Revisions on patients who have had an initial preservation rhinoplasty?

Question

I've had a preservation rhinoplasty as my primary rhinoplasty. I'm now considering a revision rhinoplasty. My nose tip seems too deprojected/wide/flat looking and I would like a smaller, narrower, nose tip. Would rib typically need to be used on a patient whose had a preservation rhinoplasty? Or would the patient typically have enough cartilage to refine the tip once more? I like my bridge for the most part, my tip is just too wide/bulbous/flat looking.

Jonathan Kulbersh, MD · Answer

Thank you for your question. Assuming your initial preservation rhinoplasty was at least one year ago, you may consider a revision procedure to help you achieve your desired appearance. Revision rhinoplasty is an excellent choice for improving the wide and bulbous nasal features you describe. 
During this surgery, the nose can be augmented to be more narrow and projected for a natural result that is harmonious with the rest of your facial features. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who can assess your medical history as well as your aesthetic goals.

Andrew Miller, MD · Answer

Based on your description, you sound like a good candidate for revision rhinoplasty. The tip can be refined and better projected. Usually the patients own cartilage can be used, since in a preservation rhinoplasty, a lot of cartilage is left. The first step is to see a rhinoplasty expert for consultation and computer imaging.

Marc Polacco, MD · Answer

Thank you for your question. The most important question is, how long ago was the original surgery? Swelling persists in the tip the longest, and the thicker your skin, the longer it takes to resolve. If it has been less than a year, I'd definitely give it more time. The good news is, changes to the tip, especially making it smaller and narrower, often require a few techniques but usually no cartilage grafting unless there is significant weakness to the structure. I hope this helps, and all the best to you.
-Dr. P

Samuel Lin, MD, FACS · Answer

Great question. It is important in a patient with a prior procedure a detailed examination that includes the inside of the nose as well as a discussion of goals of the procedure is important. An in-person visit would be required to assess remaining cartilage structure as well....

Jeffrey Lisiecki, MD · Answer

Great question--it depends a lot on the type of preservation rhinoplasty you had, and how much septum was harvested. Preservation rhinoplasty is kind of a catch-all term to describe a handful of different techniques. Some of these can be destructive or destabilizing to the important structural parts of the septum. I would go into your case (or pretty much any revision rhinoplasty) planning on using rib cartilage, even for just a tip revision, to be able to set the projection and rotation to the desired place. The good news is that fresh frozen donor rib cartilage is now available and is a great option that allows the use of rib cartilage without the pain and scar of taking your own rib.

Vasfi Celik, MD · Answer

The cartilage tissue called septum in the middle of the nose, which is adequate in the primary surgeries, is usually inadequate in revision surgeries. Therefore, depending on the problems in the nose structure, revision rhinoplasty may require;
Costal cartilage graft (rib cartilage),Conchal cartilage graft (cartilage taken from the ear),Septal cartilage graft.
I generally need rib cartilage in revision surgeries with or without preservation rhinoplasty. 
Changes at the tip of the nose are possible with revision while preserving the flawless beauty of your nose bridge.

William Portuese, MD · Answer

Much more information is needed, such as a full set of facial photographs from all angles, and a copy of the operative report. As long as it has been at least one year after your initial surgery, then you can consider undergoing a revision. Revision rhinoplasty is much more difficult than A primary rhinoplasty due to the fact that you had previous alterations to the normal anatomy. It's also very important to know how much cartilage is leftover on the inside of your nose for potential grafting purposes.

David M. Kowalczyk, MD, MBA, FACS · Answer

Hi there! Preservation rhinoplasty is excellent for bridge and midvault work. But, we often must combine it with some form of structure rhinoplasty at the tip. It depends on what maneuver was used to address the septum after let down. If overlapping was done, there may be enough septum low. If there isn’t, rib would be a great choice. It would depend totally on the amount of septum left and the degree of projection needed. I would seek consultation with a facial plastic surgeon who’s competent in revision and dorsal preservation rhinoplasty. Best of luck!

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