I'm considering removal of the 8mm DCF graft, as it's off center, bridge+tip too high,b/w eyes too narrow, too broad/chunky & unnatural. Ive seen my surgeon multiple times about the crooked appearance, he denies it. Enquired about removal he said 'it's trouble/doesn't want to mess with it'-I've osteotomies,L strut,banked cartilage,spreader grafts,nasolabial folds. My physician honestly told me that it's noticeably crooked. What are the options + consequences of removing the graft from the nose?
Answer
It is possible to modify a diced cartilage-fascia graft that has been used for dorsal augmentation (increasing the size of the bridge). Interestingly, the diced cartilage heals together over time and can be recarved to improve the contour. Additionally, the entire graft can be repositioned. You should wait at least 1 year prior to considering revision rhinoplasty. If you are unhappy with your result and you have discussed your concerns with your surgeon, you may consider seeking another opinion from a board certified plastic surgeon. Make sure you do your research as you should see a surgeon that has both experience with revision rhinoplasty and also the use of diced cartilage-fascia grafts. A good starting point would be to visit the website of the Rhinoplasty Society. Another opinion with an experienced surgeon may provide you options for improvement, or alternatively, may confirm what you first surgeon has said.
Dr. Jamil Ahmad, MD
Board Certified Plastic Surgeon
Answer
The answer is - yes it can be removed.The timing though will be the key as it is going to be more difficult early after surgery and for at least a couple of months.That is why it is suggested that revision rhinoplasty be 6 -12 months after the original surgery. Given that you are 1 year post surgery it is likely that the swelling has resolved and the solution to your concerns will be a revision rhinoplasty with removal of the cartilage graft. Jeremy Hunt
Dr. Jeremy Hunt, MBBS, FRACS
Board Certified Plastic Surgeon
Answer
Sounds like the DCF graft has become malpositioned. It should be able to be removed and either repositioned or have another graft placed. Another option is to use filler like Restylane to camouflage the irregularities. This is a procedure that should be performed by higly skilled injectors only.
Dr. Theda C. Kontis, MD
Board Certified Plastic Surgeon
Answer
Diced cartilage in tubed fascia grafts can be removed but they are more challenging to remove than solid cartilage grafts. An open approach may likely be the best option to remove it. Of course a game plan to do what is necessary after the graft comes out will be helpful.Mario J. Imola, MD, DDS, FRCSC, FACS.
Answer
Yes, it can sometimes be difficult to take down some of the grafts, but not impossible. Good luck in deciding to move forward.
