factors help your recovery overall.

Is the surgery risky?  Every additional rhinoplasty adds risk due to the potential disruption of blood supply to the skin.  However, if your nasal skin is not too thin, you're a healthy non-smoker, and at least a year has passed since your last surgery, the overall surgery risk is significantly reduced.

Is excision of scar tissue easy to do?  In my opinion, rhinoplasty is the most difficult surgery in aesthetic plastic surgery.  However, scar excision, especially from the nasal tip, is something I do routinely in my practice and carries minimal risk in my experience.

Due to your prior rhinoplasties, the cartilage in your septum was likely harvested and so you will likely require MTF (Musculoskeletal Transplant Foundation) aka cadaver cartilage to perform this revision rhinoplasty.  Also note that if your septum is deviated and you have breathing difficulty, a revision septoplasty may benefit you as well, which can be covered by health insurance.

The next step for you is to pursue the right aesthetic plastic surgeon for your revision rhinoplasty.  In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course.  Also, be sure to see plenty of before-and-after pictures in women who have a similar nose appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome.

After seeking out a board-certified plastic surgeon who specializes in aesthetic plastic surgery, I think the most important component of the consultation is to establish a good connection with your plastic surgeon.  It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For more information on rhinoplasty, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. The best way to augment the radix is with diced cartilage wrapped in fascia. This is the safest way to do this with the least risk of malposition. 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

Tanveer Janjua, MD · Answer

A radix graft is not difficult and the swelling in tip will not be bad as the tip can be spared and the graft can be placed endo-nasally. However if an open approach is used then swelling in the tip can last a long time.
Regards
Dr. Janjua

Sean Fisher, MD · Answer

Every subsequent revision patients undergo in rhinoplasty surgery mean a longer recovery and increase risk of complications. having had 3 prior surgeries not preclude you from a subsequent revision but I would strongly recommend consulting with a surgeon who has advanced training in rhinoplasty surgery. If you are otherwise pleased with the results, it may be possible to place radix graft while maintaining the structure of your nose otherwise. However, to offer a full assessment of what is possible you should be seen for an examination. 
Sean Fisher MD Aesthetic Plastic SurgeonSeattle, WA

Is it possible to add cartilage to my radix in a revision rhinoplasty? How difficult would this be?

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Is it possible to add cartilage to my radix in a revision rhinoplasty? How difficult would this be?

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Answer: Revision rhinoplasty

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Everything you need to know about Revision Rhinoplasty

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