Revision rhinoplasty question - adding cartilage?

I just saw a surgeon and he told me that my bridge is too thin (I agree and I hate it) and my tip is bulbous and it lacks support. He said he will widen my bridge with septum cartilage and add cartilage to my tip for support and make it thinner. Does this sound reasonable? I don't want to regret my choice again. I hate my nose now, I was prettier before surgery and I just want to have my face back! So are these techniques common with less risk?

Doctor Answers 17

Revision Rhinoplasty

Most patients who have revision surgery need it for one of 4 reasons. In order of common to less common:

1) because too much supporting cartilage material was removed in the primary procedure and the nose looks skeletonized

2) due to unrecognized or unrepaired nasal deviation

3) had a partial procedure and the nose is out of balance now

4) had poor work, a healing complication, or a different post-surgical issue affecting the outcome

Cartilage replacement is often required in cases 1,2, and 4 and occasionally in reason 3. Structural integrity is critical for long term results and your structure should be relatively similar before and after a nose procedure. There is a reason your nose has the material inside that makes it have a shape; to breathe and support itself. A skilled Rhinoplasty surgeon should be able to reshape the nose without removing a lot of cartilage. In the end, most Rhinoplasty procedures are not simple and should not be simple. Even ones you think are going to be simple can end up complicated and vice versa.

For revision, your surgeon needs to have a lot of experience with both primary and revision cases, in order to be able to problem solve during the operation, giving you the best outcome possible.


Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 48 reviews

Revision rhinoplasty with septal cartilage graft

The most important thing for you to do is seek out a board certified plastic surgeon with EXPERTISE in revision rhinoplasty.  This is a difficult procedure and it is imperative to have a qualified surgeon.  Regarding the cartilage graft, yes, the operative plan sounds reasonable and in the hands of the right surgeon, poses minimal risk.  Your nose can be widened with the grafts as well as your tip refined.  Ask to view the surgeon's portfolio of revision rhinoplasty patients and make sure he/she meets the qualifications for performing revision rhinoplasty.

Rod J. Rohrich, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 55 reviews

Revision Rhinoplasty

Yes.  What you have described are common techniques for the issues you mentioned.  Cartilage can be taken from the septum with little risk.  Strips can be use to "spread" the bridge out if too narrow and this sometimes helps breathing as well.  Additional cartilage graft is then placed to augment the tip projection.  If the tip is also bulbous then some time cartilage can be thinned and removed to narrow the appearance.  Remember though, revision rhinoplasty can be very difficult and a surgeon that has experience in that procedure should be sought out. 

Jason P. Rehm, MD
Chattanooga Plastic Surgeon
4.3 out of 5 stars 7 reviews

Best Technique for Revision Rhinoplasty

Thank you for your question. It is imperative to find a qualified board-certified facial plastic surgeon for this procedure, as a revision rhinoplasty is considered one of the most difficult procedures in cosmetic surgery. From what you described, the revision your surgeon has proposed sounds reasonable. However, it is difficult to assess your the status of your nose without pictures or an in-person consultation. My suggestion would be to conduct additional research about your surgeon’s revision rhinoplasty ratings prior to committing to the procedure. Consulting additional board-certified facial plastic surgeons is also a useful option for you to explore. Good luck!

Sam Rizk, MD
New York Facial Plastic Surgeon
4.6 out of 5 stars 65 reviews

REVISION RHINOPLASTY. CARTILAGE GRAFT?

I use a crushed cartilage graft wrapped in temporalis fascia to rebuild the bridge of the nose. I use an open rhinoplasty technique so that i can insert the composite graft accurately and place strut grafts in the tip also. You can see a patient like this on my website - patient # 90515.  Be sure to consult with a Plastic Surgeon experienced in nasal aesthetic surgery who is certified by the American Board of Plastic Surgery and a Member of the American Society for Aesthetic Plastic Surgery (ASAPS). Check out his web site for before and after pictures of rhinoplasty surgery.

Laurence Kirwan, MD, FRCS, FACS
Norwalk Plastic Surgeon
3.5 out of 5 stars 9 reviews

Revision Rhinoplasty

A revision rhinoplasty is perhaps one of the most challenging operations there are in cosmetic surgery. In fact, I often suggest that patients look at revision rhinoplasty results in order to find a good rhinoplasty surgeon. This is much more telling than the number of cases a surgeon says they have done or how experienced they say they are.

Most revision rhinoplasties involve adding or altering the cartilage of the nose. Cartilage is frequently used to augment an area where too much was removed or to camouflage an area or shape that unfortunately did not turn out well in the first operation.

So to answer your question, yes it sounds reasonable but make sure you check out your surgeon’s revision rhinoplasty work before you commit to surgery and also make sure you have made you goals very clear to your surgeon.

I hope that helps.

Best regards.

Brian Windle, MD
Kirkland Plastic Surgeon
4.9 out of 5 stars 61 reviews

Revision rhinoplasty for lack of support and bulbous tip

Considering a revision rhinoplasty is frequently a tough and emotional decision. Without seeing your nose it is difficult to say whether or not a proposed surgical plan is reasonable. However, in the many revision surgeries that I do, I commonly need to re-establish the structure and support of the nose using cartilage from either the nasal septum, ear, or costal rib cartilage. It is important to feel comfortable with your surgeon and make sure all your questions and concerns are answered. This will help to clarify expectations and help you better understand the procedure. 

Michael T. Somenek, MD
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 29 reviews

Revision rhinoplasty

The need for revision rhinoplasty is an unfortunately common occurrence and I am sorry that you are dissatisfied with your first operation. 

Revision rhinoplasty is a very complex operation and often makes use of cartilage grafts to restructure, reshape and/or camouflage the aspects of the nose that you find objectionable. What you have described is within the realm of techniques utilized, but unfortunately it is too general to provide a concrete 'yes' or 'no' answer to your question.

I always recommend my patients to obtain at least 1 additional rhinoplasty consult (especially in cases of revisions) in order to ensure they have confidence in their surgeon moving forward, whether it's me or someone else. In that spirit, I would highly recommend seeking a formal consultation with an additional surgeon to get your question answered and feel more confident in your choice! Good luck!

Revision rhinoplasty question - adding cartilage?

Thank you for your question. The techniques of adding cartilage to the tip and the bridge are well described in the rhinoplasty literature. Revision rhinoplasty procedures are challenging, particularly if patients have had a difficult experience in the past. It is very important to clearly discuss your expectations with your surgeon and be reasonable with your own. Best of luck!
Regards
Dr Guy Watts

Secondary and tertiary rhinoplasty require technical skill with advanced grafting techniques

Unfortunately you are in good company.  Most rhinoplasty patients out there are very unhappy with their results in 1-2 years.  The explanation for this is very simple:  Most surgeons performing rhinoplasty do not have advanced training or experience, they perform the rhinoplasty of 50 years ago.  Decades ago thought process of rhinoplasty was to remove cartilage to refine the shape of the nose and perform it through an open approach.  An open approach makes it easy for neophyte surgeons to access visualize and manipulate the structures but also unnecessarily destroys two arteries and veins that are important for nasal vascularity.  The open approach thus ensures that patients have 1-2 years of risidual swelling which hides the final result.  Most rhinoplasties out there I consider cartilage robbing thus when the swlling resolves there is inadequate structure to provide aesthetic appearance and fight the cicatriacial forces or the continued scarring that results from the lowered oxygen tension and fibrosis of tissues.  One additional problem it that most rhinoplasty surgeons out there inadvertently break the connection between the bony nose and the cartilagenous nose.  this can cause irregular narrowing and what we calll "the inverted V deformity" which means the outline of the nasal bone becomes visible through the skin particularly in flash photography under certain lighting conditions.

In my opinion, an expert level rhinoplasty is always performed in a closed technique and ALWAYS involves grafting to add to the structural integrity of the nose.  The act of opening the nose even under the closed technique causes healing and some contraction, thus for a long term beautiful result the nose must be left more structurally sound than it was found.  This is missed upon most rhinoplasty surgeons. 

In secondary cases such as yours it is even more crucial that sound grafting techniques are used.  It sounds like at a minimum you will need bilateral spreader grafts and a columellar strut but a complete L-strut should be considered and harvesting a small bit of rib cartilage may be necessary depending on your findings.  Is sounds like your surgeon is on the right track.  Definitely do not consider any rhinoplasty procedure that does not include grafting preferably by an experienced Plastic and reconstructive training with ddition fellowship level craniofacial and aesthetic training.  Of course this is my bias because it is my training but I think this level of training is very necessary for success in secondary and tertiary rhinoplasty because there is delicate nuance involved and every patient requires different maneuvers.  I hope this helps!

All the best,

Rian A. Maercks M.D.

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.