Rib Graft Bridge and Tip... Crooked, What Are my Options?

I am 1.5 months post ops and it's very obvious that my rib graft is crooked from the Start of my bridge to the tip... Much to the left. Is the only option to have another surgery or can this be corrected some other ways? I am certain it's not from swelling as I can feeling the graft and see it very clearly that it's more left ..... Even wearing my glasses, I had the get adjusted because it doesn't fit right since the nose piece needs to be adjusted more to the left. 3 docs all agreed.

Doctor Answers 9

Crooked rib graft

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Your graft may be crooked or it may be warped. You'll need to have it surgically adjusted. I doubt you will be happy with filler.

West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

Revision rhinoplasty may be necessary, but you need to wait a bit.

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Dear Sammie125;

It is only 1-1/2 months since surgery and, while you claim that, “My rib graft is crooked from the start of my bridge to the tip,” wisdom suggests that you still wait a bit.  Unless this looks absolutely grotesque and terrible, time may cause some improvement.  In any event, it will also be a technically easier operation for your surgeon to do after some time has passed. 

Occasionally, some people are lucky to have a situation whereby a little filler can restore some symmetry.  I would not know whether that is possible without seeing you, but it is certainly something that ought to be considered before signing up for the revision rhinoplasty

If already three doctors have agreed that you are going to need revision surgery, then most likely you will, but did any of them think you would be helped by a filler?  You can do a “filler test” to see if there is a significant improvement.  Ask about it.

Robert Kotler, MD, FACS
Facial Plastic Surgeon

Robert Kotler, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 90 reviews

Rib Graft Bridge and Tip... Crooked, What Are my Options?

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 Sadly, no if after the initial post Rhinoplasty swelling subsides (within several months) and the rib grfat is truly crooked...a Revision Rhinoplasty would be required to modify the graft.  IMHO, rib cartilage/bone as well as banked cartilage/bone all have the habit of dissolving unevenly over the years and for that reason I do not use this material for building up the nasal bridge.  I would remove the rib graft and replace it with a straight silastic dorsal graft that's more reliable, IMO.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Rib graft not straight after surgery

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There are several reason for a rib graft to not be straight after surgery. The corection depends on the size and position of the graft. More often than not I prefer to allow the rib to attain some vascularity prior to correction. The answer in each case is somewhat different depending on the prior surgery ,the correction that is needed and the condition of the soft tissues.

Crooked Graft Corrections.

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You have one of three choices: 1) see if the abnormality can be corrected with filler injections, 2) remove the implant, reshape it, and reinsert it and 3) remove the implant and replace it with another type of implant.  

Philip J. Miller, MD, FACS
New York Facial Plastic Surgeon
4.7 out of 5 stars 100 reviews

Crooked Nose after Rib Graft

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If your surgeon and all surgeons who have seen you agree that the rib graft is crooked, you have 2 choices; either reposition the graft or depending on the width of the graft, place fillers.

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

Crooked graft after rhinoplasty

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 A crooked graft usually has to be removed and replaced or repositioned.  You can camouflage it sometimes with fille material.

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

Revision Rhinoplasty

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If the rib graft is crocked, then you will need another surgery. If the rib graft is salvegable, by removing it and burring it to be straight, that is good, otherwise you may need another graft, Rib cartillage or synthetic (Rib cartilage is more biologic)

Samir Shureih, MD
Baltimore Plastic Surgeon

Sometimes a crooked graft on your nasal bridge can look better after an Injectable Filler procedure.

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I read your concern. You may want to re-post your question with a photo for the RealSelf community of experts to comment on:

I have personally placed an ePTFE graft for dorsal nasal augmentation that ended up looking a bit crooked after swelling resolved. In my patient, the asymmetry was most prominent at the top of the bridge at the radix. Rather than removing the graft, I used an injectable filler to restore symmetry. This could make your nose look wider, so without a photo, I could not know whether this option could be right for you.

Hope this helps.

Dr. Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 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.