7 months post-op. My straight/solid rib rhinoplasty is warped. Is shaving down or screwing to the bone a good option? (photo)

Question

My straight/solid rib rhinoplasty is warped. I got the surgery done 7 months ago and the warping started week 8. My surgeon suggested shaving down the graft or screwing to the bone. Other surgeons advised against it pointing out the graft has a curvature and can’t be fix using either of these two methods. 1) What technique would you recommend? 2) And what is the absorption rate using your suggested method? This has been a very stressful journey so your advice will be very appreciated.

Steven M. Denenberg, MD · Answer

On this profile view, you've got that unnatural-appearing bump just above the tip. Seems to me, though, that if that bump were shaved down, your nose would look very long. I'd think about considering a significant elevation of the tip, too. Elevating the tip could have other benefits.
The bridge of your nose looks a little concave to me. If the tip comes up, the nose is overall smaller, and the convexity wouldn't be as important -- it might even look right with the smaller nose. Then, making a nose smaller just tends to de-emphasize any other asymmetries or problems. Also, we don't see a frontal view, but if the graft is off-center from the frontal view, and that asymmetry can't be corrected completely, then again, elevating the tip can make the nose look less crooked.
I'd like to see what that would look like with a morph, but this one photo isn't good enough for making a morph of your nose.
Don't really know what screwing the graft to the bone would do. The problem seems to be close to your tip, which is far away from any bone.
Finally, how thick is the graft? Usually, rib is used to make a big elevation of the bridge, but your bridge seems low-ish to me, at least from this photo. Why was rib used in the first place? Was the rib operation a revision?
Seems I asked more questions than you did! Sorry. I'm trying to help...
Remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have more surgery if you are able to make yourself very confident in your surgeon's skills. The changes I described above require advanced techniques, requiring skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. For those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.

Ronald J. Edelson, MD · Answer

I can see the point from the graft right above the nasal tip.  There are two option.  Shave down the point, redo the graft, or remove the graft entirely and do something else altogether.  I don’t  think trying to screw that part of the graft will work at all.

Alexander Ovchinsky, MD · Answer

Unfortunately rib cartilage warping is a fairly common and difficult to fully control problem, especially if the cartilage graft is taken from a younger patient. Your surgeon knows the intricacies of your graft and your surgical details the best, thus I would rely on his or her advise. Couple of options that come into mind:- shaving the bottom protruding portion of the cartilage down- probably the quickest option but doesn’t prevent from further warping. Probably shaving the excess, scoring the cartilage partially to break the tensile forces and suturing it to the cartilaginous nasal structures has the best chance with this route -replacing warped graft with another rib cartilage graft- again doesn’t fully prevent from warping problem. Options here include cutting the cartilage differently, reinforcing the graft with permanent sutures, suturing the bottom portion and maybe fixing the top portion with K wire or a screw after placement, or using a cadaveric cartilage graft which may be less prone to warping than your own. - removing the graft and using a silicone dorsal implant (not in favor of those but in certain instances they work fine and may be a good option)- removing your graft, mincing it into small pieces, wrapping in fascia or Alloderm and placing it back- this will not provide structural support but aesthetically works well. Hope this helps. Dr. O

Johnson C. Lee, MD · Answer

Thank you for your photo. Unfortunately warping can happen to rib cartilage grafts. The graft may be able to be trimmed as long as the shape can be maintained with compromising the integrity of the remainder of the graft. It is unlikely screwing the graft will be beneficial as there is no bone in that part of the nose. You may be better served with a new graft placed or diced cartilage fascial grafting to minimize the risk of warping. Hope this helps!Johnson C. Lee, MD 
Board-Certified Plastic Surgeon

Tarek V. Copty, MD, FACS · Answer

hi d_d,
I have been performing revision rhinoplasty as a speciality of mine for over the past ten years and have seen this complication come into my office often from other surgeons quite often. You would never screw the graft in as it is warped. In my opinion the caudal (lower) aspect of the rib cartilage is warped upwards and needs to be shaved down. I believe this is an easy fix. But once this is done I also strongly believe you will need more tip definition and projection; your current tip is a little rounded and lacks definition. Once the rib graft is shaven down or fixed the issue with the tip will become more prominent. 
I suggest you see a plastic surgeon who is experienced with revision cases as you will want this to be your final procedure to attain your desired results without further surgery.

7 months post-op. My straight/solid rib rhinoplasty is warped. Is shaving down or screwing to the bone a good option? (photo)

Answers (7)

Answer: Warped cartilage graft

Answer: Warped cartilage graft

Answer: Revision Rhinoplasty / Rib Graft

Answer: Revision Rhinoplasty / Rib Graft

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Everything you need to know about Rhinoplasty

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7 months post-op. My straight/solid rib rhinoplasty is warped. Is shaving down or screwing to the bone a good option? (photo)

Answers (7)

Answer: Warped cartilage graft

Answer: Warped cartilage graft

Answer: Revision Rhinoplasty / Rib Graft

Answer: Revision Rhinoplasty / Rib Graft

Browse related questions

Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.