Revision Augmentation Rhinoploasty Problems

Had a revision with rib graft in bridge and columella 5 months ago. Nose is very hard and looks almost triangle shape. It looks big and high for my face (this is a change than on first reveal). I hope the bone will shrink some, do i still have swelling? Also I have alar base scars like stitch holes. How can i resolve this. It is upsetting.

Doctor Answers 7

Revision rhinoplasty healing takes time but their are options

Following revision rhinoplasty the healing period can be long and ardous especially if a rib graft was used. It is not uncommon to still have swelling at 5 months. But be assured your nose will continue to shrink and soften with time. Ask your physician if he or she thinks a steroid injection would help. Occassionally this can accelerate the shrinkage of the nose especially if paper tape is applied after wards and kept on at night specifically. The alar base scars should also become better camouflaged with time. You may want to consider a fractionated laser treatment to reduce their appearance. I know this can be difficult time period but try your best to not get too anxious. If after a year you are not still satisfied you can consider another revision. Although going through another procedure is not ideal an overbuilt nose can be shaved down and made smaller through a closed approach. Good luck

Chicago Facial Plastic Surgeon
4.2 out of 5 stars 30 reviews

Revision rhinoplasty with rib graft

The swelling after a revision rhinoplasty and especially after using rib cartilage can still be quite evident 5 months after surgery. Rest assured that the swelling and stiffness should continue to improve. There is a bit of a trade off with using rib cartilage in that it can make your nose stiffer, but the benefit is that there is much more stability to the tip structure. Your surgeon should be able to give you an idea of how much stiffness improvement to expect.

Regarding the alar base scars: the skin in this area is often quite oily and prone to thickened scars. Some patients benefit from either a steroid injection or dermabrasion to the scar during the healing phase. 

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 reviews

Recovery process after a revision rhinoplasty

The recovery process after a revision rhinoplasty, especially in a surgery that uses rib graft is more prolonged than that of the initial surgery. The rib graft tends to be stiffer and more firm than cartilage from your septum or the back of your ear. You should anticipate any longer period where this area is firm or stiff. Be sure that you follow closely with your plastic surgeon as they will want to know how you are healing and that your cartilage is settling in a straight fashion

Pat Pazmino, MD, FACS
Miami Plastic Surgeon
4.7 out of 5 stars 101 reviews

Rib grafts will soften and shrink over time

Be patient.  Rib cartilage grafts start out being firm, especially near the tip and nostril areas but they will soften over time.  it is doubtful that your surgeon used rib bone in your nose (although it may feel like it).

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Stiffness in the nose is normal with a rib graft

Rib cartilage is often used during rhinoplasty when large changes need to be made to the nose.

The hardness is pretty typical and for many an acceptable trade-off to having a better shape to the nose. But if you think the graft has made your nose too large, it may be correctable with a revision surgery to reduce the volume of the graft.

I think by 5 months, enough swelling will have resolved to get a sense of this.

David W. Kim, MD
Bay Area Facial Plastic Surgeon
4.8 out of 5 stars 37 reviews

Healing after Revision Rhinoplasty

Healing always takes longer after a revision procedure, especially when augmentation is necessary. Ii is likely your appearance will chage significantly over the next six months. For your information, if the graft was taken from the rib it is probably cartilage, not bone.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Nasal augmentation with a bone graft

Your nose feels hard because there is now bone where there was only softer cartilage prior to your surgery. Rib grafts can resorb over time, but if they were properly placed, the result might be permanent.

Howard T. Bellin, MD (retired)
Manhattan Plastic Surgeon
2.5 out of 5 stars 3 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.