Visibly lumpy bridge after asian rhinoplasty - Can ear cartilage grafts (asian rhinoplasty) be removed?

Question

Had an asian rhinoplasty 9 months ago, and had ear cartilage grafts put in the bridge (radix area). After swelling went away, the graft is very visible and you can clearly see and feel the edges. From a distance, it looks like a bump. No fascia was used to wrap the graft, an intact (not crushed/diced) piece approx 4-5 mm long. Do I have to wait up to a year since my surgery to get a revision, or is this something that can be fixed now in a simple procedure? Could the graft resorb on its own?

Donald B. Yoo, MD, FACS · Answer

Removing an onlay graft on your bridge can safely be performed at any point after surgery (and especially at 9 months post-op this will not create any increased risk).  The ear cartilage graft is unlikely to resorb on its own.  The question is whether or not you will be satisfied with the appearance of your bridge and radix without anything to augment that area.One of the great strengths of the diced cartilage fascia (DCF) technique for radix and dorsal augmentation is that when performed well it creates the smoothest, most natural contour.  At 9 months post-op, you could safely undergo a revision to remove the visible cartilage graft and replace it with a DCF graft.

Robert Kotler, MD, FACS · Answer

Dear nosiekorean;

Nine months ago is adequate time to see
how things have played out, and indeed, as you noticed, when the swelling went
away, the graft is visible.  A surgical
revision rhinoplasty would entail going back into the nose and shaving down the
grafts to give the best possible appearance. 
Indeed, solid grafts, as apparently were placed, are amenable to being
shaved down.  The question of waiting a year for a surgical revision, is probably an adequate
timeframe after surgery to have the procedure.  But the final measure of the
wisdom of that will be the examination by the consulting nasal surgeon.

The graft will not reabsorb on its own
after this point in time.  What you have
is pretty much the “final result.”

The other option is to see if
concealing the graft with filler would reduce the unsatisfactory
appearance, and yet should not make the nose look too large.  That can be determined only at consultation
with an experienced surgeon. The homework
time you spend will be worth it. You want to do rhinoplasty right – the first time. The
most critical element of the process is surgeon selection. Ideally, you want a
board-certified surgeon, in either plastic surgery or head
& neck
surgery fellowship-trained, one who is highly focused
on the procedure(s) you want, who performs them at
least weekly and has been in practice for a minimum of ten
years.

Websites are the
key to understanding the practice. You should see at least dozens
of before and after pictures, showing the changes in the procedure
you want.The most helpful
sites have a variety of graphics, including photos of how you might look one or
five or ten days after surgery. Look for detailed explanations of
all procedures. The site should answer nearly every question you have. Generally, the top
practices
have the thickest, richest and most informative websites. The dedicated doctor spends
much time building an educational website for your benefit.The more before surgery consultations you go to, the more you’ll
learn about your procedure. Prepare a list of questions beforehand and take
notes as the surgeon talks. In the best practices, no interruptions should take
place. And,
you should be spending more time with the surgeon than with the office
administrative staff. You should not feel rushed or that you are on a
consultation conveyer belt. Take a friend or relative along as two
brains are always better than one in gaining information and understanding. If
you hear a medical term you don’t understand, ask the surgeon to explain it in
plain English. Ask yourself two key questions:  “Is this surgeon teaching or
selling?” And,
can I put my life and my face into this particular doctor’s hands? Can I
trust him?” Another super-important element of the best consultations:
Computer Imaging.Here’s how it works: photos are taken
of you as you are and uploaded onto a special computer system
that can
morph your presentappearance into an anticipated
after picture. (The technology is also known as Computer Morphing.)

Imaging is an incomparable learning tool because it
provides a forum for doctor- patient agreement on an
after surgery result that would satisfy you and
is a
result the doctor can deliver. After all, cosmetic surgery is 100% visual. It’s about
appearance but without visuals, everything is left to
the
imagination.  To
anticipate a successful outcome, there must be a meeting of the minds between
surgeon and patient.

Why waste your time on a consultation in
which the
surgeon can’t demonstrate what he envisions as the outcome? Would you buy a
painting without seeing it? In my opinion, a consultation
without computer imaging is nearly worthless.Best wishes,

Robert Kotler, MD, FACS

Over 4,500 nasal procedures performed

Suzanne Kim Doud Galli, MD, PhD, FACS · Answer

You may not have to wait a year for this issue. There are maneuvers to adjust the graft at this point. Have your surgeon evaluate the area.

Steven Wallach, MD · Answer

If at 9 months thenose is soft, then it might be possible to remove the radix graft.  I am not a big fan of them for this very reason.

Andrew Kornstein, MD, FACS · Answer

At this juncture I would presume the graft has been vascularized;it may, however,  progressively warp.Have you noticed an increase in warping?Or has the graft pushed up against the skin(closure to the surface)?Small irregularities can be treated by crushing the cartilage percutaneously;larger irregularities require removal and replacement with a "smoother " option.I do not believe you must wauit for a full yearHope this helps.

Richard W. Fleming, MD (retired) · Answer

You will be almost a year post-op by the time you could schedule a revision rhinoplasty. The solid grafts can be removed, diced, and wrapped in fascia to achieve the smooth bridge augmentation you desire. Diced cartilage in fascia is the technique I most often use in Asian rhinoplasty augmentation.

Visibly lumpy bridge after asian rhinoplasty - Can ear cartilage grafts (asian rhinoplasty) be removed?

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