I Am Having Revision Rhinoplasty to Remove a Rib Graph. What Am I in Store For?

"I Am Having Revision Rhinoplasty to Remove a Rib Graph. What Am I in Store For?

I am also doing this with no sedation only a local numbing. There is very few information about rhinoplasty with no sedation. I know everyone is different but, I was wondering the level of pain. Also why sedation would be recommended. The Doctor said I(myself) may abort this during the numbing process. How long does the numbing process generally take?"

Jinger-  I am a little confused and a lot of concerned about your plan here. Firstly, you have a rib graft reconstruction of your nose...this I assume was used for a either a revision of a previous cosmetic rhinoplasty failure or reconstruction from a traumatic injury. The rib graft is used either for support of the nasal elements to prevent total collapse of your framework or it was used to augment the dorsum (and you have what I refer to as a Toothbrush or Tongue Depressor defect...basically a stiff slab of rib along your dorsum) In either case, this graft was more than likely secured and/or has formed scar tissue. Removing it or even a piece of it is NOT an easy undertaking. 

Which leads me into my second concern...LOCAL ANESTHESIA for a rhinoplasty? Let alone a revision? I am not the world's fastest surgeon, but I am also not the slowest...I love to do rhinoplasty surgery, it is a passion of mine. I also am passionate about my results...but to obtain great results, all aspects of the case must be controlled and move systematically and methodically without interruption or distraction....meaning, the patient shouldn't move or jerk as I am placing sutures smaller than the diameter of their hair in small, thin nose cartilage. The patient cannot be talking and/or moving while I am operating. And finally, before I even start opening the nose to perform a rhinoplasty, I inject local anesthesia which contains medicine that constricts blood vessels to prevent bleeding....BLEEDING obstructs my vision and ability to place sutures perfectly and can potentially adversely affect the outcome. I cannot imagine injecting local anesthesia in an AWAKE patient...OUCH! Make my own eyes water as I type...

Therefore, to give you the option to stop the procedure during the injection...sounds like a set-up to abort for sure. Might be more expensive to undergo more advanced anesthesia, but I would do it for sure!

Hope this helps!

Dr. C

johnconnorsmd.com

it depends entirely on the size and location of the graft - a small graft in an easy to reach area can be removed under local but not a large graft that is firmly seated and required to be dissected out

This could be a problem for the surgeon who finds that more work is necessary and doesn't have the degree of patient immobility and comfort needed to do his/her best work, or it may be a problem for you if the desired outcome requires another surgery, each subsequent one becoming more difficult or predictable!

Why local anesthesia? I assume your surgeon has access to full anesthesia and/or sedation in an accredited hospital, surgical center, or office surgical facility. If not, did you have your rib graft placed under local anesthesia by this doctor or by another doctor entirely? Assuming your surgeon is fully-credentialed and has all options for anesthesia available, this is being done to reduce costs--nothing wrong with that, particularly if you are paying the bill. But if this is recommended as a way of doing a "no-charge" revision surgery, this may end up being a waste, or worse, an error. And if you do decide to abort, then what? Where will the revision be done, under what anesthesia, and at whose cost? Keep your focus on the way to achieve the desired result for your nose--there is a reason there are so many questions about revision rhinoplasty in this forum!

Rhinoplasty is one procedure I will not perform without IV sedation or general anesthesia. Removal of a rib graft may or may not be quick and easy.

I actually have not performed a rhinoplasty or a revision of a rhinoplasty under local anesthesia.  I explain to all of my patients that if a revision is to be performed that I waive my fees but that the anesthesiologist and facility fees are going to be paid for by them.  In instances where the surgeon owns the facility obsviously this is not the case.

I personally prefer to do all Rhinoplasty Revisions in a certified surgery center with anesthesiologists and local anesthesia combined. This is safer and allows for additional work if necessary. Revision Rhinoplasty can be more complicated and involved than initially planned.

Regarding:  "I Am Having Revision Rhinoplasty to Remove a Rib Graph. What Am I in Store For?
I am also doing this with no sedation only a local numbing. There is very few information about rhinoplasty with no sedation. I know everyone is different but, I was wondering the level of pain. Also why sedation would be recommended. The Doctor said I(myself) may abort this during the numbing process. How long does the numbing process generally take?"

One of the critical elements for surgical success is a clean, non-bleeding field which does not move. Few, if any surgeons, can perform good quality surgical work on a moving and bleeding patient who is poorly cooperative.

It is NOT clear WHY your rib graft is removed BUT i assume it was placed there either because your nose required support or to increase its profile. What makes you think the rib graft would just slip out? What if more work was required and you were in pain?

Doing a nose operation under local anesthesia sounds very suspicious as a purely cost cutting tactic which may end up costing you much more later in other procedures.

You need to understand what you are getting yourself into before you step into that operating room.

Dr. Peter Aldea

Removal of rib-cartilage graft degree of difficulty depend on the age of the graft, how solid is the healing from the previous surgery.

It may NOT be as easy to take out under local anesthesia.

Personally I would not want to perform a rhinoplasty under jsut local anesthesia, I think patients are more comfortable with general or deep sedation. If they are comfortable, then I can focus on performing the best rhinoplasty I can.