Surface Infection One Year After Rhinoplasty

Question

I had an open rhinoplasty which involved taking cartilage from my ear and using it to pull my nose downwards/lengthen it as a follow-up to upper/lower jaw surgery that tipped my nose up. I had a small bump right below the tip of my nose, beside my left nostril. It was a small bump that randomly one day became infected like a pimple. I left it alone and it kept getting larger so I drained it (a strange pus-like fluid comes out) and now it is reoccurring/won't go away. Thoughts?

Richard H. Tholen, MD, FACS · Answer

This appears to be an infection in the cartilage graft and overlying skin. After 1 year, this probably started as an area of breakdown in the skin over the graft, perhaps from pressure, irritation, or thin skin that just allowed bacteria in. Infection starting in the graft or sutures would have presented itself earlier, causing the skin breakdown rather than the other way around. At any rate, now things look the same--skin breakdown and infected cartilage graft beneath with persistent drainage. This will not get better on its own!

	You should see your surgeon immediately for culture and antibiotic therapy that can be adjusted if the cultures require. You may lose a portion of your graft, but after 1 year there should be enough stability in the reconstructed nose to maintain appearance. A small touch-up procedure could be performed once all is healed if necessary for optimal improvement.

	This is an infection until proven otherwise; please call your surgeon today!

Eric M. Joseph, MD · Answer

I read your concern and reviewed your photo. Recurrent infection with purulent drainage at your left columella is likely originating from a permanent suture that might have been used to anchor your ear-cartilage graft in place. If that's the case, you would benefit from seeing your surgeon for evaluation and possible suture removal which could resolve the situation. Also, your surgeon could obtain a specimen for culture and consider a trial of oral antibiotics.

	Ask your surgeon if any foreign-body materials were used to reconstruct your nose.

	I hope this is helpful for you.

Michael L. Schwartz, MD · Answer

This is a suture abscess. See your surgeon instead of doing self drainage. The stitch can be removed in the office with local anesthesia and prevent recurrence of the problem.

Louis W. Apostolakis, MD · Answer

From your description I would very much suspect a suture has become infected. In all likelihood this is not the result of anything you or your surgeon did wrong, it can just happen. While the condition may resolve with aggressive antibiotic treatment, it is almost certainly going to recur at a later date. In my opinion, the only course is to open up the area, find the offending suture and remove it. The problem may be directly under the pimple, or it may be tracking under the skin from someplace nearby. Usually, removal of the suture is possible without affecting the overall appearance of the nose and without an outright rhinoplasty revision. It is certainly possible the problem in your nose is more widespread, but I suspect an isolated suture, removal of which should cure the problem.

Peter E. Johnson, MD · Answer

The small pimple like area of infection you describe suggests a suture that has been retained such as a permanent or nondissolving suture t hold cartilage grafts in place. Keep the area clean and keep hands away. Let your surgeon see you to get the situation under control.
	Best of luck,
	peterejohnsonmd

Mario J. Imola, MD, DDS · Answer

Hard to be sure not knowing what maneuvers were performed during your rhinoplasty, but this likely represents an infection of the cartilage graft or sutures used to secure a cartilage tip graft during the original surgery. In order to lengthen the nose, a tip graft was likely carved from the ear cartilage and sewn onto the end of the existing lower cartilages. The site of your infection corresponds to the usual suture placement used to secure tip grafts. If a permanent suture was used, then this may have become infected. Alternatively, the cartilage graft itself may have been left too bulky in this location. Either way, I would recommend oral antibiotics and careful exploration of the site which could be done under local anesthetic as an office procedure.

Francis R. Palmer, III, MD (retired) · Answer

This is most likely due to a stitch used to sew the ear cartilage graft to the nasal tip and columella. The permanent stitches, along the bottom of the columella, can erode through the skin and create an infection. Go back and see the surgeon for antibitics and an attempt to remove the retained suture. If left alone, the infection can cause some of the ear cartilage to dissolve making the tip appear crooked. I have used tissue glue for the past 10 years to avoid just this scenario when securing ear cartilage grafts to the tip during Open Rhinoplasty.

Surface Infection One Year After Rhinoplasty

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