Onlay Dorsal Graft - Removable?

hi docs... i had my rhinoplasty 4 months ago..done by maybe the best italian specialist, my problem is that when we were planning for the operation i was very scared and asked exactly what he would do to my nose to make it larger in the middle vault where my problem was, infact when i had nasal strips i could breathe better and my nose would look better, and i didnt want to change too much my nose just add support on the sidewalls, so he said me that i'd need support on the middle vault and he would put spreader graft and a columellar strut to make the tip not lower too much especially when smiling. i was ok with that....... then when i woke up i asked how it went and he said perfect and he said he had also put an onlay dorsal graft to give more support and to make my nose look more masculine.

my problem is that now i have more support on the sidewalls but also have this dorsal graft that makes my nose higher and still make the angle between dorsum and sidewalls sharp wich was why i did the have that angle more flat....

my question is why did he put an onlay dorsal graft as i didnt ask for higher profile neither i had saddle nose neither i wanted it narrower, actually was opposite i wanted it larger fuller..... and is this onlay dorsal graft removable and would i have to pay for it? this thing makes me mad as i didnt ask for this, i was very cleared what i wanted and in pre-op planning i asked exactly what he would do to my nose... and he never mentioned putting a graft on the dorsum

Doctor Answers 9

Revision rhinoplasty

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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.

Newport Beach Plastic Surgeon
5.0 out of 5 stars 22 reviews

Rhinoplasty with onlay dorsal graft

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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

Talmage J. Raine, MD, FACS
Chicago Plastic Surgeon

Dorsal Onlay Graft From Rhinoplasty Is Removeable

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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.

Onlay Dorsal Graft - Removable?

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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.

Erel Laufer, MD
Dunedin Plastic Surgeon
4.7 out of 5 stars 35 reviews

Removable Dorsal Graft

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

Elliot M. Heller, MD
New York Facial Plastic Surgeon
4.5 out of 5 stars 96 reviews

Dorsal work rhinoplasty

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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.


Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Onlay dorsal graft is removable after 1 year.

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

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

Dorsal Onlay Graft

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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.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Revision Rhinoplasty and Expectations

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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

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 52 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.