I can't breathe 7 months after tip plasty. Is this a normal thickness for a rib strut graft? (Photo)

Question

Hello so i recieved a tip plasty 7 minths ago and my surgeon used a harvested rib strut cartilage. Up to now, i have extreme difficulties breathing as im convinced that my surgeon has made the strut wayy too thick. I measured it with my fingers and i can confirm it is a little over 1 cm thick. Is this a normal thickness for rib strut grafts??? My surgeon keep telling me its due to swelling but its been 7 months.

Lexie Wang, MD · Answer

If I were your surgeon and felt like this was swelling, then I'd at least recommend trying steroid injections. Have you asked about that? It's hard to know for sure what that is without seeing/feeling. It is possible that you have struts holding a piece of cartilage in place and that's what you're seeing.  You definitely should NOT be struggling to breathe so your surgeon should be trying to help you with this.

Eric M. Joseph, MD · Answer

If the bulge that is inside both nostrils is firm to the touch, and if your surgeon confirms that this is transplanted rib cartilage, I agree that it is way too thick. It appears to be occluding your away on both sides. It may be reasonable to wait a full year to repair this, depending on what type of procedure was performed. An examination would be necessary to determine the feasibility of a revision procedure sooner than 12 months postoperative. Thank you for this question, and I wish you well moving forward. Sincerely, Dr. Joseph

Ronald J. Edelson, MD · Answer

I advise that you wait for one year from the time of surgery to consider revision. It appears your cartilage graft is thick as you mentioned and removing it might be of some benefit

Ruslan Zhuravsky, DO · Answer

Great job with the photo! This area can be very difficult to photograph to demonstrate the issue properly. Yes, it appears the obstruction is coming from a very wide septum, and based on your description, a wide graft is likely the cause. It can also be two grafts on either side of the septum. This area is in charge of supporting the middle portion of the nose, as well as giving support to the tip, so we focus on making it strong. However, there is the balance btwn strength and obstructive bulk. You're also a point that is very tricky... the cartilage itself will thin and decrease with time, but this can take many months to years, and there's no great way to predict how much it will thin. Not being able to breath through your nose can be very uncomfortable so waiting years to see how much improvement you get may be frustrating. Going back in at 7 months may also be a little premature because of concerns for blood flow and possibility of improvement without surgery over the next few months.This is not a case that has a clear cut answer, but rather one where we would have to weigh out all the pros and cons, then make a decision. From what I'm seeing in your case, if possible, I would favor waiting until the 11 or 12 month point.I hope this helps.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photograph, you appear to have a deviated septum. This can be fixed with a Revision surgery.. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

I can't breathe 7 months after tip plasty. Is this a normal thickness for a rib strut graft? (Photo)

Answers (5)

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