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?
Answer: Grafting cartilage in rhinoplasty it is a common practice to add cartilage to both support and widen the thin parts. I would recommend having at least 2 consults.
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CONTACT NOW Answer: Grafting cartilage in rhinoplasty it is a common practice to add cartilage to both support and widen the thin parts. I would recommend having at least 2 consults.
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CONTACT NOW December 13, 2016
Answer: 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 skeletonized2) due to unrecognized or unrepaired nasal deviation3) had a partial procedure and the nose is out of balance now4) had poor work, a healing complication, or a different post-surgical issue affecting the outcomeCartilage 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.
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CONTACT NOW December 13, 2016
Answer: 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 skeletonized2) due to unrecognized or unrepaired nasal deviation3) had a partial procedure and the nose is out of balance now4) had poor work, a healing complication, or a different post-surgical issue affecting the outcomeCartilage 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.
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December 2, 2016
Answer: 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.
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Answer: 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.
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November 8, 2014
Answer: 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!RegardsDr Guy Watts
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Answer: 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!RegardsDr Guy Watts
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September 12, 2014
Answer: 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.
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CONTACT NOW September 12, 2014
Answer: 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.
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