4 months post primary rhino, 1 month post implant removal, nose is uneven. Is it due to swelling, or do I need revision? (Photo)

A Goretex implant was removed from my bridge due to infection. I want a revision but I'm undecided about using the same surgeon: 1. Doc wants to mix ear cartilage w/dermis from my butt area to give my bridge more height. He is not willing to harvest rib cartilage because of its close proximity to vital organs. Is this a viable plan? 2. What is the best approach to fix my uneven nose? Will this look better in time or is revision the only answer? Thanks for all your help!

Doctor Answers 5

Revision rhinoplasty post implant removal

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My advice is to wait a little longer. The uneven aspect of the nostrils may be a consequence of a number of things related to the surgery not solely the implant.  A third surgery on the nose is definitely no simple matter. Options for donor sources include ear and rib.  Ear cartilage as an onlay graft works ok but it is not a great structural graft and this cartilage can have some irregularities which can show through over time. Wrapping cartilage in dermis or overlaying dermis will look good at first, but can decrease the viability of the cartilage and contribute to resorption because cartilage nourishment is coming from contact with the skins blood supply.  
When more graft material is necessary, I prefer using ones own rib cartilage taken from underneath the rectus muscle so that it does not create a deformity.  Warping can be an issue so one has to work very hard at fashioning the graft from a piece that does not exhibit this tendency.  I have not used cadaver cartilage for this purpose.  I have also had success with medpore, which is a porous although more rigid onlay graft which appears to be more resistant to infection.  This graft I do cover with acellular dermis to avoid adhesion to the skin which can create some outlining of the graft. 

Albany Facial Plastic Surgeon

Revision rhinoplasty or not.

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First. Wait one year. Do NOT use Goretex or rib. If you need revision see a very experienced revision rhinoplasty surgeon. In 35 years I have never use synthetic materials in noses. Far will absorb unreliably. Your septal or ear cartilage should be used. I have never had an infection with these. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Revision rhinoplasty

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You need to wait for at least a year before a revision rhinoplasty. From the limited photos; I believe a rib graft would be the best way to proceed in your case. Find a board certified surgeon who is well versed in rhinoplasty. Donald R Nunn MD Atlanta Plastic Surgeon

Donald Nunn, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 51 reviews

4 months post primary rhino, 1 month post implant removal, nose is uneven. Is it due to swelling, or do I need revision?

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Still to soon for any more surgery. Allow 6 months of healing before attempting allograft or autografts.////

Dorsal augmentation

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Rib cartilage is often the best to give a moderate dorsal projection because often the septum does not provide enough. I have used irradiated cartilage ( cadaver donor) with success.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

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