Onlay Dorsal Graft - Removable?

Question

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 rhino.....to 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

Elliot M. Heller, MD · Answer

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

Nima Shemirani, MD · Answer

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

Toby Mayer, MD · Answer

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

Tim Sayed, MD, MBA, FACS · Answer

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.

Barry L. Eppley, MD, DMD · Answer

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?

Answers (5)