Concerned with Cartilage Removal During Rhinoplasty

I am worried that my doctor will remove too much cartilage during Rhinoplasty, making the bridge of my nose structurally deficient. Is there a way I can make sure this doesn’t happen? What should I ask or tell my doctor?

Doctor Answers 10

Avoiding overresection

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Experience is a must. The surgeon should optimally have a busy practice with a large number of nasal surgeries.

You can also learn a great deal by looking at the before-after pictures of the surgeon's work.

Overresection tends to produce characteristic features. There is a pinched appearance to the tip. This results from too much tissue being removed from the tip of the nose, or applying a "cookie cutter" formula to all noses, resulting in unrecognized overresection of the tip.

The dorsum of the nose also is telling. If you see a scooped out appearance on many of the patients, or an odd bulge above the tip on a side view, this may indicate that the nose was overresected.

Styles have actually changed over the years as the anatomy of the nose has been better studied, and many of the noses that were done in the 1970's and 1980's would be considered overresected by today's standards.

A board certified plastic surgeon or facial plastic is your only safe choice, in my opinion.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 191 reviews

Open communication is important

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It is important to talk with your doctor and discuss with him your expectations and goals regarding a rhinoplasty. It is also important to make sure that he or she has done thousands of rhinoplasty surgeries so that your surgeon can give you a very natural-looking nose that is structurally strong. Open communication is very important.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 155 reviews

Removal of cartalige

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You are wise to ask this question.  The typical amount removed does not play a role in the structural support system.  However, do clarify before surgery how much will be removed.  If visual imagining is available this may help you too.

Relate your cosmetic desires to your surgeon

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Express your desire to the surgeon (using photos or computer images) and put your trust in his/her skills. Other than that it is hard for you to control the ultimate outcome. Please realize that if this is your concern and it is repeatedly stressed, the opposite outcome could occur. You may not have enough cartilage removed.

It is difficult to know the exact or precise amount to remove. To some extent, even if the "perfect" amount is removed, the process of healing could result in a different outcome.

Surgery involves risk and estimates based on experience. You must be willing to accept this prior to undergoing surgery.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Cartilage removal in rhinoplasty

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If you are worried about dorsal over-resection, you should reinforce that with your doctor. Make sure your doctor is an experienced rhinoplasty surgeon as well.

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

Yes it is possible to avoid this problem.

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Go to an experienced rhinoplastic surgeon who does large numbers of noses that you like. Some doctors like a scooped out bridge. I don't! Other doctors besides myself do not make that look. Find one like that and you will not have that problem.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Concern about a structurally deficient nose after Rhinoplasty.

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You should research your surgeon carefully, and go for several consultations. I think your question should be: "What can I do to optimize my chances of getting a great result after my rhinoplasty?"

You should consult only board certified surgeons that are experienced in Rhinoplasty. You should see many favorable before and after photos of Rhinoplasties. It's always reassuring to see a photo of someone with the same nasal concerns as you, along with a post-operative photo that looks great.

Take your time, and I think you'll know you're with the right surgeon when you meet.

Best regards.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 432 reviews

There are some things you can do...

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I don't think that there's anything you can ask your surgeon or tell your surgeon that would influence how much cartilage is removed. However, there may be some ways to minimize the likelihood of an over-resected nose.

First, make sure you're seeing a surgeon whose primary or major interest is rhinoplasty and who is properly trained and board-certified in specialties related to rhinoplasty (i.e., American Board of Facial Plastic & Reconstructive Surgery; American Board of Plastic Surgery; and/or the American Board of Otolaryngology).

Second, carefully examine the surgeon's before and after photos. If needed, ask how far out from surgery the post-op photos are (anyone can look okay a month out). Do the noses look pinched? Do they look too angular? Is the profile too scooped? These are some tip-offs that the nose may be over-resected.

There's no way to guarantee a good outcome, but these are some of the things that may help. Most surgeons who are current in their rhinoplasty knowledge are very aware of the risks of overaggressive removal of support.

All the best,


David C. Pearson, MD
Jacksonville Facial Plastic Surgeon

Insist on an experienced surgeon

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The best way to obtain the type of result that you desire is to find an experienced Rhinoplasty Surgeon who has done at least 500 procedures on the nose. Look at the Doctor's website and make sure you like what you see. Anyone who will not show you pictures does not have results that they wish to show! And remember it is not what you remove from a nose but what is left behind that determines the final shape.

S. Randolph Waldman, MD
Lexington Facial Plastic Surgeon
4.6 out of 5 stars 19 reviews

Communication with your rhinoplasty surgeon is key

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I would express these concerns with your rhinoplasty expert prior to undergoing the surgery. They will be attentive to your concerns and make sure all your fears are addressed.

Todd B. Koch, MD
Buffalo Plastic Surgeon
4.6 out of 5 stars 37 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.