Revision by Caudal Septal Replacement, Is This Right For My Complicated Case?

Had nasal trauma when I was four.Due to severely deviated septum,was operated when I was 12.A part of the dorsal septum was removed.Had rhinoplasty in 2006,followed by another in Sept.2011.Still the nose is deviated.Stressed and unhappy with the outcome,planning to repeat the surgery by CSR.Removing the defective caudal septum and replacing it with autogenous rib graft(please be reminded that my dorsal septum is almost absent)and have columellar strut(with Marseline mesh)to define the lost tip. Is this the right treatment for me?

Doctor Answers 3

Caudal septal replacement

Rib cartilage can be a great source of structural support in reconstructive cases like yours where there is inadequate septal cartilage to work with.

Caudal septal replacement is an excellent technique to rebuild a deviated nose.  Without seeing or examining your nose it's hard to say if this is the best treatment in your specific case, though. I prefer avoiding foreign implants such as mersilene in the nose.If rib cartilage is being harvested I would expect there to be plenty of cartilage grafting material available such that mersilene can be avoided.

Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 reviews

Caudal Septal Replacement for Septal Devation

I'm sorry you have had such a protracted difficult coarse of nasal reconstruction. Normally we ask for pictures to help us evaluate patient's noses, but your case is so difficult that I would not feel comfortable discussing your problem or treatment alternatives without examining you and reviewing your previous treatment records. 

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 39 reviews

Deviated Septum with revision rhinoplasty

Your case is indeed complicated. Pictures would help to asses how deviated your nose is. No nose is perfectly symmetric, and your expectations should be adjusted accordingly.

Rib cartilage is a good choice for septal replacement,  however from your description it is hard to know if the whole septum needs to be replaced. 

You may need spreader grafts as well to straighten the nose. As far a Merceline mesh, It is a very old material, and I would remove it.

Because of the complexity of your nose, ensure that the surgeon specializes in Revision Rhinoplasty. Even in the most experienced hands, your case sounds complicated and your expectations should be realistic.

Best of luck,

Michel Siegel, MD
Houston Facial Plastic Surgeon
4.6 out of 5 stars 113 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.