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 19

Revision rhinoplasty question- adding cartilage?

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Thank you for sharing your question about rhinoplasty. Although it is difficult to give an accurate assessment without an in-person evaluation or a photo, what your doctor has described does sound reasonable. I always recommend my patients go on several consultations prior to selecting a surgeon to make sure they are happy with the planned treatment. In my practice, I like to use 3D digital morphs of my patients to communicate possible outcomes. This is a helpful tool in making sure you and your surgeon are on the same page. The most important thing is that you are comfortable with your treatment plan and that you trust your qualified surgeon. Best, Dr. Griffiths

Revision Rhinoplasty

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Yes this sounds reasonable, however it is recommended that you either share you photos with us or consult a board certified plastic surgeon near you who can guide you well after examination. 

Rajat Gupta, MD
India Plastic Surgeon

Revision Rhinoplasty

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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.

Revision rhinoplasty with septal cartilage graft

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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

Revision Rhinoplasty

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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. 

Best Technique for Revision Rhinoplasty

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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
4.7 out of 5 stars 77 reviews

REVISION RHINOPLASTY. CARTILAGE GRAFT?

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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

Revision Rhinoplasty

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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.

Revision rhinoplasty for lack of support and bulbous tip

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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

Revision rhinoplasty

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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!

Bryan Correa, MD
Houston Plastic Surgeon

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.