My rib graft to nose is not connected to the bridge of nose! It moves left and right and is very crooked? (Photos)

Question

Why has my rib graft separated from bridge of nose! It can move left or right

Philip S. Schoenfeld, MD, FACS · Answer

There are certainly many advantages of using a patient or cadaver cartilagenous rib in rhinoplasty surgery.  I generally reserve the use of rib grafts for those patients who require revision nasal surgery or in cases of extreme trauma or cancer reconstruction.  There is a lot of cartilage available to reconstruct the nose with.  Unfortunately, there are also a few issues that we see with the use of rib grafts, especially if the graft is from a cadaver.   Warping of the graft and mobility or rejection of the graft is a common post procedure complication.  Persistent graft mobility would indicate that the graft is not incorporating into the tissue and needs to be reevaluated.

Steven M. Denenberg, MD · Answer

It's possible that your three-quarter views, and your profile views, might be improved quite a bit, too, if the *size* of the graft as well as the position, is adjusted, too. Be sure to read the section in the "Learn more" link on how to stay out of trouble while searching for a rhinoplasty surgeon, and how to tell whether your previous surgeon should be performing your revision. You should only have surgery if you are able to make yourself very confident in your surgeon's skills. 
I usually make computer morphs when I'm answering questions like this, to show the changes that are possible for your nose with a rhinoplasty, but unfortunately the photos you submitted aren't good enough for making morphs. At the *very* bottom of the "Learn more" page is a link to instructions on taking and sending photos that are comprehensive and useful for an online consultation like this, in case you'd like a more complete evaluation.

Richard Mark Winters, MD · Answer

It appears that the graft was utilized as an onlay.... these can be prone to warping... when patients present for revision rhinoplasty who have had significant over-resection of their dorsum, rib grafts are an important source of cartilage because of their abundant supply and anatomy... however, even when carved carefully, they can warp... there are a number of maneuvers that can mitigate this but require considerable skill and experience to carry outgood luck

My rib graft to nose is not connected to the bridge of nose! It moves left and right and is very crooked? (Photos)

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