How Soon Can A Rib Graft Rhinoplasty Revision Be Done?

Q: Dr. Eppley, I had a rhinoplasty with rib graft. The surgery was to reduce the height in the bridge of the rib graft. Now the center vault of my nose feels soft, mushy. I think the surgeon removed my graft in the center bridge area. I am afraid, another surgeon said that if you remove the rib graft without replacing it, the nose can retract. Is this correct? How long do i have after the surgery to get a rib graft to replace what was taken out? Question, how soon after surgery can I have the rib graft replaced? I hope I phrased this correctly. Please help.

A: If I understand your situation correctly, you originally had an augmentative rhinoplasty with a rib graft. Then 11 days ago you had a revision to reduce the height of the rib graft in its upper portion over the bridge. Now there is a concern that the middle portion of the nose (or rib graft) is ‘missing’.(soft and mushy) It is unclear if the actual height of the graft in the bridge/radix area was adequately reduced or not. Since the tip also feels soft and high, I assume this revisional procedure was done through an open approach.

Your question is whether this missing portion of the rib graft should be replaced due to fear of irreversible skin contraction. I would not have similar concerns about the middle vault skin irreversibly contracting. While some skin contraction may occur, it can always be stretched out later to accommodate more graft material. If the tip in a rib graft rhinoplasty loses considerable underlying support, skin retraction there may be kore problematic. The real question is not skin retraction but whether you feel there has been adequate reduction in the bridge and/or too much reduction in the middle of the graft. While only being 11 days after surgery, swelling would usually make that hard to judge. But you are very familiar with after rhinoplasty swelling so you are in a better position to judge these early results than many. If one is convinced too much cartilage has been removed or additional adjustments needed, then that may be a valid reason for an additional revisional procedure.

Dr. Barry Eppley

Indianapolis, Indiana