Can a dorsal onlay graft be placed in a closed rhinoplasty?

Question

The dorsal onlay graft (ear cartilage) that I have is slanted and too thick. Do I need a full rhinoplasty to correct it or can it be reshaped/repositioned in a closed rhinoplasty?

Roberto E. Garcia, MD, FACS · Answer

Thank you for your question.  Revision rhinoplasty of any kind is a challenging surgery and should really only be done at the hands of a double board certified Facial Plastic Surgeon.  This is very important as there are those that call themselves board certified Plastic Surgeons and have very little experience in the nose, especially with revision nasal cases.  Having said that, grafts can shift especially if not crushed or secured to the nasal skeleton.  If you have thin skin, the graft can become more visible, so this becomes more important.I hope that this helps and again the most important part is seeking the advice of a specialist in this field.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  For a revision rhinoplasty such as this, I highly recommend an open approach.  For dorsal augmentation, I often use diced cartilage wrapped in fascia, which will not have the same risk of malposition as a simple cartilage onlay graft.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Mark Been, MD · Answer

Thank you for your post. Yes, dorsal cartilage graft can be reshaped and repositioned using closed rhinoplasty techniques. Be sure your surgeon is one who is experienced in this approach. Good luck.

Nirmal Nathan, MD · Answer

Your goals could be accomplished with either an open or closed rhinoplasty approach. I think there is way too much hype about each surgery because people use it for marketing purposes. The only real difference access wise on an open versus closed approach is the small incision at the base of the nose. In my opinion (and I am comfortable with both approaches), you should proceed with an open approach. An open approach gives much better exposure and control for a revision. Good luck.

Garrett H. Bennett, MD · Answer

The dorsum can be approached with either an internal or external rhinoplasty for both primary and revision surgeries. Onlays can be removed, reshaped and replaced. There are times when the scar tissue will have filled in the area around the graft and a much smaller or no graft may be necessary at all. Surgeons tend to have comfort with open or closed techniques and some are proficient at both.

Frank Scaccia, MD, FACS · Answer

Can not answer this question without an in person consultation.  It would be possible to trim any excess cartilage or even totally remove and then replace your graft through a closed approach. I like to use external guide sutures which tie over a bolster on the skin for 1 week to insure the graft is properly positioned and doesn't move when placing grafts. The patient would have to know ahead of time of the possibility that the surgery may require transition to an open approach for better visualization if intraoperatively it becomes necessary.

William Portuese, MD · Answer

Yes, a revision rhinoplasty procedure to re-position a dorsal onlay graft can be performed with a closed rhinoplasty technique. This is a full  revision rhinoplasty procedure to correct it. It's also important to know how much cartilage left over on the inside of the nose for potential grafting purposes

Can a dorsal onlay graft be placed in a closed rhinoplasty?

Answers (7)

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