Will my Revision Rhinoplasty Results Soften?

I had a revision rhinoplasty recently, and the graft tissue used was irradiated costal cartilage. Evidently, my first surgeon was unorthodox in his techniques, and this surgeon required a great deal of material to rebuild. The surgery took 7 hours. I was not told prior to the surgery that this would be an option, so now, of course, I am worrying over it.

While I am not upset at the results, even two weeks out from the surgery it looks straighter and collapse free, it is hard like a mannequin's nose. I guess this is a characteristic of this material. Will it ever soften? Also, what is the amount of shrinking that occurs over time with this material? It is so solid I cannot imagine any shrinking taking place. What happens if something strikes my nose? I feel as if this is more likely to crack and less to bend.

Doctor Answers 10

Revision Rhinoplasty

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The healing process with any rhinoplasty can take up to a year or longer. During this time, scar tissue matures and the soft tissue envelope contracts so that the results become more visible.

Consequently, over time the nose usually becomes softer, but the type and location of grafts used can impact just how "soft" the nose will feel.

Rib cartilage (both irradiated and autologous) remains firm over time, and noses in which these materials are used typically maintain their shape and support because the rib cartilage does not shrink. Rib cartilage does have the tendency to crack if hit with enough force.

Dallas Facial Plastic Surgeon
4.7 out of 5 stars 149 reviews

It will take at least 6 months to see and feel the final result.

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You have had very complex surgery and it is great that you already see major improvement.

To answer your questions, the graft probably will not shrink or become softer with time. There is some risk of the graft warping (twisting) somewhat with time.

Also the grafted nose is more susceptible to trauma, but I would lead a normal life and not worry about this, because it would take a really powerful blow to injure your nose.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Irradiated Rib Cartilage will likely hold up

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Although a greater absorption (shrinkage) of irradiated cadaver cartilage is a concern, most surgeons who used this material a lot and have a long enough follow up experience (= many years) report that this is minimal and/or rare. Your nose should not be significantly more susceptible to traumatic fracture than before your rhinoplasty operation.

As noted by the other surgeons, stiffness of the nose is normal, may not normalize entirely and represents a sign that your surgeon re-established the needed nasal support.

I hope this helps.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 48 reviews

Second Rhinoplasty takes twice as long

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You have several issues to consider.

First, the skin and soft tissue will be hard and swollen. This tissue may take up to 3 years to get soft. Some doctors will inject steroids into the tissue to make the swelling go away faster, but time is the best cure.

Second, the cartilage should remain stiff, but has the potential to warp over time. Some doctors will put a piece of wire within the cartilage to reinforce it and avoid the warping. I prefer to use your own cartilage for this process because it is your own tissue and will not have any rejection issues. The key part of this process is to be sure that the cartilage only extends across the upper two thirds of your nose. If it extends to the tip, the tip will remain unnaturally hard forever and will be subject to breaking even with gentle trauma.

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 34 reviews

Revision Rhinoplasty with Irradiated Costal Cartilage

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Most surgeons performing a revision Rhinoplasty, which requires a significant amount of cartilage, will opt for autologous costal cartilage (your own rib cartilage). If your own costal cartilage was not available (it was calcified or you refused), irradiated Coastal Cartilage would be a second option.

Diced cartilage grafts are gaining popularity to fill significant dorsal defects, but cannot be used to create the stiff struts and internal supports that are sometimes needed for large saddle deformities or overly shortened noses.

In general, costal cartilage has a problem with warping. Irradiated cartilage has been reported to resorb over time, but surgeons disagree as to the amount of cartilage loss. There is general agreement that costal cartilage reconstructed noses will be stiff, which will not improve over time.

It sounds like your reconstruction was a success. Your nose is straight and the collapse was corrected. If after 6 to 12 months your results are still good, I suspect they will be maintained for a long time.

Daniel Reichner, MD
Newport Beach Plastic Surgeon
4.9 out of 5 stars 51 reviews

Give your Rhinoplasty results some time to stabilize

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Graft materials either irradiated cadaver or autologus rim cartilage are not entirely predictable.

Rhinoplasty results may take a year or two to achieve a mature/stable result.

In regards to your specific questions:

  1. Will it ever soften? Yes, it is very likely that it will soften.
  2. Also, what is the amount of shrinking that occurs over time with this material (It is so solid I cannot imagine any shrinking taking place)? There are reports of this material lasting for decades.
  3. What happens if something strikes my nose (I feel as if this is more likely to crack and less to bend)? Yes, that is true but remember if you get hit hard enough, a natural nose can break the cartilage as well.

Any material has the potential to warp. Some surgeons place metal wires in the graft to minimize this tendency.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

The tissues may soften with time

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The tissues may soften with time. However, the graft materials require structural integrity to maintain their shape to correct the contour defects which you had. Also, with repeated rhinoplasties, the skin can become thinner from repeated trauma. You may consider Retin-A ointment daily to the skin to help thicken the dermis. However, you should discuss any interventions with your surgeon first. Good luck with your recovery.

Firmness is normal

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These are all questions you should direct to your surgeon because only they can exactly answer them based on their own experience with following patients they have done similar operations on. But in general, secondary rhinoplasties with substantial grafting done will be quite stiff for a long time and will never be as soft as the unoperated nose. The grafts are necessary for structural integrity and thus are necessarily stiffer.

Difficult to tell how it will look over time

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Irradiated costal cartilage has variable resorption capacities, so it is impossible to tell how it will look over time. There is some shrinkage that will naturally occur over time. The nose is not less likely to bend if it gets hit. It is going to take approximately a year or even two years to determine what the final result will be from the rhinoplasty. Two weeks out from the surgery is far too soon and still changing so be patient.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Irradiated cartilge in Rhinoplasty

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Without being the surgeon, it is difficult to tell you exactly. But, the cartilage itself will not get softer. As for the tip, it really depends upon what type of graft material was used. Usually, the irradiated cartilage is used on the dorsum only, but sometimes it is used for other grafts as well. Be patient.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.