I had a Rhinoplasty which involved augmentation as a previous doctor "took too much out" in the first surgery.

hi i had a rhinoplasty which involved augmentation as a previous doctor "took too much out" in the first surgery. my goal is to make the nose as long and projected as possible as its very flat. i had a medpor shell implant as septum grafts were unsuccessful. i also had a columella strut taken from the ear and that was unsuccessful too. although im happy with the inplant he says he will need to take a rib graft for the strut. any tips or advice. i am really tired of revisions.

Doctor Answers 4

Rib graft the best long-term choice

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Using your own rib is the best long-term choice for structural grafting of the nose.  Implants may need to come out sooner or later and ear cartilage typically lacks structural support.

Seattle Facial Plastic Surgeon
4.7 out of 5 stars 229 reviews

Unfortunately, Medpor is not a permanent soluton for rhinoplasty

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Some surgeons use artificial materials because they are easier and do not involve harvesting rib or some other graft.  Patients who have had unsuccessful results have already gone through pain and expense and want a simple solution.  I am sympathetic.

Unfortunately, implants are not the solution.  In a scarred nose,  if your surgeon is going to take rib, why not re-do the Medpor and place your own cartilage?  That is what is most likely to give you a lifetime solution.

As for the strut, normal  tip projection does not come from a strut, but from the strength of the tip cartilages.  Hard as it is to read the advice, you may be best off finding a surgeon who can replace your Medpor and create good projection with tip grafts.  Make sure you see good results and that you like the doctor--no surgeon gets great results all the time!

Mark B. Constantian, MD, FACS
Nashua Plastic Surgeon

Rib Graft for Columellar Strut

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I'm sorry your unsatisfied with your previous rhinoplasty results. A rib graft can be used to support the tip and increase or maintain tip projection. The strut can be placed despite the presence of a Medpor graft.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 42 reviews

Revision rhinoplasty to improve tip projection

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Rib cartilage is an excellent grafting material for revision rhinoplasty. It is strong enough to provide significant tip support. Using specific surgical techniques a durable increased tip projection can also be attained.

Medpore could be replaced at the same time as rib cartilage should provide enough cartilage for this as well.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 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.