Will I need a rib graft for tip derotation?
Doctor Answers 10
This is a very good question. Most surgeons consider the minimum dorsal and caudal strut that one may leave in the nose and still offer adequate support to be 1 cm at the very minimum. Many surgeons would elect to leave more, especially in patients where the septal cartilage may itself not be as strong. One could not be sure that there is enough left to further counter-rotate your nose until opening the nose. Additionally, although your operative report may state the above measurements, they are typically estimates and not measured with a ruler during surgery. I would recommend proceeding with surgery only if you are comfortable with the concept of a rib graft, as it may be required. Ear grafts typically are not strong enough for this purpose. Lastly, know that counterrotating a nose is challenging and every patient’s result will vary depending on the amount of scar tissue. If you pull down on your nose and it counterrotates easily this will bode well for you. If, however, it is more stuck in a rotated position the amount of counterrotation possible will be limited. If you proceed with revision surgery be sure that you seek a revision rhinoplasty specialist as this is a high level case.
Rib graft or not
IS rib needed for tip derotation?
You can learn more about upturned tip correction at my web reference link below.
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Nasal tip rotation after rhinoplasty #plasticsurgery
You appear to have an appropriate nasolabial angle after rhinoplasty surgery.
I understand you're not happy with your rhinoplasty result, but a single profile photo is not a substitute for an examination.
Your nasal tip may lower spontaneously, depending how far into your healing you are. And gravity may derotate your tip gradually with age.
Hope this helps, and wishing you well.
Tip derotation after rhinoplasty.
Nasal tip de-rotation
You will need some cartilage to lengthen the tip and de-rotate the tip down. The first choice is the septum. You need approximately 1cm width of septal cartilage dorsally and 1cm caudally to support itself. It is possible that you may have enough septal cartilage to perform the lengthening however, an examination can only tell for sure. The second choice is the ear. The conchal portion is what is usually used. Depending on what kind of otoplasty you had done, it is possible to use some of the concha without disrupting the otoplasty. If all is exhausted then there is plenty of rib cartilage available. Keep us posted. Best of luck, Dr. Michael Omidi
An in-person exam with a board-certified plastic surgeon is the best way to assess your needs and provide true medical advice. The response to the question does not constitute a doctor patient relationship or formal advice.
Over rotated tip
Sources of cartilage for nasal de-rotation
These are also the order of usefulness and ease of removal. If you need more de-rotation you may need additional cartilage but sometimes re-working the existing "trip-pod" cartilage framework that supports the tip may also be useful and sometimes all that is needed.
All the best,
Dr. Remus Repta
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.