Rebuilding the nose: second rhinoplasty procedure.

Hello,Thanks for your question. Looking at your previous questions, it sounds as if you are only 1 month postop from your primary rhinoplasty surgery. As you may already know, it will be another 11 months until your nose is completely healed. By your description, it sounds as if you are concerned with an over-resected dorsum. You have asked about the use of rib vs. ear cartilage for revision rhinoplasty. For bridge augmentation I prefer to use rib cartilage. In fact, I prefer to rebuild the bridge using diced cartilage-fascia grafting. With this procedure, I take rib cartilage and morselize it into tiny pieces. I then wrap the diced cartilage in temporalis fascia soft tissue from your temporal hairline area. This makes a tissue implant that is gorgeous and natural looking when placed into the nasal bridge. 40% of my rhinoplasty practice involves revision rhinoplasty cases. I have a specialization in rhinoplasty surgery and would be happy to answer any further questions at my office in Denver.Good luck,Dr. Shah

Dear B_collins in Ohio City, CO:

     Whether or not to use rib or ear cartilage really depends on the circumstances and I would not want to offer you an answer without the benefit of having consulted.  I am sure all surgeons would feel the same way.  Rhinoplasty or revision rhinoplasty are aesthetic exercises and one that requires artistry.  No two surgeons have the same sense of artistry.  You may be helped also, ultimately, by fillers, temporary or permanent, and you should check that out. 

Do your homework.  Since you are dissatisfied with the first rhinoplasty, let’s hope that the second will be your last. 

     Best wishes,

 

Robert Kotler, MD, FACS

Over 4,500 nasal procedures performed

A thorough internal examination of the nose is required  in addition to the operative report from the primary rhinoplasty to determine how much cartilage is left on the inside of the nose for grafting purposes. Nasal cartilage is always the primary grafting source for revision rhinoplasty. Ear cartilage is also acceptable. Rib cartilage is rarely required