When is a Revision Rhinoplasty Appropriate? As a Last Resort or Asap?

My PS can't pinpoint the exact infection or cause. The antibiotics are slowly helping w/ the swelling & pain. I'm wondering if I should consider revision rhino asap (it's been 7mths) or wait to see If it reoccurs? There's goretex sheets and ear cartilage in there. Can the goretex be removed while at the same time rib cartilage replaced? Or would that require a 3rd surgery? Piggybacking onto: http://www.realself.com/question/wearing-glasses-bacterial-pink-eye-swelling-nasal-implant-months-after

Doctor Answers 7

Grafts after rhinoplasty infection

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It is always best to remove an infected implant and allow full treatment of the infection before placing new grafts.  It also best that you wait several months for swellling to decrease before designing another rhinoplasty.  Grafts from your own cartilage would have a much less chance of infection and are recommended if you want to avoid further infection.

Baltimore Facial Plastic Surgeon
4.9 out of 5 stars 62 reviews

Revision Rhinoplasty

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Gortex implants become infected, and it is not always possible to remove the infection through antibiotic alone. After 7 months, it would be wise to consider re-operation to explore the implant, and possibly remove and replace the implant with alternative material, such as rib cartilage.

Elliot M. Heller, MD
New York Facial Plastic Surgeon
4.5 out of 5 stars 96 reviews

Rib graft safe after removal of implant

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If your implant is infected it should be removed and you may safely have autologous (your own) rib used to rebuild your bridge.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Infected nose and revision surgery

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Hey NYCgirl2011 - sorry to hear you are having troubles - I would hope by now that your primary PS has cultured the nose and is directing the antibiotic towards the bacteria present - if you are getting less tender and less swollen it suggests that the infection is effectively being treated - you can continue this path as long as you continue to progress.  If you stop improving then a simple intranasal approach to remove the Gortex primarily may be indicated.  I would suggest that you wait a good 6 months after the infection is gone(putting you about 1 year from the original operation) prior to decisions re: revision surgery.  Choose one who does  lot of revision surgery as revision surgery in and of itself is difficult - when you throw an infection on top of it the procedure has an additional degree of difficulty. PK (peconic-faces.com)

Paul E. Kelly, MD
Hamptons Facial Plastic Surgeon

An infected implant must come out, but you can be reconstructed

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The odds are that your Gore-Tex is infected.  Antibiotics would have helped infection around ear cartilage (which itself is very uncommon).

Your infected implant must be removed by the route that is least likely to spread the infection (usually through the inside of nose).

Once you are all healed, you can be reconstructed--but only let someone use your own cartilage or bone--no more implants! 

It is not safe to put a new graft into an infected area.  Not only will the infection affect the new material, but the surgeon will have now wasted another graft.  Your tissues are too precious.

Good luck.

Mark B. Constantian, MD, FACS
Nashua Plastic Surgeon

Timing of Revision Rhinoplasty

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Revision rhinoplasty should not be done either as a last resort  or ASAP. Even though you're 7 months after revision rhinoplasty with placement of Gortex and ear cartilage, wait until the infection has been totally resolved before deciding if another revision is needed. It may ultimately be necessary to remove the Gortex and cartilage graft to clear the infection.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Gortex in nose

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If you have an infected implant in your nose, you may  need to have it removed and then wait a few months to have a new graft placed inside.   Putting a new graft while still being treated for an infection is not advised.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

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.