Is It Possible for Skin to Not Reattach to Cartilage After Rhinoplasty?

Question

I had a poor rhinoplasty 5 years ago leaving me with collapsed upper lateral cartilages and agressive removal of lower lateral cartilages.When I pinch my nose I cannot feel any cartilage support at all supporting my nostrils and sidewall of nose.My skin is average thickness and very loose since the rhinoplasty.Is it possible that the skin did not reattach to any cartilage and formed scar tissue(because the cartilage was collapsed/removed)causing this to happen?Is it repairable with a revision?

James C. Marotta, MD · Answer

What you describe is not a problem of the skin "reattaching" to the cartilage after your rhinoplasty but that it sounds like you don't have enough cartilage structure to support the weight or amount of nasal skin you have. Over-reduction of the natural nasal cartilages in rhinoplasty instead of reshaping them can lead to this problem. It is definitely correctable with revision rhinoplasty. Rebuilding some of the lost nasal shape with cartilage grafts from the septum, ear, rib or cadaveric rib cartilage can restore structure to the middle third, upper lateral cartilages and nasal tip and nostril support to achieve a functional and attractive nose.

Steven J. Pearlman, MD, FACS · Answer

The key to both primary and revision rhinoplasty is support. The bony and cartilage structure that supports the nose needs to be maintained. Depending on how strong your cartilage is, more or less can be removed in rhinoplasty and not compromise breathing. Other ways to make a nasal tip smaller without removing a lot of cartilage is by the use of grafts of your own cartilage. I find that I use grafts of the patient's own cartilage in over 905 of primary rhinoplasties and almost 100% of revision nosejobs.

Sam Naficy, MD, FACS · Answer

Although it is hard to tell without seeing your pictures what you are describing is likely just related to over-resection of your cartilages resulting in poor structural support and collapse - this can be improved with a revision

Michael L. Schwartz, MD · Answer

it's not that your skin doesn't attach, it's likely that you don't have enough cartilage structure to support your skin, nostrils and tip. In both primary and revison rhinoplasty the goal is creation of a stable supporting underlying structure which the skin can then conform to. This can be done in revision rhinoplasty for you.

Peter E. Johnson, MD · Answer

Your skin will reattach to the remaining cartilage after rhinoplasty. We dislike any technique which is described as aggressive, especially in rhinoplasty. Nasal shaping is often a 'subtractive' procedure, though leaving adequate support remaining for the tip and airway are important. If your tip lacks support and shape and the bridge is pinched revision can be effective with appropriate cartilage grafting.
	Best of luck,
	peterejohnsonmd

Is It Possible for Skin to Not Reattach to Cartilage After Rhinoplasty?

Answers (7)