What Type of Graft Do I Need For My Secondary Corrective Augmentation Rhinoplasty?
Q: Dr. Eppley, I made a big mistake ten years ago and did a rhinoplasty. The results are not very good, since I looked better before. Recently I’ve been researching the best plastic surgeons to correct it. My nose is broader, rounder and shorter than before the surgery. They cut off too much bones to the sides of the nose bone. Also the top of the cartilage part is cut. My goal was better symmetry, but it came with these big side effects. Instead of trying to correct the symmetry by realigning the cartilage they just made the nose smaller. I prefer my old nose to what I have today. I want to add bone/cartilage to the left and right sides, but ok if only one side is possible. In the close up you can see there is an edge in the middle of the nose. I want to add to atleast right side. They said they removed at most 3 mm so I dont want to add a lot, but I think it will have major improvements to my looks. It would make the nose look more defined and narrower. Its like a pyramid. Cutting off the top of the pyramid and the top will be broader. I also want to know if it’s possible to fix the slight upturned nose. I am open to use cartilage, bone graft from ribs or artifcial grafts. I am aware this is a complex and costly procedure. I have attached 6 pictures. One is how I looked before the surgery.
Looking forward for a response. Thank you!
A:Thank you for your inquiry and sending your pictures. As you have detailed you had a reductive rhinoplasty which, amongst numerous issues, over rotated the tip of the nose…which men typically do not like. Now what you need is a secondary augmentative rhinoplasty for correction. The key to any augmentative rhinoplasty is to have enough building materials to do the job…which comes down autologous cartilage. Is there enough septum left to adequately add back what is needed or should a small costal rib graft be taken? (ear cartilage is not enough and is curved and structurally weak) Bone grafts are poor rhinoplasty materials and banked or cadaver cartilage is much harder to work with and may be prone to some resorption.
For the nose outside of the tip residual septal cartilage is probably adequate. But to derotate the tip, which requires a tripod structural reconstruction approach, rib cartilage is the best choice. Thus just use rib cartilage and leave the septum and ears alone.
Dr. Barry Eppley
World Renowned Plastic Surgeon