Rib grafts removal after rhinoseptoplasty - is it possible 9 months post op?

Question

I had primary rhinoseptoplasty done 9 months ago using rib grafts and what I got after was overprojected tip of the nose, protruded upper lip, especially at the nasolabial angle that makes my jaw retracted and extremely hard, immovable nose that is very uncomfortable to kiss someone with. My surgeon said that he spliced rib cartilage to be used as spreader grafts joined together with what I now suspect with too thick columellar rib graft. Is it possible to remove said rib grafts from my septal cartilage or are they inseparably fused now?

Eric M. Joseph, MD · Answer

Removal of cartilage crafts, and rib cartilage grafts is indeed possible, however, the feasibility of doing this would require an examination, or at least evaluation of your photographs. Thank you for your question. Sincerely, Dr Joseph

Ozge Ergun, MD · Answer

Secondary rhinoplasty isn't always as challenging as people might expect. Once we've accessed the rib cartilage, it's fairly straightforward to separate it from the other nasal cartilage structures. Of course, harvesting the rib cartilage does create donor site morbidity for the patient, and we value this tissue greatly. So, we can re-sculpt it and use it in a more subtle way during the procedure.

Alejandro Nogueira, MD · Answer

You'd rather post to us some images of your case so that in this community of experienced professionals we can provide a grounded advice.

Should the rib grafting have been wrongly carved, over thickenned, made too long, etc, why removing it? Those grafts were place for a very good reason, themselves are not the cause of the poor results and the discomfort but their calibration is, so you need a full revision and visualize the state of the structure and redesign, recarve, reshape it.

Seek the advice of a experienced revision rhinoplasty surgeon. It is very uncommon caudal extension graft and spacer grafts have to be taken from the rib, however there are indications for that in some chosen cases.

As guidance, see below one case of mine in which rib cartilage spacer grafts and caudal septocolumellar grafts were employed.

Lexie Wang, MD · Answer

It is always going to be possible to separate the grafts; however, I don't recommend doing anything for at least a year after your last surgery.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your description, you may benefit from a revision rhinoplasty to soften the tip and make it more comfortable. A surgeon can accomplish this by removing the grafts and performing nasal tip deprojection, among other maneuvers. With good surgical technique, you could likely have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Steven M. Denenberg, MD · Answer

The grafts can be removed or adjusted, depending on which grafts are causing the trouble and what needs to be done with them to get your nose close to the way you want it. Sounds as though the nose is overall much too strong. Don't know what to say with any specificity without pictures, but yes, many, sometimes most, of the problems from a primary can be corrected in a revision, especially if the main goal of the revision is to make the nose overall smaller.

Anmol Chattha, MD · Answer

Rib cartilage grafts are not permanently “fused” to your septum &mdash; they can usually be revised or removed if they are too thick or projecting. Overly bulky columellar or spreader grafts can sometimes cause the type of stiffness and projection you describe, and revision surgery can thin, reshape, or replace them to restore balance and comfort. The challenge is that at 9 months you still have some healing and scar tissue present, so most surgeons prefer to wait until the 12-month mark before doing a major revision. In the right hands, these grafts can absolutely be modified to improve both function and appearance.

Rib grafts removal after rhinoseptoplasty - is it possible 9 months post op?

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