Q: Dr. Eppley, I had a primary rhinoplasty over a year ago where my doctor used diced costal cartilage in fascia but I do not feel we had the same aesthetic vision. My nose is still larger and higher than I would like it to be (more masculine than feminine). I would like it to be smaller and more feminine. I am wondering were I to pursue revision rhinoplasty, would the diced cartilage with the fascia be shaved? If so, would new fascia (requiring a second operation site) need to be applied over the shaved sections? I am trying to assess the risks associated with revising a rhinoplasty that was done using diced cartilage and the likelihood that it can be reshaped. I can live with my nose today but don’t like it.
A: When undergoing a rhinoplasty, because it is a facial structural change, it is important to see what the result may be like through computer imaging before surgery. This is an operation that is about changing how you look so there is significant psychological overtones to how the result will impact a person afterwards. While computer imaging is a prediction and not a guarantee of a rhinoplasty outcome, it does shake out whether what the plastic surgeon envisions and what the patient hopes to achieve are closely matched.
Secondary revision of a prior dorsal augmentation with diced cartilage can be done. The augmented cartilage can be shaved down or completely removed depending upon what creates the best aesthetic result. It almost sounds like in your case that the need for an augmented dorsum may not have been desired at all since you now realize that a smaller and lower dorsum is desired. You have correctly pointed out, however, that dependent on how smooth the diced cartilage reduction is done that some graft coverage may be needed. If there are some irregularities that are best covered by a graft, I would choose an allogeneic dermal graft (less than .5mms or less) rather than another fascial harvest.
Dr. Barry Eppley