Will my Revision Rhinoplasty Results Soften?

Question

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.

C. Spencer Cochran, MD · Answer

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.

Frank P. Fechner, MD · Answer

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.

Daniel Reichner, MD, FACS · Answer

Mandy,
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.

Otto Joseph Placik, MD · Answer

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:

Will it ever soften?  Yes, it is very likely that it will 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)?  There are reports of this material lasting for decades.
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.

David Shafer, MD, FACS · Answer

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.

Will my Revision Rhinoplasty Results Soften?

Answers (10)

Answer: Give your Rhinoplasty results some time to stabilize

Answer: Give your Rhinoplasty results some time to stabilize

Answer: The tissues may soften with time

Answer: The tissues may soften with time

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Everything you need to know about Rhinoplasty

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Will my Revision Rhinoplasty Results Soften?

Answers (10)

Answer: Give your Rhinoplasty results some time to stabilize

Answer: Give your Rhinoplasty results some time to stabilize

Answer: The tissues may soften with time

Answer: The tissues may soften with time

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Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.