Q: Dr. Eppley, I had a rhinoplasty done in 2008 which was the worst decision I ever made. The surgeon overresected my dorsum, leaving me with an unsightly saddle nose deformity. I lost many friends and my confidence suffered for years because the nose was simply wrong. I am considering your diced cartilage injection technique because it’s the fastest way for me to regain my dorsum. May we discuss further?
A: What is important in any revisional rhinoplasty procedure is the result not that any one technique is faster or less invasive. When it comes to rebuilding the dorsum, you need cartilage and ac cartilage harvest. Whether this could be done from the septum, ear or rib depends on how much volume you need. Then there is the issue of a scarred dorsum as a result of the first procedure. This makes the skin much harder to raise and more difficult to get a good pocket. Diced cartilage, unless it is wrapped in a carrier (fascia or surgical) can create an uneven contour if it is merely injected in large volumes. It is more appropriate for small defect areas.
In short, the diced cartilage injection technique may not be suitable for a larger augmentation of a low dorsum. I would have to see pictures to be sure. Standard techniques such as cartilage onlays or block rib grafts may be suited for your revisional rhinoplasty. Don’t compound your original problem by seeking a technique that is ‘fastest’ or has the least recovery, have a technique done that offers the best result even if it is not the ‘fastest’.
Dr. Barry Eppley