Onlay Dorsal Graft - Removable?

Attempt to put onlay dorsal graft to balance the nose- it could be removed if you do not like the appearance.

It is still a little early to make judgments on the look.  If he is a great surgeon (sounds like he is, based on your description), he had a to have a reason for putting the onlay graft.  Sometimes, when you are changing the shape of the nose, you notice new things that pop up.  It could have been after rotating the nose or taking down the bridge, your nose would look better after the onlay graft.  Picking your surgeon involves trusting him enough that he would do things in your best interest.  He likely had the best intentions for you, so see how it heals.

My advice would be to wait it out.  If you are truly unhappy after a minimum of 6 months (better to wait a year), then it can be removed.

Best,

Nima Shemirani

Onlay dorsal graft is removable after 1 year. It is necessary to wait that long for the swelling to go down all the way.

Revision rhinoplasty is quite challenging. WIthout seeing you face to face and examining your tissues, it is hard to determine whether removal of the graft and other techniques would be helpful. Basically, you will probably not get a lot of helpful comments here, as the communication between you and the surgeon before surgery, and now after your surgery, is the most important issue. Some changes in rhinoplasty are more predictable than others. However, results often take months to a year or longer to "mature," so I would recommend periodic reassessments in the surgeon's office. Express, as diplomatically as you can, your concerns and listen to the surgeon's advice. Second opinions can be helpful as well.  I emphasize to my patients that revisions are not uncommon - they are required in perhaps as much as 15% of rhinoplasty cases even in the hands of the most experienced rhinoplasty specialists.

What you did and did not communicate with your rhinoplasty surgeon is an issue between you and him and no one outside that conversation can really comment. The pertinent question you are asking here is whether the dorsal graft is removeable. The answer is that it can be. Even though you are only four months after surgery, the sooner you have it removed the better as long as you are absolutely certain that it is aesthetically undesireable.

You give a long description without photos  so it is hard to assess the residual deformity.

To answer your question an onlay graft can be removed but it is best to wait until full resolution of the healing process which can be assessed by the surgeon.

Without being there for your consultations and with no access to photos it is very hard to make any definitive statement about your surgery as well as why your surgeon chose to perform certain techniques during your procedure. However, rhinoplasty is not an operation that exists in a vacuum. Certain steps can alter (unintentionally) other aspect of the nose that need to be addressed during the surgery.  Some of these can be anticipated and come can't.  Thus, a surgeon must enter into a nasal surgery with a plan but also be able to deviate from this if needed.

Communication is the key with any procedure and imaging can be very helpful in making a surgical plan and agreeing on an "ideal" outcome.  No surgeon can promise you a specific result, but setting mutually agreed upon goals is very helpful.  Revisit with your surgeon to discuss this.  Any other opinion is just that.

Best of luck

Vincent Marin, MD, FACS

San Diego Plastic Surgeon

Without seeing your pre-op nose, It is impossible to answer your question as to why the onlay graft was placed. However, wait another 6 months to see the final result; if you're not satisfied the graft can be removed.

This is obviously a very complicated question.  The short answer is, yes, the dorsal graft can be removed.  I would discuss the options with your surgeon.  I would think that you would incur some costs in doing so.

Wishing you all the best,

Tal Raine MD FACS