I need a 3rd revision. Should I have a 4th rhinoplasty for warped rib cartilage graft & droopy tip? (Photos)

Based on the photos that you provided, I definitely think that your nose has a high probability of getting a good result from a revision. I highly recommend that you discuss your concerns with your current surgeon and, if your current surgeon does not perform a lot of revisions but does not feel comfortable performing her vision surgery, seek out an experienced rhinoplasty surgeon.

An in person consultation would be necessary to evaluate the quality of your skin but from the photos, you nose does not look too scarred.  Replacing the rib graft which is a single piece with finely diced rib cartilage wrapped in fascia would eliminate the problem of warping, and it should also be possible to elevate the tip and get more projection.  The fascia would be taken from the temple region (scar in hair bearing skin and not visible, but you would almost certainly need some additional cartilage from either the ear or the rib again. It is important to understand  the inability to guarantee a successful outcome from any procedure, but it is highly likely another revision by an experienced revision rhinoplasty surgeon would be successful.  I would avoid foreign materials or cadaver cartilage.  They are appealingly easier, but with less predictable long term outcomes.

Hi and sorry for your difficult time with your rhinoplasties.  I would remove the warped rib graft and place a Surgiform ePTFE implant (goretex).  This implant doesn't warp and is very well tolerated.  You may also need some tip grafting with septal or ear cartilage to give support to the tip.  These things are very doable and common in my practice as I do about 40% revision rhinoplasties.  I do about 250 rhinoplasties each year.  

With each nasal surgery, the procedure becomes more difficult, less predictable, and more prone to complications. Autologous rib grafts have the unfortunate tendency to warp. When faced with a situation like this, focusing on the good parts of your nose will help you better define the parts that really need to be considered for the next procedure. I would consider preserving the autologous rib graft and disguising the warped appearance with injectables or further grafting. The addition of a small tip graft can solve your drooping tip. It is important in these circumstances to narrow the focus and the scope of subsequent procedures to achieve the best result, possible, while minimizing risk. Consult with a board-certified plastic surgeon who specialies in revision rhinoplasty.  
All the best!
Craig A. Foster, MD, DDS, FACS

NYU Trained in Plastic Surgery

Double-Board Certifications

Hi,Yes you can get a better result. I would do this as open revision rhinoplasty and you may need ear cartilage graft. But if you already have rib cartilage, it may just need to reposition the graft.Best,Dr.S.