Revision Rhinoplasty After Having Rhinoplasty and Septoplasty

Question

I had primary rhinoplasty and I hate the result. I have been told I will need grafts and they can be obtained from my septum, but in my notes it says I had septoplasty also. I have no idea why that was preformed as well, as I have no allergies and I did not have breathing etc issues. Will there still be some left if I have had that procedure done.

Sam Naficy, MD, FACS · Answer

It depends on how much cartilage was left in your septum. Some surgeon will dictate that in their operative note. Depending on what needs to be done additional cartilage from the ear or rib may be required.

Eric M. Joseph, MD · Answer

I read your concern. If you would require cartilage grafting for revision rhinoplasty, and if your septal cartilage is deficient, your surgeon may use rib cartilage, irradiated-cadaver rib cartilage, or ear cartilage.

	In my practice, I can usually tell if there is adequate septal cartilage in the office, before surgery. While viewing your septum with a headlight and nasal speculum, I will gently push on the septum with a cotton-applicator. If your septum feels very soft, and mobile, then you might not have enough for grafting purposes. If your septum feels firm and immobile, you may have enough for your procedure.

	I hope this is helpful for you.

	Regards from NJ:

Thomas A. Lamperti, MD · Answer

There may be enough cartilage in the your septum for your revision procedure. Often there is enough left in place after surgery to use for grafting.

	It can be difficult to ascertain how much cartilage is there until surgery, however, so often I'll prepare (and consent) patients in similar situations for a possible ear cartilage harvest as well.

Jacob D. Steiger, MD · Answer

With revision rhinoplasty, grafts are often used to repair the nose if there is cartilage missing from the prior procedure(s). Grafts are most commonly fashioned from your own cartilage.  Cartilage can come from the body and the septum is the most common source. I have found that despite having a septoplasty with the rhinoplasty, many people still have enough septum for revision. Other sources of cartilage are the ear (done in such a way that does not change the appearance of the ear), or a portion of the rib. Occasionally cadaveric rib can be used as well and some artificial implants. 

	 

	I would recommend that you do your homework and visit with surgeons that have experience with revision rhinoplasty until you feel comfortable that you are in the right place.

Peter E. Johnson, MD · Answer

The septum is the choice area for cartilage grafts in nasal revision, and it is unfortunate that you had a septoplasty that seems to be unnecessary. There is a possibility that there is adequate cartilage left and as a rule we look there first in revision rhinoplasty. As a second choice the ear can be prepared if the septum does not have what is needed.
	Best of luck,
	peterejohnsonmd

Mohsen Tavoussi, MD, DO · Answer

Modern septoplasty does not necessarily mean septal cartialge removal. Readjustment of septal cartilages is also septoplasty. Most often in rhinoplasty, some septal cartilages are harvested to be used as grafts. We routinely, replace extra cartilages, not used during rhinoplasty, back into the septum. In revision rhinoplasty, we find there are adequate amount of cartilages in placed to be used.

Marc Schneider, MD · Answer

Many times when performing a primary rhinoplasty, the surgeon will harvest cartilage to use as a graft. The grafts are used to effect a change in nasal projection, shape and size. Typically, not all of the cartilage of the septum is harvested and often times some remaining cartilage may be put back. Secondary rhinoplasties often times harvest portions of the remaining septum for use.

Richard W. Fleming, MD (retired) · Answer

You may still have a complete septum after your septorhinoplasty. If there is not adequate cartilage in the septum, your ears are a great source of material for grafting. If there was any septal abnormality before the original rhinoplasty, a septoplasty may have been done to avoid airway obstruction secondary to a reduction rhinoplasty.

Oleh Slupchynskyj, MD, FACS (retired) · Answer

Hi,

	Septoplasty usually removes septal cartilage. However, it depends how much septal cartilage was removed. Sometimes a small amount is removed and there is adequate cartilage for a revision. If not, ear cartilage can be used for a revision.

	Best,

	Dr.S.

Sheldon S. Kabaker, MD FACS (retired) · Answer

There are all kinds of things done with the septal cartilage when a septoplasty is done. In many instances, the major portion is removed and discarded. If cartilage grafts are needed for a revision rhinoplasty , your surgeon should be able to review old operative reports and by palpation determine the likelihood of you having sufficient cartilage for his needs with your revision rhinoplasty. He should also have alternative sources in mind when doing this surgery such as the ability to harvest your own rib or ear cartilage or have preserved donor cartilage available.

Revision Rhinoplasty After Having Rhinoplasty and Septoplasty

Answers (10)

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