I am exactly 1 year post-op. I have inverted-V, alar retraction and overresection of the alar cartilages wich left my nose concave at the tip and dorsal area. I also got dents from too agressivly osteotomies. I need some reconstruction of the dorsum as wel as the tip area. Septal cartilage is gone, what do you advice me, donor cartilage(tutoplast or ihcc?) or autogenous rib? A doctor also said I have thin dorsal skin. Please I need help, thank you. I am 20 years old.
Need Revision Rhinoplasty Advice Please?
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Doctor Answers 6
Need for a revision Rhinoplasty?
I need to see pictures, but it does sound like you can achieve an improved appearance with re vision surgery by an experienced specialist. In your situation I prefer to use ear cartilage. In patients with very thin skin fascia can be placed to hide the unwanted signs of cartilage grafts such as sharp edges and irregularities.
Cartilage for revision rhino
No doubt that you need cartilage. I prefer autogenous rib, less chance of absorption but a greater chance of warping over time. Ihcc and tutoplast are both great products and should you find a rhinoplasty specialist that prefers these materials and has used them for years with good results then I think that would be fine. Basically see several rhinoplasty specialists who have been in practice for at least 10 years, look at as many photos as you can and go from there. I wouldn't make the implant material be the deciding factor. Good luck!
Rhinoplasty issue and grafts
Depending upon your dorsal issue, a cartilage graft or rib may be good. IHCC is good as well if you need a lot of graft and do not want to harvest your own rib.
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Revision rhinoplasty can accomplish many goals such as repairing an inverted V. The inverted V is best repaired with spreader grafts in addition to sometimes performing osteotomies. Over resection of the alar cartilages can be treated with a combination of composite grafts to help with the alar notching, or alar batten grafts. Concavities in the tip and bridge will require additional cartilage grafting from the ear or rib if the nose cartilage has been completely depleted. Thin skin may also require some additional grafting with fascia, to camouflage the cartilage grafts.
Need Revision Rhinoplasty Advice Please?
It's best for you to have personal consultations with a handful of experienced Revision Rhinoplasty Surgeons to be evaluated and receive recommendations of what can be done with Revision Rhinoplasty at this point. Some type of dorsal graft would be required to correct the area of over-resection. What type will depend upon the thickness and quality of the overlying nasal skin.
Thin Skin, Inverted V, alar retraction
To begin with a year is an adequate amount of time to wait after a rhinoplasty before proceeding with revision. Your understanding of the need for additional cartilage (for support) to correct your problems is important before proceeding. The most proven time tested source of this cartilage is autologous cartilage harvested from the rib. This can be obtained from a small incision in the infra-mammary crease. This cartilage is then shaped to replace and reconstruct what is absent or misshapen. The thin skinned can be addressed with a fascial graft. This is connective tissue that is most easily obtained from the temporal area through a small incision within the hair that does not require the trimming or cutting of the hair. Revision rhinoplasty is always more difficult and requires more expertise, but can achieve excellent results in form and function.
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.