I met with 2 drs and I’m having a hard time choosing.Both are double board cert facial plastic surgeons specializing in rhino revision; great reviews and pictures; personable; provided digital workup; open procedure 1st Dr says I will need donor rib cart. and my ear cart. to revise nose. $14000. Will submit to ins for nasal valve work, not deducted from 14000. 2nd Dr. says rib cartilage warps and that he’ll only use septal and ear for my surgery. Cost is $9000. Doesn’t work with ins.
Answer: Wait. What? Why does everyone want to put cartilage in your nose? Where do they want to put it? Seems to me that your nose needs an elevation and re-shaping of the tip, and smoothing of the bridge. Putting a big piece of cartilage in the bridge would make your nose look far too large. Maybe the rib and ear cartilage are being planned for some other area, but I don't see it.I made a morph of your current posting: Click on the "Learn more" link, just below my response, or go here:
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Answer: Wait. What? Why does everyone want to put cartilage in your nose? Where do they want to put it? Seems to me that your nose needs an elevation and re-shaping of the tip, and smoothing of the bridge. Putting a big piece of cartilage in the bridge would make your nose look far too large. Maybe the rib and ear cartilage are being planned for some other area, but I don't see it.I made a morph of your current posting: Click on the "Learn more" link, just below my response, or go here:
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January 23, 2018
Answer: Do I need rib cartilage for my rhinoplasty revision? You need to be examined to give you a valid response, but your pictures show a long nose with some tip irregularities and collapse of the right upper lateral cartilage which could be the cause of internal valve obstruction. I don’t think you need a rib cartilage graft. The septum could be used for spreader grafts to open the internal valve on the right. If the septum is not available, ear cartilage is the next option. The tip needs to be lifted a bit to shorten your nose and the tip cartilages need to be reshaped. $10,000 is a good total fee and you should keep whatever the insurance pays.
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January 23, 2018
Answer: Do I need rib cartilage for my rhinoplasty revision? You need to be examined to give you a valid response, but your pictures show a long nose with some tip irregularities and collapse of the right upper lateral cartilage which could be the cause of internal valve obstruction. I don’t think you need a rib cartilage graft. The septum could be used for spreader grafts to open the internal valve on the right. If the septum is not available, ear cartilage is the next option. The tip needs to be lifted a bit to shorten your nose and the tip cartilages need to be reshaped. $10,000 is a good total fee and you should keep whatever the insurance pays.
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January 23, 2018
Answer: Comparing consults for revision rhinoplasty Experienced matters the most when choosing a facial plastic surgeon for revision rhinoplasty. In our practice, rib cartilage is rarely ever performed. There should be enough cartilage left over on the inside of your nose or ear to perform a closed revision rhinoplasty procedure. Placement of a rib into the nose makes it feel very hard and unnatural. Continue to do your homework
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January 23, 2018
Answer: Comparing consults for revision rhinoplasty Experienced matters the most when choosing a facial plastic surgeon for revision rhinoplasty. In our practice, rib cartilage is rarely ever performed. There should be enough cartilage left over on the inside of your nose or ear to perform a closed revision rhinoplasty procedure. Placement of a rib into the nose makes it feel very hard and unnatural. Continue to do your homework
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January 23, 2018
Answer: Complex revision Thanks for your question. If you were my patient, we'd be talking about doing a lot of grafting to try to build up your dorsum and fix what's going on with your nasal tip. Structural grafting like you'll need to correct your middle vault collapse needs to be strong- either septal cartilage or rib cartilage. Since you've had surgery before you may not have adequate cartilage in your septum, which means rib is an option. Using cadaveric instead of your own is really up to your surgeon and what they're comfortable with. I will use cadaveric in anybody over 40 years old. Younger than that, I favor using your own. Rib cartilage can warp, so that's a risk we take. I haven't seen it happen in my practice yet, but it can happen.I like using ear cartilage to help reshape the lower 1/3 of the nose. It's a little softer and the contour is correct.If you're having breathing issues, that is a legitimate thing to submit to insurance. In picking a surgeon, you can consider several factors. In this case, experience probably trumps everything else. This is complicated work so you want to go with someone with a track record of success in these situations. You should expect to have improvement from revision surgery, particularly if you're having breathing problems. However, you should know that revision surgery may not get you a perfect nose. Scarring from your prior procedure can limit what's possible from an aesthetic perspective.For an example of a revision using her own rib and ear cartilage, check out this example from my photo gallery. Good luck!
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January 23, 2018
Answer: Complex revision Thanks for your question. If you were my patient, we'd be talking about doing a lot of grafting to try to build up your dorsum and fix what's going on with your nasal tip. Structural grafting like you'll need to correct your middle vault collapse needs to be strong- either septal cartilage or rib cartilage. Since you've had surgery before you may not have adequate cartilage in your septum, which means rib is an option. Using cadaveric instead of your own is really up to your surgeon and what they're comfortable with. I will use cadaveric in anybody over 40 years old. Younger than that, I favor using your own. Rib cartilage can warp, so that's a risk we take. I haven't seen it happen in my practice yet, but it can happen.I like using ear cartilage to help reshape the lower 1/3 of the nose. It's a little softer and the contour is correct.If you're having breathing issues, that is a legitimate thing to submit to insurance. In picking a surgeon, you can consider several factors. In this case, experience probably trumps everything else. This is complicated work so you want to go with someone with a track record of success in these situations. You should expect to have improvement from revision surgery, particularly if you're having breathing problems. However, you should know that revision surgery may not get you a perfect nose. Scarring from your prior procedure can limit what's possible from an aesthetic perspective.For an example of a revision using her own rib and ear cartilage, check out this example from my photo gallery. Good luck!
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January 23, 2018
Answer: Revision Rhinoplasty Hi,Septal or ear cartilage should work fine. Also just reshaping the cartilage you already have in your tip should work well too. If you have nasal valve collapse or nasal obstruction from a deviated septum , depending on you insurance coverage, some of the cost could be defrayed. 14K seems high and 9k seems more within reason but choose the surgeon you think will do a better job.Best,Dr.S.
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January 23, 2018
Answer: Revision Rhinoplasty Hi,Septal or ear cartilage should work fine. Also just reshaping the cartilage you already have in your tip should work well too. If you have nasal valve collapse or nasal obstruction from a deviated septum , depending on you insurance coverage, some of the cost could be defrayed. 14K seems high and 9k seems more within reason but choose the surgeon you think will do a better job.Best,Dr.S.
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