Anthony Bared: Hi, how are you? My name is Anthony Bared. I'm a facial plastic surgeon in Miami Florida and I'm here today with a patient who I recently performed a revision rhinoplasty on about a month ago, who underwent a procedure several years ago and was unhappy with the long-term results of her previous rhinoplasty. Given the history and the deformity that we're starting with, my recommendation was for a rib-rhinoplasty to harvest rib cartilage from her right chest wall to use to help her with the aesthetic goals that she would desire. That was in part also due to procedures that she had had previously which did not allow us to use the ear cartilage.

That being said, we're here with our patient. This is her pre-operative imaging. Her profile view, as you can see, her aesthetic goals were, she had a scooped out appearance of her profile elevated tip which was overly rotated. Essentially, what is called a foreshortened nose. So this is very often seen with reductive rhinoplasty procedures where someone who had, let's say a hump, has a removal of that hump and it was too aggressive and that causes not only a lowering of the dorsum but also subsequently weakening of the tip cartilages and that causes what we call a rotation of the tip in an upward direction.

And it's not as evident on a frontal view because of the two dimensional quality of the imaging, but as you can see her tip is rounding morphous and you can see a lot of nostrils on front view which goes along with what our findings are in our profile view. So, now here we are, one month post-operatively. She obviously has a degree of swelling which will settle down over time.

But the dorsum was elevated with a rib cartilage graft which allowed for the elevation of her dorsum as well as the refinement of her tip. Her tip cartilages were once again sutured in a less rotated position and refined as well and that allowed for not only refinement of the tip, but for elevation of the dorsal septum, of the dorsum of the nose; which also provided for a nice little super tip break which will continue to define itself, obviously, since we're very early in this procedure.

Martha said that she did not have a lot of pain following the surgery, given the fact that some patients are a little intimidated by rib cartilage grafting. Was it a very painful procedure?

Martha: No, not for me. It was very soft. I could sleep good. I think the first night was the only night that I was like with a little bit of discomfort because of the surgery. After that, I could sleep good and I never felt too much pain.

Anthony Bared: Good. So, great. So there you have it. Hopefully we'll have the opportunity to follow Martha as her swelling resolves and see further refinement of her tip and dorsum. Thank you very much.

Rib Revision Rhinoplasty For Scooped Dorsum and Rotated Tip

Dr. Anthony Bared is with a female patient on whom he performed a rib revision rhinoplasty to improve upon the previous procedures she had had in the past.