Can I have my strut grafts and spreader grafts removed?

Question

I had a revision septorhinoplasty with strut grafts and spreader grafts. My nose is huge, bulbous and there is zero definition of my nares. Can I have these removed to have my old nose back? I look hideous. I'm 10 months post OP. I've posted before and after photos.

Steven M. Denenberg, MD · Answer

You only posted these two frontal images, but first it would be important to look at all the views: the profiles, too (both of them), and also a bunch of views of different angles from the left and right. Those would allow a good assessment of what we want to change, and by how much, and it would allow a surgeon to make morphs, so you can understand better what you're looking for, and fine tune your ideal goal.It's *much* more likely that the natural cartilages require some modification, than that just removing grafts would restore your nose. There's much more finesse to the operation available. And you really only want *one* more operation!
I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should always be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and only the surgeon has that information and judgment.)
Remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs 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. And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.
Your nose is also a perfect example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

Tanveer Janjua, MD · Answer

It is possible to remove the grafts but the post op swelling can take up to a year. Regards

Richard Mark Winters, MD · Answer

spreader, strut and lateral crural strut grafts are structural cartilage and designed to be 'invisible' as opposed to onlay grafts which are visible by nature... that said, there are many factors in rhinoplasty (especially in revision rhinoplasty) which are not in the control of the surgeon
even with properly placed structural grafts, some bulk may be added to the nose.... occasionally, scar tissue and edema will prevail in the operated areas even when the grafts are not bulky... once the construct of the nose has been made sound with structural grafting, it is often possible to debulk scar tissue and reduce/reshape/remove/replace grafts to get closer to the desired result without destabilizing the nose
good luck...

William Marshall Guy, MD · Answer

Hello Brazcal,Sorry to hear you haven't been happy with your rhinoplasty.  Spreader grafts are designed to open up the internal nasal valve, help straighten the nasal dorsum, and/or provide support when a large hump is removed.  Strut grafts are usually referencing lateral crural strut grafts which are also designed to help prevent collapse of the nasal valves.  These grafts do add width to the nose.  To answer your question, the grafts can be removed.  This will cause the nose to not be as wide.  However, it would be important to know why they were placed in the first place and what else was done surgically.  The reason is that if they are removed it is possible your nose would begin to collapse inwards causing difficulty with breathing.  You indicated you are 10 months post op so most of your swelling is gone.  I would still recommend waiting a full year to be safe.  As far as getting your old nose back, it might be close but unlikely it would be exactly the same if everything was removed.  I would recommend you discuss your concerns with your doctor and consult with a facial plastic surgeon as well to learn about what can be done.I hope this helps and good luck.

Richard W. Fleming, MD (retired) · Answer

You have been patient waiting to evaluate your result. There may be some slight improvement over the next several months but I agree that is will never be satisfactory. You need a careful examination, review of your operative report, and thorough discussion of your alternatives with an experienced revision rhinoplasty surgeon.

Can I have my strut grafts and spreader grafts removed?

Answers (5)

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