Advice on graft removal? (Photo)

Question

I had a rhinoplasty in April 2023. I was supposed to only have my septum deviation corrected but when I came out of surgery the doctor told me he had extra cartilage so he rebuilt my tip. Apparently I got a tip graft and alar rim grafts as well as a septal extension graft. The tip of my nose is constantly white and shows a triangle through my skin. My tip is very pointy and am having resistance with breathing because my tip and alar rims are so bulky! I would like to remove these grafts!

Steven M. Denenberg, MD · Answer

A tip graft, a septal extension graft, and alar rim grafts are powerful ways to fundamentally change the appearance of the nose. Correction of a deviated septum should not change the appearance of the nose at all. Did you give the doctor *permission* to fundamentally change the appearance of your nose? Was that part of the plan? Also, am I hearing this right? He rebuilt your tip *because* he had extra cartilage? That never happens. You decide before surgery whether to rebuild the tip, and do that or don't do that regardless of whether there is extra cartilage after the septoplasty.
Anyway, your nose looks long-ish to me, and that's what a tip graft and a septal extension graft will do. I see to elevate the tip, remove the tip grafts, try to get a natural-looking tip, in a revision operation.

How *much* to elevate the tip, or adjust the appearance of the tip, or make other changes (such as the excess width just above the tip on the frontal view)? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision, but if your reporting is accurate, you probably should have already answered that question.

Jeffrey H. Spiegel, MD · Answer

Yes, tip grafts can cause this, particularly in someone like you with fair and delicate skin.  Fortunately, this can be corrected.  We would do a revision rhinoplasty where we remove the graft, and blend in the irregularities.  It should look much more natural and to your liking.

Mats Hagstrom, MD (license on probation) · Answer

I suggest you get a few in person second opinion consultations.
To make an accurate assessment on the outcome of a plastic surgery procedure we generally need to see a complete proper set up before and after picture. If you don’t have proper before and after pictures and ask your surgeon to forward the pictures they took.
if you were truly only scheduled and consented for a septoplasty and your surgeon did a rhinoplasty, then your surgeon operated without consent.
That is considered battery and if you would like you could talk to a personal injury attorney about it.
If you were consented for rhinoplasty surgery, then your doctor was operating with consent.
Rhinoplasty surgery is fairly complex and patients should be very careful in selecting providers. Being bored, certified, and plastic surgery with years of experience does not mean that somebody has mastered anyone single procedure, especially not rhinoplasty surgery. Perhaps your provider was an OtorhinoLaryngologist. Regardless Difficult surgery is difficult surgery.
I generally recommend patients have multiple in person consultations before choosing a provider.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients had similar characteristics to your own.
An experience provider should have no difficulty showing you before and after pictures of at least 50 previous patients.
Being shown a handful of pre-selected images, representing only the best results of a providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider or how many of these procedures they’ve actually done.
Recognize that revision rhinoplasty surgery is much more complex and difficult in comparison to primary procedures.
 Choose your provider carefully.
Best,
Matt hagstrom, MD

Advice on graft removal? (Photo)

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Advice on graft removal? (Photo)

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Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.